asked the Minister for Health the estimate of expenditure by each of the regional health boards for 1972-73.
Ceisteanna—Questions. Oral Answers. - Regional Health Boards.
7.
As the estimate prepared by the health boards and submitted to my Department are still under examination, I am not yet in a position to furnish the information requested by the Deputy.
Surely the Minister can furnish the estimates and the demands. Those of us who are on health boards have already got the demands and we find these are up from 33? per cent to over 40 per cent. Surely the Minister can give the figure for the demands that have been made?
I have the estimates but we have to make an examination of them in regard to adjustments that are required and so on.
What type of adjustment has to be made? Surely adjustments have nothing to do with the question that has been asked. The Minister was asked to give the estimates presented to the different health boards. He is not asked to give them after adjustments have been made. Surely the information is available in the Department and, if not, the Minister could have got it from the different CEO's? Why is it not available to the House? Is it because the Minister does not want to admit that there is nearly a 40 per cent increase?
The Deputy is making a speech.
No, I am quite prepared to admit that there is a very big increase and that about 95 per cent of it is due to extra remuneration, cost of materials and cost of drugs and other matters arising from the inflationary period through which we are passing.
And the patients are not getting an aspro extra?
That is not correct.
Is the Minister prepared to state what grants will be made available?
That does not arise on the question.
But it would be incidental to it.
No, it would not be incidental to it.
Would the Minister give an answer.
I hope to announce as early as possible the grants that will be available. These will be announced earlier than last year.
Why can they not be announced now?
Could the Minister not give the dates now? Usually notification of grants is withheld until the estimates are discussed. Are we to assume this year health boards will get the estimates in time for discussion at the estimates meeting.
I hope to be able to give the information at an earlier date than last year.
Why is the Minister not prepared to give a tabular statement in reply to the question?
There are adjustments to be made. There are services such as the choice of doctor service——
But without the adjustments, can we not have provisional estimates?
There are proposals for possible improvements in the service that are still awaiting Government decision.
The question asks for the estimates of expenditure by each of the regional health boards for 1972-73.
I have already replied to the Deputy. I am not telling the House any untruth. There are adjustments to be made in relation to such matters as capitation grants for the voluntary hospitals and other matters.
All we have asked for is the estimate. We know there are always adjustments to be made in estimates.
I am not going to give the estimates until I finalise the matter and I hope to do this as quickly as possible.
(Cavan): Why cannot the Minister give the estimates as they were presented and as requested in the question?
Because I still have adjustments to make.
Can the Minister give the percentage over-all increase?
It varies from area to area.
Can the Minister give the average?
I and other Ministers for Health have to try to introduce an estimate in which there is from 3 per cent to 5 per cent increase in the volume of the services, in the character of the services and all the rest of it is an increase in respect of remuneration, salaries, cost of materials, drugs and maintenance. Every Minister for Health in Europe faces the same problem because the health service is 70 per cent a labour cost service and I, in common with other Ministers, am trying to secure a net improvement in the character of the services as far as I can.
(Cavan): Is the Minister afraid of shocking the House and the country?
If, in fact, the increase in volume of the service is between 3 per cent and 5 per cent, in the light of the general trend of remuneration in the country, the total increase must be something probably well under 20 per cent. Is that the case? If it is more than that, how does the Minister explain it?
I could not give the percentage to the Deputy.
Will the Minister not agree that it varies from 33? per cent to 40 per cent? Why can the Minister not give it? Has it shocked him or have the Government not got the money to honour their obligations?
Later on, if the Deputy asks the question I shall give a statement about the increase in volume and the total cost of the health service related to other matters such as increased user of services because more people are going to hospitals and more places have been provided in homes for mentally handicapped and so on. I shall be able to give the increase in costs arising purely from increased remuneration and I shall be able to give approximate figures for the increase arising from increased user and the improvement of services such as the choice of doctor service which will cost something like half a million pounds this year.
(Cavan): At a later date will the Minister give the estimates as presented and as adjusted?
I shall consider that. Yes, if it is possible to do so.
It must be possible to give the estimates.
8.
asked the Minister for Health how it is proposed to divide the estimate for the Southern Health Board for 1972-73 between the Cork Corporation, Cork County Council and Kerry County Council.
In the absence of agreement on the part of the rating authorities concerned, it has been necessary for me to appoint a person to determine the basis on which the costs of five of the health boards, including the Southern Health Board, will be contributed. The determination in each case will apply retrospectively to the 1st April, 1971, when the Health Act, 1970, became operative. In respect of the years 1971-72 and 1972-73 it is necessary that I should specify a basis on which the costs of each board should be shared pending the final determination, and I have specified for each board concerned a basis related to the average health expenditure of each of the contributory bodies in the five years ended in March, 1971.
While this interim basis will determine the gross amount of a health board's expenditure appropriate to each of the contributory bodies, there will be available, as in recent years, special grants from the Vote for my Department for the purpose of alleviating the burden of health costs on the rates. The information on which decisions on the levels of this special subvention in all areas must be made is still under examination and I am, accordingly, not yet in a position to furnish the information requested.
The Minister is to appoint an arbitrator to decide between the Cork Corporation, the Cork County Council and the Kerry County Council, regarding the amount of levy to be paid. Can the Minister state if he has set a time limit on the arbitrator to decide how much each of those authorities should pay?
Mr. Barragry says that he will be able to have made a decision by June of this year. If, as a result, there are discrepancies as to the rates paid in 1971-72 and 1972-73 which would involve decreases in rates in some cases and increases in others, these may have to be spread over as much as five years in order that the effect would not be too burdensome on the group of county councils who may have to be assessed with more and the group of county councils who have been over-assessed. I hope the Deputy understands what I mean by this. The reason I chose the five years proportion of rates was that it was the only way to do it. If I chose population or county income or the amount of money raised by one penny in the rates, I would be preconceiving a notion which might be taken by Mr. Barragry, the arbitrator chosen, and then people might say that he had been influenced by the Minister in making his decision on the apportionment in the rates. Therefore, taking the proportion of rates for five years previously struck by each county council seemed to be the fairest way. I understand it has been generally accepted.
It has not.
I am not disputing the means by which the arbitrator will decide and come to a conclusion, but would the Minister explain to the House why it will take until next June to do this simple mathematical problem?
It is a very complicated business.
Will the Minister tell the House why the ratepayers in County Kerry have to pay £1 in the £ increase, Cork County Council pay 50p and Cork Corporation 30p when everyone knows that people in Kerry are much poorer than people in Cork?
The Deputy should inquire from the Minister for Local Government in regard to the whole rating structure throughout the country. There are many arguments about this. For example, if the Deputy compared the actual cost of rates per head of population in Kerry, Mayo, Clare and Sligo, he would find that there was little variation in spite of the fact that there was a much bigger rate struck per £ of valuation. Other experts say that is not an altogether correct way of analysing the matter. This is a complex business which we cannot discuss at Question Time. The arbitrator will do the best he can to make a decision that will be fair in the circumstances of the present rating methods in the country.
(Cavan): Does the Minister not agree that what he has said proves beyond doubt that the present rating system is unfair, unjust, crazy, and that it should be scrapped?
I cannot accept that.
Would the Minister state the statutory authority he has for making an apportionment between the different local authorities pending the arbitrator's apportionment?
It is some section of the Health Act but I could not say which one. Indeed, it may be sections of other Health Acts. The legislation is extremely complex. I am more concerned with practical issues but if the Deputy will ask a question I will tell him exactly the sections and clauses of the Acts under which I can do this.
Is the Minister not aware that last June he informed the different health boards that he was about to appoint an arbitrator——
That does not arise on this question.
Further, is the Minister aware that health boards have not accepted his assessment——
Question No. 8 refers to three places.
The Minister last June informed the health boards in Cork and Kerry and in other places that he was appointing an arbitrator but we have not had an arbitrator. I should like to tell the Minister that the Midlands Health Board have not accepted his assessment——
The Deputy is now giving information. I am calling Question No. 9.
9.
andMr. Cooney asked the Minister for Health if he will abolish regional health boards in view of their excessive administrative costs and restore health service operations to the county councils.
I have no powers which would permit me to do what the Deputies mention and I do not accept that the administrative cost of the health boards is excessive. The cost of top management in the boards, when all approved posts are filled, will be about one-quarter of 1 per cent of the revenue expenditure of health boards. At lower levels in the organisation, there has been no significant increase in the numbers of staffs in the health services since April, 1971. If the form of organisation recommended for those levels in the recent management report is accepted generally, the additional cost in a full year with all posts filled will be about one-fifth of 1 per cent of the revenue expenditure of the boards.
I very much deprecate the irresponsible statement made in some areas suggesting that there has been, or will be, an excessive burden of costs relative to personnel.
I do not think that such modest increased investment in administrative staff should be questioned, if we accept that there must be an effective and efficient administration of the services and of the vast amount of resources involved—about £70 million in the current year. The range and complexity of the services are being constantly increased. There are ever-growing demands and greater expectations for services which cannot, here or in any country, easily be met from the amount of resources available. In these circumstances, improvements in services must be achieved through greater efficiency in the utilisation of limited resources and this will call for more expertise on the part of the boards and their administrations.
In the health boards, programme budgeting is being introduced; the personnel function is being developed and expanded; steps are being taken to improve hospital administration; and community services are being developed through direct action by the boards and the building of strong links with voluntary organisations. All these measures are accepted as being desirable and necessary, and the establishment of the health boards, based on larger units of administration, make their implementation more feasible and more economic by enabling the optimum use of the limited numbers of qualified personnel available.
As I have already made clear on many occasions, every modern health administration recognises that with growing specialisation there must be a reorganisation of hospital services and for this purpose the area of administration must be extended. Secondly, if community services are to be fully developed on a decentralised basis there must be a headquarters staff that will provide a promotion structure of personnel with expertise in their field.
Purely within this context, and without regard to the much wider considerations justifying the establishment of the health boards, a decision to restore the administration of the services to the local authorities would make it more difficult to undertake these measures, would very likely be more expensive in terms of staff required, and almost certainly be less effective because of the loss to the services of the wider co-ordination and greater concentration of expertise which health boards can bring to bear on these pressing problems. The case for setting up the health boards, which was accepted by this House when it passed the Health Act of 1970, has not been weakened in any way since.
Finally, I would point out that the freeing of management in local authorities to concentrate on services other than health is an important factor which should not be overlooked in this whole matter.
Surely the Minister has got the message loud and clear from every corner of the country that the costs involved in the new health boards have skyrocketed to such an extent that he was too embarrassed to tell the House the estimates he has received from the various health boards and refused to give the percentage increases? In view of the message that is coming loud and clear, would he consider restoring the services to the county councils? There is no service being provided by the health boards that could not be provided equally efficiently and far more cheaply, as in the past, by the county councils.
The Deputy is being an innocent in talking about the great increase in the cost of the health services——
The Minister is being an innocent; he is quoting McKinsey here——
I have explained that in every single year where there are large increases in remuneration the health service bears an extra proportion of those costs because it is a 70 per cent labour cost service. It always has been so and this is the case in other countries. The nearest comparison I can make is with the post office where the labour cost is even higher than 70 per cent, or CIE. The idea, when we have had a year of inflation, that because the health boards are initiated they are responsible, as compared with county health authorities, for an inflationary increase in remuneration, wages, salaries, cost of medicine, cost of maintenance and cost of materials is quite ridiculous. The Deputy should not try to deceive the people by suggesting that the creation of health boards has caused the inflation.
It must be obvious to the Minister that if you are going to introduce new bureaucratic structures——
If the Deputy thinks that one-quarter of 1 per cent and one-fifth of 1 per cent——
The Minister was asked for the figures.
——which is the actual cost of, first of all, the headquarters staff of personnel managers— in the first report of McKinsey—and, secondly, the cost of the support staff is excessive, he ought to have his head examined.
(Interruptions.)
The Minister's reply would suggest that the health boards are functioning very well. Is the Minister fully satisfied that what was envisaged is in fact taking place? He knows it is not taking place. Comparing what was being done at county council level with what is now being done at health board level, would the Minister not now agree that the whole purpose of the health boards was to provide jobs for the boys? That is exactly what happened.
I totally deny that.
I knew the Minister would.
Some Deputies are just getting cheap publicity out of this because they know——
The Minister knows they are not working.
I have heard from Deputies on all sides of the House that they are operating very successfully.
There will be a revolution in the country.
If the Deputy expects that when we start eight miniature parliaments at once deriving from 27——
I do not see our board working properly.
We cannot have a debate at Question Time.
It will take at least three years before the eight health boards can be seen to be operating.
At what cost?
Question No. 10.
Would the Minister agree that the increase in remuneration generally in the past year has not exceeded 17 per cent——
We cannot have a debate at Question Time. Question No. 10. Will Deputy FitzGerald allow questions to proceed?
The Deputy did not make use of his statistical knowledge.
I am asking a question. It is not fair to the Minister.
The Deputy will get it straight from me. He made no calculation about the very great decrease in the number of hours worked by health staffs. He had no figure for that.
Will the Minister answer Question No. 10?
He made no allowance for the special status pay that was rightly awarded to the nurses. He made no allowances for those things.
We are getting the figures from the Minister now.
They have not got an 85 or a 90-hour fortnight now. There is no use in the Deputy quoting the national statistics for increased remuneration.
There is a use when we get an answer from the Minister which he would not give previously.
They were paid for in last year's Estimate.
Would Deputies allow Questions to continue?
The House will get the exact figures when they are all prepared for the minute increases in the cost of headquarters staff and, as far as I can give it, the element of purely increases in remuneration and increases in the cost of materials and drugs and, as far as I can give it, the increase in user of the hospitals and institutions and the actual increase in the volume of services as, for example, the choice of doctor. Everything the Deputy said today that suggests that the health boards have been instrumental in grossly inflating costs will be disproved.
Will the Minister move on to the next question?
Why then are the ratepayers of Westmeath being asked to pay 80p when we were told a few years ago that the health services would cost only 2s. 6d. in the £? The figure is now almost £3 in the £ in Westmeath.
It will be found that I am right and not the Deputy.
We cannot have a debate at Question Time.
The figure will be £2.80 in Westmeath.
Question No. 10.