I move:
That Dáil Éireann condemns (a) the failure of the Government in many instances to meet their statutory obligation to provide medical attention for persons in need of it; (b) the withdrawal of medical cards from persons who should be entitled to them; (c) the closing down of hospital wards; (d) the wasteful delay in opening Beaumont hospital; and (e) the general rundown of vital health and welfare services in every area.
Since this Government came to power we have alerted the House on numerous occasions to the serious consequences that would arise from the policies they were pursuing in administering the health services. The Government chose to ignore the warning and now every health board is in crisis and people, particularly the less well off, are suffering a degree of hardship unknown in the country for the past 30 years.
Not one health board was able to meet their financial commitments in 1984 and the situation has deteriorated seriously during the current year, the direct result of the Minister's actions. Every Member of this House, and particularly those who are members of health boards, are aware of the serious situation. They know that it is the less well off, the elderly, the unemployed and the handicapped who are suffering most. This is the result of actions of the Government who promised on coming into office — I will quote from their document, the Joint Programme for Government:
In carrying through this programme of reform we shall ensure that the existing level and quality of health care will be maintained. In particular, care must be taken to ensure that any adjustments do not militate against the less well off.
Certainly the reverse has been the case because it is the less well off who have suffered. There has been an unprecedented reduction in the level of services in acute hospitals, in long stay hospitals and particularly in community care services. The health boards are in a state of crisis. They have done their best to provide health services within their reduced allocations.
In his amendment the Minister says the Government have provided £1,071 million in the current year for health services but if inflation is taken into account the figure should have been £1,132 million. In other words, there has been a cutback of 5 ½ per cent in the allocation for health services since this Government came to office. This is the cause of the problems. It is the reason the health boards and the voluntary hospitals are in a state of crisis. The Government have not given sufficient funding to ensure that these institutions can administer the health services as they should be administered.
From reading an answer to a question I put to the Minister on 19 February 1985 it can be deduced that there has been a considerable reduction in the allocation to each health board. The North Western Health Board have had a reduction in real terms of 6.7 per cent in the past three years. The Western Health Board suffered a reduction of 6.6 per cent, the Mid-Western Health Board a reduction of 5.9 per cent, the Midland Health Board a reduction of 5.6 per cent, the North Eastern Health Board a reduction of 5.1 per cent, the South Eastern Health Board a reduction of 4.7 per cent, the Southern Health Board a reduction of 1.6 per cent, and the Eastern Health Board a reduction in real terms of 1.2 per cent. When one takes into account the rapidly expanding population in the Eastern and the Southern Health Board areas, it is obvious that the reductions of 1.6 per cent and 1.2 per cent are not a true reflection of the real situation in those two health board areas.
For the first time, the health boards this year were given an allocation to provide payment for the general medical services. They were informed that any excess in expenditure on the GMS would have to be met from their overall allocation. They were also told that if they saved anything they could use the savings elsewhere in administering the health services. However, there will not be a saving in the allocation for the GMS this year. In fact, each health board is in a serious situation as a result of having to fund the GMS. Previously it was funded from central funds through the general payments board but this year the health boards are obliged to fund the service from the extra allocation given to them by the Minister.
A week ago I submitted a question and today I received an answer. Question No. 591 on today's Order Paper asked the Minister for Health "the estimated overexpenditure on the GMS in each health board area in the current year; if it is intended to correct the deficit, and if he will make a statement on the matter". I received the following answer:
The provision in Subhead G3 of the Health Estimate in respect of the expenses of the General Medical Services (Payments) Board is £93 million in the current year. This represents a 7 per cent increase on the provision for 1984, i.e. £86,681 million. The provision was based mainly on an estimate of the numbers eligible for general medical services and on reasonable average levels of visiting and prescribing by general practitioners involved in the services. I am concerned that the visiting and prescribing rates have shown an increase in the early months of this year, and unless the situation is corrected, problems may arise in funding the scheme. The question of the measures which might appropriately be taken is at present under active consideration.
The answer to my question explains many of the problems because I was able to find out that the estimated over-expenditure by the health boards is £8.04 million. In the North Eastern Health Board the projected deficit at this time is £1 million. The fact that it was not possible for the Department to give me that information is an indication that they are unaware of the problems facing the health boards. They do not appear to be in contact with the boards because I am sure they would have been only too willing to give the Department the information in view of the serious situation that exists.
The manner in which the question was answered and the attitude and approach of the Minister to the health boards is probably a contributory factor to the very serious situation of the health boards. The expected deficit in the running of the general medical services will be over £8 million for 1985. That leaves the health boards with three alternatives. The first is to save money from other services, which is impossible in view of cutbacks, because all the other services in the health board areas are suffering as well. The second alternative is to allow the general medical services to collapse when the allocation for the current year has been spent. It has been suggested to me that in certain health boards areas that could happen in the middle of November, that the health boards would not be in a position to pay either doctors or pharmacists for their services from the middle of November to the end of the year. Their third option is to curtail the level of service. This appears to be the only practical option as a result of the new system of payments. It would appear that this is what is happening in all the health board areas from the information I am receiving from my colleagues in this House and those on health boards.
In a letter to the chief executive officers of the health boards of 30 April 1985 it was pointed out that there would be no increase in the allocation for general medical services in the current year irrespective of whether or not there was a deficit. The letter detailed negotiations at present in progress with the medical practitioners and with the pharmaceutical industry. The letter continues to say:
In the short term, however, pending the outcome of these various negotiations, a significant contribution to cost containment can be made by health boards themselves through their control of the numbers covered by medical cards.
That is telling the health boards to have a stricter interpretation, in other words, that people who would normally receive medical cards from the health boards will not now receive them.
I might continue to quote the letter:
Each additional person covered by a medical card will cost a health board nearly £80 a year on average. The vigorous application of the guidelines for medical cards in accordance with the standardised procedures agreed in 1983, following the report of a working group established by the Department, would help to secure control of numbers. Applicants whose incomes exceed the guidelines should be issued with cards only where it is clear that hardship would otherwise arise. Equally, control of numbers rests upon effective review procedures to ensure that cards do not continue to be held by those no longer eligible. The issue of cards for the shortest realistic period and their review by the due date should ensure a continuing turnover of partients within the medical card population. It may well be that this would produce a further significant reduction in the number of eligible patients and thus ease the problem of funding.
We would all agree that medical cards should not be issued to persons who are not entitled to them for one reason or another. Equally we would all agree that the CEO's throughout the health boards should decide on the guidelines from year to year. I believe that the guidelines are too low and that they should take account of statutory deductions. I gave an example in this House before of a man with four or five children who had a gross income of £145 and whose net pay after PRSI and tax were deducted amounted to £112 which left him ineligible for a medical card even though the £112 was well inside the guidelines for a married man with three or four children. While we all accept that there has to be guidelines, what we are now saying is that the rigorous investigation, the manner in which this letter from the Minister's Department is being dealt with by the boards means that people who would normally receive a medical card will not now receive one. We are concerned that there are many people, particularly those in greatest need—not necessarily those with the lowest income but those who are just outside the limit of the guidelines — who are not receiving medical cards because of the method of investigation, and who are not in a position to provide medical care for themselves.
It is significant that in four of the eight health boards the number of medical cards has dropped considerably since the Minister came into office—the Midland, the Mid-Western, the North Western and the Western. When one considers that we are in recessionary times, with massive unemployment and increasing redundancy, it is extraordinary that the number of people covered by medical cards has been reduced in any health board area.
A rigorous investigation has been carried out. Persons who are unemployed have their income taken into account on the basis of their P60 for the previous year which does not always take account of their present income. Redundancy money is taken into account in assessing eligibility — the small amount of redundancy money that a person would receive was not always taken into account, so that is something new. Many people find themselves denied a service which they cannot reasonably be expected to afford because of insufficient funding by the present Government. It is not the fault of the health boards because they were confronted with this situation. They were told that in 1985 they would be responsible for financing the general medical services. They were given an allocation and told they would have to finance the services from other sources if they had not sufficient funds in their allocation. As everybody knows, with the cutbacks, there is no other source within the health boards from which to find funding.
There are over 80,000 persons on the waiting list for a dental service, over 40,000 of whom are children. For example, there are 10,000 children on the waiting list in Kerry and 9,000 children on the waiting list in the Carlow-Kilkenny community care area. This is an intolerable situation, to have young children needing fillings on a waiting list who, by the time they are seen by a dentist, will have to have teeth extracted. How any Minister or indeed any Member on the Government side of the House could be satisfied with that level of service and could support the amendment submitted by the Minister is a mystery to me. It is easy to quantify the dental service because the figures are there in terms of the waiting lists. There is also the fact that the ad hoc dental scheme has been abolished in practically every community care area, which is an indication of the serious situation obtaining. There are community care areas where children only will receive treatment: adults will not receive treatment, except expectant mothers and handicapped persons. The reality is that those only — irrespective of their income, whether they have a medical card, a pension, a supplementary allowance or anything else — who can afford to pay for a service will receive it. There has been no public service available to many people since this Government came into office.
The sight testing scheme has been abolished in many community care areas, which means there are now many persons in the community who are unable to make provision for dental service or sight testing. These people have no access to such services at present. For example, a widow with two children with a medical card receiving £67 a week made representations to me about her 15 years old daughter who had a number of precarious top teeth in the front. No service was available to those people because the relevant health board did not have the funding to provide the necessary dental service.
It is estimated that there are approximately 500 beds due to be closed in coming months as a result of the cutbacks. This is as a result of the directive from the Minister to the health boards requesting a reduction in the number of staff employed, overtime and locum cover. For example, in the kidney unit attached to the Meath and St. James's Hospitals all the beds for those services have been closed in St. James's Hospitals and 15 have been closed in the Meath. The waiting list has gone from 148 in May 1984 to 275 in May 1985. The waiting list has doubled in one year. This has put tremendous pressure on the staff of the hospital and must create a risk for patients. I quoted in this House a letter from a consultant in a kidney unit in this city in which he outlined the case of a young man bleeding from his kidney who could not be accommodated immediately because 40 beds were closed at that time and in which he stated that he hoped to get the man in as soon as possible. That was a potentially very serious condition and because 40 beds were closed the surgeon could not accommodate him.
At a meeting of the Southern Health Board in Cork yesterday when an allegation was made that patients prematurely discharged from the hospital had died as a result of being discharged too soon, the chief executive officer pointed out that the board were being forced by the Department to leave unfilled two out of every three vacancies.
