asked the Minister for Health if in future it will be necessary for health boards to have sanction from his Department to create new posts before they apply to Comhairle na nOspidéal.
14.
Ceisteanna — Questions. Oral Answers. - Comhairle na nOspidéal.
13.
asked the Minister for Health if he proposes to change the role of Comhairle na nOspidéal; and, if so, if he will make a statement on the matter.
I propose to take Questions Nos. 13 and 14 together. I presume that the Deputy's question has been prompted by my recent address to Comhairle na nOspidéal. In the course of that address I referred to the very serious financial circumstances of the country, the need to reassess our priorities, and to redeploy our resources in the most effective manner possible.
I stated that in the current situation Comhairle na nOspidéal would be obliged to assess the manner in which they carry out their functions. I questioned the realism of the comhairle continuing to consider and approve appointments which cannot be funded in the foreseeable future and suggested that the comhairle, working with my Department, must adopt a revised approach to the processing of applications, both for new and replacement posts.
I indicated to the comhairle that I would be instructing the health agencies that, prior to the making of applications to the comhairle, my Department must be consulted as to the financial implications. This will involve an assessment of the full costs of the application — not just the costs of the appointment itself but also the costs which could possibly arise from resultant requirements in other categories of staff, and in accommodation and facilities. Agencies will be required to indicate if the additional costs involved can be borne by the agencies themselves from within their agreed budgets. If the agencies cannot carry the additional costs, my Department will discuss with them the possibility of making funds available on the basis of the absolute requirements of the particular service involved and the options and alternatives that might be available.
I also told the comhairle that I would expect them to require agencies making application for posts to include in their submission an account of the outcome of their consultations with my Department. This arrangement does not hinder agencies in making applications to comhairle, nor does it represent any change in the essential role of the comhairle. I have now formally instructed the health agencies to proceed in future along the lines I have indicated.
Surely this represents a major change in the role of the comhairle? The comhairle had the statutory responsibility for regulating consultant appointments. From the Minister's reply, am I right in taking it that in future appointments will have to be sanctioned by his Department before they can be made?
In effect it will mean that before the comhairle take the decision in relation to any application all the cost implications will be totally known to the Department, the comhairle and the health agency concerned — for the very simple reason that we have at the moment about 78 such applications and I have no money.
I accept that the Minister has no money, but surely this is interfering with the role of the comhairle and that it is a major change in their role that the Minister should take this attitude. The comhairle were set up and given statutory responsibility to regulate the consultant appointments. Surely it is a major change in that role that the health boards now have first to go to the Department.
There is a serious problem that any such appointment can vary in cost from £30,000 to £40,000 per appointment, up to £½ million.
I have not been able to work out an average because the data has not been kept. But one might be talking of at least £250,000. Frankly, in a situation in which we are spending £1,000 million a year and, for every consultant one appoints, one has to appoint a battery of back-up staff, beds, accommodation and facilities, the implications of every appointment must now be absolutely known to each health board, to each voluntary health hospital, to each agency. Above all we in the Department have to know what we are doing in terms of future revenue implications. It is mainly in that line; it is not to cut across the statutory powers of An Chomhairle. Comhairle na nOspidéal still retain the statutory power of appointment. That is a necessary and eminently reasonable proposal. I do not propose to interfere with that. But, as far as the money is concerned, I have to find the money; they make the appointment.
One must accept that there is a change in their role. In relation to the last part of the Minister's reply, does the Minister accept that there is a change in the role of An Chomhairle and that he himself is justifying it on its financial implications?
There is a change in so far as everybody, from now on, members of An Chomhairle, Departmental staffs and the administrators of the health services, will know the cost to the last penny, as far as I am concerned, of every appointment and the continuing implications of those appointments. I am strongly of the view that, in the past, that discipline did not apply because we have now reached a plateau in many respects in terms of health expenditure. It has been growing at a phenomenal rate and the taxpayer at large is just not prepared to put up any more money.
Does the Minister intend to introduce legislation to give effect to the changed role of Comhairle na nOspidéal?
No, quite definitely. I have remained rigorously within the statutory situation affecting An Chomhairle. I do not propose to interfere with that.