asked the Minister for Health the amount provided in the Estimate for his Department for 1976 under subhead G.2 for recoupment of expenses of the General Medical Services (Payments) Board; how this compares with the actual expenditure by the board for this purpose in 1975; and if the amount provided for 1976 will necessarily involve a cut-back in the general medical service.
Ceisteanna—Questions. Oral Answers. - Health Services.
13.
The amount provided for the General Medical Services (Payments) Board under subhead G.2 of the Vote for the Department of Health in the current year is £24.120 million compared with an expenditure of £21.5 million in 1975. The 1976 allocation is estimated to be sufficient to maintain services at the 1975 level.
Is the Minister satisfied that an increase from £21 million to £24 million is anywhere near adequate in the light of the general economic and financial situation with inflation calculated to be at least 15 or 16 per cent during the coming year and with increasing costs generally? Is the Minister satisfied that the figure provided is a realistic one or is it simply a book-keeping exercise to try to present some feasible appearance to the budgetary provisions? Surely it is obvious to the Minister that if the general medical services costs £21.5 million in 1975 they will cost a great deal more than £24 million in 1976, even allowing that there will be no increase of any sort in the services.
I am satisfied that the services can be maintained. I should like to point out to the Deputy that of the £21.5 million paid to the General Medical Services (Payment) Board in 1975 a sum of £1.3 million was included for arrears of payments to the medical profession, to doctors specifically. Therefore, the actual figure for 1975 was £20.2 million and in 1976 it is £24.12 million, an increase for 1976 of £3.2 million which represents an increase of 19 per cent.
Can the Minister give the House a categoric assurance that the same level of service will be provided by the general medical service to all those who hold medical cards; that no instructions have been issued for a reduction in this service or withdrawal of medical cards in the case of persons who hold them and that there will be no cutbacks in the level of the service? Can the Minister give an assurance that the figure he has mentioned is adequate for all the purposes during the year?
I am satisfied that it will be adequate and no instructions, good, bad or indifferent, were given by me or my Department to the CEOs who fix the guidelines and determine eligibility for the medical service cards.
Time will tell.
I should like to ask the Minister if there has been any cutback on the 1975 services. I have been a member of a health board for more than 25 years——
It is not in order to make speeches at Question Time.
Was there any cut-back in employment or services for 1974, 1975 or 1976 as far as the health boards are concerned?
I can give the Deputy that information——
There has not been any cutback.
In the Estimate for these services for 1976 is there an amount to meet arrears in payment to doctors outstanding on 1st January, 1976?
There are no arrears due to doctors but there are arrears due to pharmacists.
14.
asked the Minister for Health the method by which the original shortfall of £3.72 million between the amount sought by the Eastern Health Board to finance its operations in 1976 and the allocation made by his Department was reduced to £0.323 million; the amounts by which the expenditure on particular services is to be cut back; and the effect the cut-backs are likely to have on the services concerned.
15.
asked the Minister for Health the amount sought by the Southern Health Board to finance its operations for 1976; the amount allocated by his Department; the deficit resulting from this allocation; and how he proposes that the board should cope with this deficit.
16.
asked the Minister for Health the amount sought by the South-Eastern Health Board to finance its operations for 1976; the amount allocated by his Department; the deficit resulting from this allocation; and how he proposes that the board should cope with this deficit.
17.
asked the Minister for Health the amount sought by the North-Western Health Board to finance its operations for 1976; the amount allocated by his Department; the deficit resulting from this allocation; and how he proposes that the board should cope with this deficit.
18.
asked the Minister for Health the amount sought by the North-Eastern Health Board to finance its operations for 1976; the amount allocated by his Department; the deficit resulting from this allocation; and how he proposes that the board should cope with this deficit.
19.
asked the Minister for Health the amount sought by the Mid-Western Health Board to finance its operations for 1976; the amount allocated by his Department; the deficit resulting from this allocation; and how he proposes that the board should cope with this deficit.
20.
asked the Minister for Health the amount sought by the Western Health Board to finance its operations for 1976; the amount allocated by his Department; the deficit resulting from this allocation; and how he proposes that the board should cope with this deficit.
21.
asked the Minister for Health the amount sought by the Midland Health Board to finance its operations for 1976; the amount allocated by his Department; the deficit resulting from this allocation; and how he proposes that the board should cope with this deficit.
22.
asked the Minister for Health if he will now make a revised allocation for non-capital health expenditure available to each regional health board which will enable the board to maintain for the whole of 1976 all the services that were in operation during 1975 at the same standard that obtained in that year.
With the permission of the Ceann Comhairle, I propose to take Questions Nos. 14 to 22 together.
I object to this procedure. Each one of the questions deals with a separate health board, a separate budgetary provision and a separate situation. It is a denial of my rights as a Deputy for the Minister to take all these questions together.
As far as I know, I am the only member of a health board present in the House.
The only member of the Labour Party present.
Where are the other members of the health boards? As far as we are concerned on the Mid-Western Health Board our situation is perfect. Deputy Haughey knows nothing at all about us.
The Chair has no control over the method of a Minister's reply.
Deputy Coughlan is anticipating embarrassment for his Minister.
The Deputy drew his gun before but he only had blanks.
It is not a matter for the Chair as to the method a Minister adopts in respect of replies to questions of this kind.
I understand that and I do not seek to reprimand the Chair. I would not attempt to do that. Would the Chair recognise that there is validity in my complaint and that the Minister is treating the House in a very contemptible fashion by the method he proposes to deal with these questions? It is a negation of democracy.
It is not uncommon to have a number of questions replied to together in this fashion. We will now have the Minister's reply to Questions Nos. 14 to 22.
I propose, also with the permission of the Ceann Comhairle, to circulate with the Official Report a statement showing the allocation for non-capital expenditure in 1976 for each of the health boards and the boards' estimates of expenditure for 1976. The table will show that, for all the health boards, the difference between the allocations and their estimates was £10.788 million, or about 6 per cent. It is not correct to describe this difference as a "deficit". As I pointed out in speaking on the Deputy's motion on 3rd March—Official Report, Volume 228, column 1260—it is customary for estimates of bodies such as health boards to be reduced after examination. The examination of the boards' estimates, with a view to reconciliation, has been carried out by my Department with the officers of the health boards.
In the case of four of the boards— the southern, the mid-western, the north-western and the north-eastern, it has been possible to achieve full reconciliation on the basis of repricing of certain items to relate them clearly to 1975 levels and by economies in expenditure on "housekeeping"— including maintenance—on transport services, on replacement of equipment, reducing locum cover and overtime to essential levels and similar items. Increased income to the boards was also provided for, including the increase in charges for private patients which will come into effect on 1st April.
For three other health boards—the western, the south-eastern and the midland—similar revisions of estimates were achieved and these have reduced the differences between the estimates and the allocations to a figure totalling about £1,300,000. Further discussions are proceeding on the elimination of these balances.
The method of reconciliation of the difference in the case of the Eastern Health Board was similar to that for the other health boards. The board's estimate was examined in detail, in consultations between officers of my Department and its officers. The estimate made by the board had not been based strictly on maintenance of 1975 levels and the examination between the Department and its officers resulted in reductions on this account in the estimated figures under several headings. Furthermore, it was agreed that the provision made in the estimates for some items could be repriced. In particular, the provision for overdraft interest was reduced by £200,000 and the provision for receipts was increased by £120,000.
The estimate as prepared by the Eastern Health Board had included provision of £1,900,000 for maintenance works on buildings and so on. It was put to the Board's officers that, in the present difficult financial situation, this figure could be reduced very considerably. A reduction of £700,000 was agreed to in it.
The total reduction in the estimate as originally prepared by the board arising from these discussions was £2,946,000. The "gap" between the board's original estimate and the allocation which I had made to it was thus reduced to £773,000. It was also intimated to the board that I would consider a proposal, which I will be referring to in a reply to another of the Deputy's questions, on the scheme for subsidising drugs for the middle income group and a proposal in relation to charges in hospitals which could reduce this deficit further. In the estimation of the board's chief executive officer this will reduce the difference to the figure of £323,000 referred to by the Deputy. The chief executive officer reported this new position to the board at their meeting on 4th March and the board have accepted the situation as thus reported. Discussions will continue with the Eastern Health Board on the elimination of the remaining part of the "deficit".
As regards Question No. 22, the matter of revising the allocations for non-capital expenditure to health boards in 1976 for the purpose mentioned by the Deputy does not arise.
Following is the statement:
|
Health Board |
Allocation for non-capital expenditure in 1976 |
Health Board's estimate of non-capital expenditure |
Difference between the allocation and the estimate prepared by the health board |
|
£(m) |
£(m) |
£(m) |
|
|
Eastern |
33.59 |
37.310 |
3.720 |
|
Southern |
29.43 |
30.360 |
0.930 |
|
Western |
25.17 |
27.783 |
2.613 |
|
South-Eastern |
19.53 |
20.290 |
0.760 |
|
Mid-Western |
17.89 |
18.490 |
0.600 |
|
North-Eastern |
13.58 |
14.440 |
0.860 |
|
North-Western |
13.21 |
13.610 |
0.400 |
|
Midland |
12.10 |
13.005 |
0.905 |
|
TOTALS |
164.50 |
175.288 |
10.788 |
Does the Minister suggest to the House that this is a serious proposal? Is he endeavouring to suggest to the House that the executive officers of the different health boards submitted estimates which were irresponsibly inflated to the extent of £10 million? Is there any other explanation of the fact that officers of his Department are able to go along to the different health boards and reduce the budgets submitted by £10 million simply by examining these estimates on paper? Would the Minister indicate which is the situation? Were the estimates fraudulent in the first place or is the alleged reduction which the Minister now proposes to make fraudulent? Which is the situation?
The estimates are framed and the amounts agreed by the health boards are sufficient to maintain the services at the 1975 level. In this House in the last few debates there was from practically every Deputy who spoke a reference to what they considered to be a certain amount of wastage in the health services and they suggested that economies could be achieved. That appeared to me to be the consensus of opinion among a certain number of Deputies excluding the Deputy who asked the question but as a former Minister for Finance I am sure he will agree that while the estimates may not be described as being inflated there is an inclination towards an element of over-estimation as far as expenditure is concerned. The various health boards were approached through their CEOs. The CEOs in turn consulted the members of the health boards and, as I have indicated in my reply, five of them agreed that these economies could be made without damaging the service. In respect of the others where there still is an outstanding deficit it is proposed to have further consultations with the health boards to see if other economies can be effected.
I have in the course of a recent speech on the Deputy's motion indicated the improvement in real terms in the health services up to 1975. I have no hesitation in saying that we must look for economies in this year where there is undoubtedly constraint. The Deputy can lay the blame on this person, that Minister, or the other Minister but the fact is that the situation does not allow me, does not allow the Government, to make the improvements that all of us would desire but I think in 1976 and without any damage or danger to patient care or to the health services generally what has been agreed with the majority of the health boards and accepted by the actual members of the health boards is desirable.
In view of the reply given by the Minister, are we now assured that what pertained in 1975 will pertain into 1976 and that the wastages that have been made over a long period by health boards and practitioners working under health boards will be curtailed and is the Minister now prepared to make a statement here that he will set up an all-party committee to investigate the working of all health boards?
The Deputy is raising other matters.
Would the Minister say——
Is this a carefully arranged diversionary tactic?
There is nothing arranged. There are no tactics. I come here as a member of a health board for 36 years. I know what I am talking about and the Deputy does not. That is the difference.
Order. Let us proceed at Question Time today in an orderly manner.
If I do not know what I am talking about, cannot you allow me to ask questions in order to find out?
Stupidity.
Deputy Coughlan. I am afraid the Deputy's interjections are leading to retorts and to disorder. I must insist that we proceed at Question Time in an orderly fashion. I would ask Deputies— Deputy Haughey and others—to put questions briefly and concisely so that we will make worthwhile progress. In the meantime, Deputy Coughlan will not intervene unless he has a positive parliamentary question to put.
He should not be described as a plant. If that is the practice of Fianna Fáil, that is their affair.
I said "diversionary tactic". You are resorting to every trick to avoid answering straightforward questions I am putting to you.
Every Deputy is entitled to put a parliamentary question or a supplementary question. Order.
I have more experience of health boards than either Deputy Haughey or the Minister.
Order.
I know what I am talking about, not like the Fianna Fáil goon.
That is not a question.
It was suggested by practically every Deputy who spoke last night, including Deputy Haughey, that consideration should be given to the establishment of a committee, described by some people as an all-party committee and as a committee by other Deputies. This is something that I intend to give consideration to and I will be referring to it in my reply to the Second Stage debate on the Health Contributions Bill. In reply to the first part of Deputy Coughlan's supplementary question, yes, I am satisfied that as far as patient care is concerned 1975 standards can be achieved.
I want to suggest that we are not concerned here with any investigation of the financing of the health services in any sort of fundamental way. We are simply concerned to try to ascertain whether the allocations which the Minister has made for the different regional health boards will enable them to maintain fundamental, basic, community health services at a satisfactory level during 1976. I want to assure you, a Cheann Comhairle, that that is all I am endeavouring to ascertain by this process of questioning. It is a very important question and is one of considerable public interest.
The Chair will facilitate the Deputy in eliciting this information but I want to dissuade the Deputy at the same time from making statements or embarking on speech-making. I am sure he will not do that.
I have not done it so far. The Minister has indicated that various devices have been resorted to in an attempt to eliminate the deficit of £3.72 million in the Eastern Health Board financial situation. I want to suggest to him that these alleged measures which the Department of Health have worked out in collusion with the executive officers of the Eastern Health Board are illusory and that, in fact, this deficit of £3.72 million still exists. Can he seriously suggest that a figure of maintenance of £1.9 million in the Eastern Health Board can be reduced by £700,000 in a realistic way and is this not simply a device, a bookkeeping affair and that, in fact, the deficit is still there? Do the measures which the Department of Health officials have worked out with the Eastern Health Board officials include, as in the case of St. Loman's, removing cornflakes from the breakfast menu, providing simpler desserts, cutting down on minerals and soft drinks with meals, cutting out patients' cigarette allowances, cutting out newspaper allowances for patients? Are these the sort of economies which his officials have worked out with the Eastern Health board officials or is he still prepared to deny that these restrictions and cutbacks are in force in St. Loman's Hospital, which is typical of this whole exercise carried out by the Department of Health?
These allegations were refuted by me some weeks ago and I still refute them. There will be no diminution as far as the services to these people are concerned. As I said, all this was suggested in some newspaper article by some unnamed spokesman. I resent Deputy Haughey saying that these cuts were done in collusion with the CEOs. The various health boards met and considered this and, in respect of about five of them, the various health boards agreed these economies should be made. Deputy Haughey continues to repeat things he said here about a month ago and I can only come to the conclusion that what he is trying to do is to cause mischief within the health boards. The various allegations that have gone around about cutting out this, that and the other as far as patients are concerned are wrong and will the Deputy not now accept my assurance that, as far as I am concerned, the 1975 level will be maintained?
I can only take St. Loman's as typical of the sort of exercise that is being carried out.
I want to dissuade Deputies from the tendency to debate these matters at Question Time rather than putting precise questions. Supplementary questions should be brief and specific and they should not be asked in multiples or in omnibus form.
If the Minister had answered my questions in the case of each health board separately and specifically, as the Chair would like us to ask supplementary questions, there would have been no difficulty, but the Minister did not do that. He lumped everything together so that he would not have to deal directly with a particular instance. The Minister has again denied that these cutbacks, these economies, have been put into force in St. Loman's. Is he aware of the fact that the journalist who published the original disclosure in regard to this hospital has since interviewed the executive concerned personally and has been able to ascertain beyond yea or nay that these economies and cutbacks are now in force and, as to 99 per cent, the original articlie he published on the situation there has been verified by him personally in consultation with the authorities of that hospital? Further, is this typical of the manner in which all these alleged economies have been carried out and given effect to and is the whole process of apparently reducing this Eastern Health Board by £3.72 million not simply a fraudulent exercise by the Minister's Department on the health board concerned?
Does the Deputy not accept from me that these economies were discussed with the health board and does he not agree with me that the Eastern Health Board approved of these economies? Does he know that? He may try to cause mischief about cornflakes and newspapers and that sort of thing, but that was a scare article.
It was true.
It was not true.
It was true in every detail.
With regard to the Western Health Board, am I to take it from the Minister's reply that the CEO and the officials of the Western Health Board have agreed they can have no cutback and work on the amount of money they are getting, which is a big cut on the estimate? Am I to take it they have agreed on that? Secondly, am I further to take it that in answer to a question earlier asked by Deputy Haughey the Minister said no direction was issued by the Department for any cutback? I take the Minister's word for it, but he also said they must live within their budget and the budget is not sufficient to carry on the service as it was carried on last year. This is the position: first, the Minister says there will be no cutback and then he says there is a certain amount of money within which they must work.
On a point of order, I want to ask a question. There is no cutback, good, bad or indifferent.
That is not a point of order.
I am asking a reasonable question about the Western Health Board.
In reply to Deputy Callanan's first question, the Western Health Board have not yet considered the estimate. I believe the board is due to meet on the 27th of this month.
But the CEO has put forward the cutbacks.
The Minister did not answer my second question.
Would the Minister explain what is the economic basis for withdrawing a taxi service to a patient obliged to visit a hospital once fortnightly, thereby forcing that patient to become a permanent patient in the hospital, the cost of which will be £60 or £70 per week? What is the economic basis for that?
It has been generally agreed-maybe not by all but by individual members of health boards— that there were abuses of the taxi service. I do not want to give the Deputy an assurance but, if he wants it, he can get it from the CEO that there will be no undue hardship on anybody being conveyed to and from a hospital or clinic.
How will it be done if they cannot have taxis?
If the cases necessitate the employment of taxis, they will get taxis. They cannot have taxis just by ordering them.
We have good medical services in the country which the Minister is supplying.
Order.
Is the Minister saying there have been no cutbacks in St. Loman's Hospital, as illustrated by Deputy Haughey, and is he further stating these cutbacks were not made by the Eastern Health Board simply because the Minister's Department did not make money available to the health board which would enable that body to continue the pattern last year and will the Minister not agree that the patients in St. Loman's have had cigarettes and newspapers cut out and is he aware I am a member of the Eastern Health Board and so can speak with some authority?
I am not aware any of the allegations the Deputy made are facts.
The Minister is not aware.
He has denied them.
They are not true.
If Deputy Coughlan persists in interrupting, I shall have to ask him to leave the House.
I want to hear the truth.
I warn the Deputy he will leave the House if he persists in interrupting.
23.
asked the Minister for Health if he is satisfied that attempts by health board programme managers to dictate to medical practitioners in the general medical service the patterns of visiting and prescribing for patients to be followed is in the best interests of public health; and, if not, if he will direct that all such attempts be discontinued.
I have no information that any officers of the health boards attempt to dictate practice patterns. Health boards monitor the visiting and prescribing patterns of doctors engaged in the general medical service and provide them regularly with information which enables them to compare their performance with that of their colleagues. Where the visiting or prescribing patterns of individual practitioners are greatly in excess of those of their colleagues they may be referred for examination by an investigating group appointed for that purpose. This group is representative of the medical organisations and the General Medical Services (Payments) Board, with an independent chairman.
Monitoring of performance is necessary, is acceptable to the profession and I am satisfied that it should be continued. It has been in operation since the scheme was inaugurated in 1972.
I want to make it clear to the Minister that in this question I am not concerned with normal practice. I am concerned with the different health boards this year being forced as an economy measure, not as a normal matter of good administration but as an economy measure, to lay down particular patterns for visiting and prescribing by practitioners under the general medical services.
That is not true.
Order.
Is the Minister aware that in the case of a number of health boards, and I mention the Western Health Board in particular, this proposal has been put forward by the executive side of the board that visiting and prescribing patterns for patients under the general medical health services be restricted and is he satisfied that is justifiable and good health administration practice and is he furthermore satisfied that it will not lead to a serious interference with the medical competence of the doctors concerned with possible serious results for the health of their patients?
There will be no change in the procedure which has obtained since the scheme was first introduced in 1972 and there will be no attempt to dictate to doctors what their pattern of visiting or prescribing should be.
The Minister may state there is no change but I am asking him if he is aware of a specific, definite proposal put forward by the executives in the Western Health Board area to this precise effect? Is he aware that this proposal is being put forward? Is he in favour of it or will he direct that it be withdrawn?
I am not so aware and I am not in favour of it.
The Minister is not aware that this proposal has been put forward?
I am not aware that this proposal has been put forward.
Would he accept my assurance that it has been put forward?
I would like to see the evidence of it.
If the Minister saw it in writing?
Yes.
If it has been put forward, will the Minister direct that it be withdrawn.
The Minister will direct that the ordinary practice which has obtained for the last four years will still obtain in 1976.
And just because these people happen to be on a general medical register, there will be no interference with the medical attention they receive from their practitioners? Would the Minister give me that assurance?
I have said this in the reply. Why does the Deputy insist on going on the way he does?
The reason I am pressing this matter is that I know from the answers the Minister has given me that he is not aware of the situation. I have seen this proposal by the Western Health Board.
This is leading to argument.
I have seen this proposal by the Western Health Board in writing——
The Deputy has already said that.
——and the Minister tells me he is not aware of it. That is why I have to persist. I apologise for taking up the time of the House, but I think it is a very important matter. Does the Minister not agree it is vital that no attempt be made to interfere with the professional competence of medical practitioners just because persons happen to be on the general medical register?
Do not let us make a big deal about this. I do not think anyone should indicate to the medical profession as to when and how they should visit or prescribe——
That is all I want to hear.
——but I have also described the procedure to be taken in respect of a doctor or doctors who, it would appear, were over-visiting or over-prescribing.
That is not what I am concerned about. What I am concerned about is this proposal——
I have no information to that effect——
Question No. 24.
The allegation made by the Deputy is vindictive and ridiculous. There is nobody deprived of medical attention because of——
Deputy Coughlan, please.
24.
asked the Minister for Health if he is aware that the intention of health board managements to eliminate all overtime and not to permit annual or illness leave substitutions in hospitals and institutions under their control must inevitably interfere with the general level of efficiency in these institutions and result in excessively long working hours for the staffs concerned; and if he will make a statement on the matter.
I am not aware that it is the intention of health board managements to eliminate all overtime and not to permit annual or illness leave substitutions in hospitals and institutions under their control. I do not, therefore, accept the inferences drawn in the latter part of the Deputy's question.
I am aware that health board managements intend to monitor and control overtime and annual and illness leave substitutions more closely than may have been the practice in the past and to authorise expenditure in these areas only when it is proved to be unavoidable.
I am satisfied that this exercise of management responsibility can and will be done in a way which will not interfere with the general level of efficiency in the hospitals and institutions concerned. I am also satisfied that excessively long working hours will not result for the staff concerned.
Is the Minister aware that management teams in practically every health board have put forward as a positive proposal to their boards precisely this suggestion which I have outlined in my question, namely, that annual or illness leave substitutions in hospitals and institutions under their control will not be permitted? Is he not aware that in every regional health board throughout the country health boards are pursuing a policy of restricting all forms of leave substitutions and that everybody concerned recognises that this is going to mean excessively long working hours for staff? If he is not aware of the situation, will he have it investigated and see to it that neither the quality of the service these staffs give nor their work——
The questions are very long, Deputy. We ought to have more precise questions and fewer in number.
These are complicated matters.
It is not true that all forms of leave and locum arrangements are to be eliminated. There is a certain amount of overtime and locum cover that can be eliminated, but for the Deputy to suggest that all such arrangements are to be discontinued is entirely wrong.
25.
asked the Minister for Health if he is aware that health boards are being forced to reduce expenditure on meals-on-wheels as an economy measure; and if he will make the necessary funds available to all health boards to enable this service to be maintained at present levels in view of the deprivation that any reduction would cause to a particularly needy section of the community.
26.
asked the Minister for Health if he is aware that health boards are being forced to reduce expenditure on home helps as an economy measure; and if he will make the necessary funds available to all health boards to enable this service to be maintained at present levels in view of the deprivation that any reduction would cause to a particularly needy section of the community.
I propose, with the permission of the Ceann Comhairle, to take Questions Nos. 25 and 26 together.
There will be no reduction of expenditure under these headings. While, as will be clear from my replies to the Deputy's earlier questions, the financial circumstances of the present year do not allow for additional expenditure in real terms on the meals-on-wheels and home help services, I am satisfied that the general allocations to the health boards will allow for a continuance of these services at 1975 levels.
Will the Minister agree that the community services in Limerick have been abused and that certain people have had their services dispensed with because of these abuses?
I have no official information with regard to Limerick. I do know there is some dispute——
Will the Minister assure the House that the abuse which crept into the home help service in the Mid-Western Health Board area——
The Deputy has already asked that question.
These old people are eating too much.
I know more about the old people than the Deputy does.
They are eating too much. Cut out their meals-on-wheels. The Minister indicated in his reply that there will be no reduction in expenditure on these services. Is that the extent of the guarantee he can give? Does he not realise that, in present circumstances, simply not to reduce expenditure could still result in a very severe cutback in these services? Is he not aware that in a number of health boards a very definite proposal to restrict meals-on-wheels and the other ancillary community services has been put forward for serious consideration and that the levels of money which are allocated for these services almost certainly indicate that these very desirable, essential humanitarian services will be severely reduced and limited this year?
I know that various suggestions have been put forward to some of the health boards and the Eastern Health Board in particular; at least that is the one that came to my notice first. There were some ridiculous suggestions, simplistic ones, that would provide for a reduction in the estimates sent forward by the health boards. Practically all of these that were submitted by the officials of the board were rejected.
Were they irresponsible?
I did not say irresponsible.
The Minister said they were ridiculous.
Do not try to put words into my mouth. I did not call them irresponsible.
(Interruptions.)
Order. If Deputies ask questions, they ought to listen to the replies.
You are trying to foment a lot of trouble. I did not say "irresponsible". I said there were some suggestions made, simplistic ones——
Ridiculous.
I did not say "ridiculous".
The Minister did.
If the Deputy wants a reply to the question——
Question No. 27.
I have been satisfied by the boards that the degree of service with regard to meals-on-wheels and home help will be maintained in the year 1976 at the 1975 levels. As I think the Deputy mentioned himself, there is more money being made available. There is 13 per cent of an increase in order to maintain the services at the 1975 levels.
The Minister said there would be no reduction in expenditure on these services. Does he realise that does not necessarily mean the service will not be cut back? Will he give us an assurance that the money will be made available for each health board to maintain these basic humanitarian services at the level at which they were supplied in 1975?
I am not aware that any board has——
I am not asking the Minister whether he is aware——
The Tánaiste should be allowed to reply in his own fashion without interruption.
These services will be maintained at the 1975 level, and there will be a 13 per cent increase in money terms in order to do that.
I am sorry to persist in this, but I think you will agree, a Cheann Comhairle, that this is a very humanitarian area we are dealing with here.
Yes.
We are dealing with meals-on-wheels for old persons. I am not asking the Minister for percentages or for assurances that there will be no reduction in expenditure because that is meaningless. Will he give me and the House an assurance that in the case of each health board area they will be directed to maintain these meals-on-wheels and other ancillary services of the same nature at their existing level and that there will be no cutback in the level of services afforded? That is all I am asking.
I am not aware that any of the eight boards intend to cut back on the level of services so far as these two services are concerned.
I am asking for an assurance——
The Deputy is repeating himself.
——and the Minister is telling me that "he is not aware".
(Interruptions.)
I am telling the Deputy that they will be maintained at the 1975 level. Is that sufficient for the Deputy?
Thank you very much. That is the first time I got that assurance from the Minister.
Next question.
I told the Deputy that four times but he did not accept it.
On a point of order——
There were two questions taken here.
The Deputy will resume his seat. I have called the next question.
Am I entitled to a supplementary question?
We took two questions here. Surely I am entitled to ask a supplementary.
No. I am calling Question No. 27.
27.
asked the Minister for Health if he recognises that any cutback now in the child and school health service would represent a major set-back in the whole concept of preventive medicine in this country, that it will do irreparable harm to the general health of the community and create additional financial and other problems for future administrations.
The issue mentioned by the Deputy does not arise. I have not been asked by any health board to approve of a cutback in the services provided in 1975 under the child and school health examination services.
Is the Minister aware that many persons, and no less a body than the Irish Medical Association, have indicated that, in their view, this cutback is not alone threatened, but is already beginning to come into operation? Will he give the House an assurance that money will be made available to provide this child and school health service at 1975 levels in all health board areas because it is essential for the future health of the nation?
The only health board that raised this matter as one of their initial suggestions was the Eastern Health Board. The members of the board rejected it, and I, as Minister for Health rejected it as well. There is no suggestion that there will be a cutback in that service.
Is the Minister satisfied that the amount of money allocated by the Eastern Health Board in their revised budgetary proposals is adequate to maintain the service at its proper levels?
Yes.
I am not.
Is the Minister aware that the Eastern Health Board, because of an insufficiency of funds, will have to see that visits to schools in the school screening services will have to be less frequent than they were? Is he concerned about this?
Of course I am concerned. I have told Deputy Haughey that the only such proposal that came up initially was from the Eastern Health Board. It was rejected by the members of the board. There is no suggestion that there will be any cutbacks.
While the members of the board would have liked to have rejected it outright——
A question please, Deputy.
——would the Minister not agree that, unfortunately——
It was rejected by the board.
——in practice it means that the frequency of medical visits to schools under the school screening of pupils' health service is happening?
The Deputy is making a statement.
It is not.
I can tell the Minister that it is.
(Interruptions.)
Order. A final brief supplementary from Deputy Haughey.
Is the Minister aware that the Irish Medical Association were so concerned about this matter, so fearful that serious cutbacks were taking place, that they took the trouble to write to every member of the Eastern Health Board setting out the situation as they saw it, and asking that the cutbacks which were positively coming into operation would not be given effect? Does the Minister accuse the Irish Medical Association of irresponsibility in this regard?
No. Again the Deputy is trying to put words into my mouth; he is very adept at that.
I am not, really.
The reaction of the IMA presumably was when the initial and very simple forms of economies were proposed by officers of the health board, but that has been rejected.
We got this letter as late as 23rd March.
28.
asked the Minister for Health if he is aware that economy measures in the use of fuel and energy supplies which health boards are being forced to undertake will inevitably lead to severe hardship, suffering and discomfort, especially for elderly inmates of homes and institutions; and the action he proposes to take in the matter.
29.
asked the Minister for Health if reductions in the transport services for conveyance of patients to hospitals, health centres and clinics which health boards are being forced to adopt will cause widespread hardship and will be likely to result in a falling-off in the standard of medical attention received by large numbers of the lower and middle income groups.
I propose, with the permission of the Ceann Comhairle, to take Questions Nos. 28 and 29 together.
I am aware that the economy measures proposed by health boards include savings in the purchase and use of fuel and energy supplies and in the provision of transport services.
I am satisfied that health boards will ensure that the manner in which savings in heating costs will be achieved will not lead to hardship or suffering, particularly in the case of elderly patients in homes and institutions.
I can also assure the Deputy that transport services will be available for patients who require them and that the savings proposed in transport costs will not, as the Deputy infers, cause widespread hardship or result in a falling-off in standards of medical care.
Does the Minister not accept that cutbacks to the extent which is agreed apparently between his officials and the Eastern Health Board in this area must inevitably result in a very serious lowering of the levels of heat, to mention just one aspect, in these homes and institutions? This can, and undoubtedly will, give rise to very serious hardship to the inmates of the various institutions. Is he not aware that the level of the cuts proposed in the Eastern Health Board and in other health board areas is such that suffering, hardship and discomfort are inevitable unless he positively intervenes to ensure that adequate allocations are made for fuel and energy supplies?
I am perfectly satisfied that economies can be made as far as heating and energy are concerned in practically all hospitals throughout the country.
Does the Minister suggest that up to now there has been wastage and that these homes and institutions have been excessively heated? Is that the kind of thing we are being asked to accept, or, is it not simply a matter of throwing these unfortunate old people to the wolves, cutting down on energy and fuel at the expense of their comfort and general situation? Is that not the reality of the position?
I am satisfied that any economies which will be effected will have no effect on patient care.
Would the Minister not agree that once one starts overall economy measures inevitably the poorest and weakest sections involved will suffer?
This is leading to an argument.
On a point of order, any brutality that has been introduced here today was——
That is not a point of order.
(Interruptions.)
Order. Deputy Coughlan will have to learn to behave himself at Question Time.
I want to ask the Minister what savings were made by the Eastern Health Board——
Order. I am calling Deputy Tunney.
——to cut out wastage——
Deputy Tunney.
I know a patient who has been provided with transport by taxi to a hospital every fortnight. How can the Minister claim that he is maintaining the transport service when this patient has been told that he will not be provided with a taxi any more?
We have already had that question.
Is there alternative transport available? Must he get a taxi every time he goes to the clinic?
The man is so incapacitated that he cannot travel by public transport.
He can travel by ambulance.
Order.
I have been told by the CEO of the Eastern Health Board, and I quote from his message——
The Minister is not allowed to quote at Question Time.
In his report to the board the CEO said that transport would be provided for all persons genuinely in need of it, that he was of the opinion that there was a great deal of abuse in the use of this facility and he expressed the belief that savings in transport costs could be achieved without hardship to patients. From the way the Deputies opposite are talking, one would get the impression that transport facilities are to be eliminated whereas all that is involved is the cutting out of abuse.
Is the Minister not aware that once a directive of this sort is given there will be genuine cases of hardship because some people may either have to deny themselves visits to hospitals or health centres or pay for transport which they can ill afford?
The Deputy is being very dramatic. As Minister for Finance, he did not provide a great deal of money for the health services.
I was the one who introduced free travel on a national scale and one thing I will not do when I get back to office is to abolish meals-on-wheels.
I have no intention of doing that, either.
(Interruptions.)
The remaining questions will appear on the Order Paper for the next sitting day.