Vol. 376 No. 1
asked the Minister for Health regarding the letter of allocation for non-capital health expenditure sent to each health board, the type of charge he proposes to introduce for the unwarranted use of tertiary services in the hospital services; and if he will give specific details in this regard.
178.
asked the Minister for Health the changes which he has stated will be introduced before 1 January 1988 for the use of tertiary referral services in certain circumstances; and the yield in a full year from such changes.
I propose to take Questions Nos. 3 and 178 together. It is the intention that a charge will be introduced in certain circumstances for persons who avail of in-patient services in hospitals outside their board's functional area without the approval of their board or in the absence of an agreement between the board and the relevant external hospital for the provision of specified services.
These measures are necessary to ensure that, where services of appropriate quality are available locally, a person will not have unrestricted access to similar external services. The necessary legislation to give effect to these measures will be introduced in the Oireachtas shortly.
At this point in time it is not possible to indicate the yield in a full year from such charges.
Could the Minister inform the House when the health boards will be told how to operate these charges and who will decide when services are used in an unwarranted manner? Who will take that decision?
Probably the Attorney General.
Would the Minister agree that very ill patients will be those who will suffer, patients coming from smaller hospitals on the recommendations of a consultant for high technological treatment?
Arrangements will be discussed with the appropriate officers of the health boards. The health boards will be informed as to how the system will work. Obviously the decision will be a clinical one based on the doctor's view as to whether such treatment can be provided in a patients's own health board area. Certainly I see no reason why a very ill patient should suffer because such a patient can be treated either in his or her own health board area and if appropriate that is where such a patient should be treated but the area may not have the high-tech facilities in which case the patient will be transferred to an appropriate hospital outside that health board area.
Will the Minister indicate the current extent of the practice which has led to his proposing legislation to deal with this matter?
I do not have the figures for the cost to each health board but shall forward the cost to each health board for services outside their area. I accept that all the services provided outside the health board area could not necessarily be provided within that area. Two health boards in particular have raised this issue and are concerned about the amount of funding spent on hospital services outside their area. We want to try to ensure that, for example, a patient suffering from appendicitis would not leave a health board area in the country and come, say to a Dublin hospital where the charges are very high in the high-tech hospitals.
Can the Minister give an assurance to the House that it is only when patients leave their own health board areas that these charges will be implemented? Can these charges be implemented if a patient leaves one hospital within the health board area to go to a hospital which can carry out more sophisticated treatment?
It is only when patients leave their own health board areas and for a service that can be provided in their own health board areas. Obviously, if a patient leaves it for a service which is not available in his or her own health board area there will be no such charge.
How is he going to define a service which is provided in a health board area? For example, in certain health board areas one could have a waiting list of three years for certain operations. Are patients from that health board going to be deprived of their right to seek medical treatment outside that health board area? Will he not accept that the introduction of this charge will interfere with the patient's right of choice of hospital and the same right on the part of the GP involved? What type of charges are we talking about for patients who seek services outside their own health board areas?
I do not accept there is a three year waiting list for any service.
For orthopaedic operations, there is in the north-western region.
And for heart operations in Dublin.
There are priority lists for public patients and public patients will receive the necessary service when they need it. With regard to the decision as to what services are available in the health board area, the services which are available to everybody would be obvious. It will be a clinical decision based on the doctor's opinion. If the doctor believes the patient should be sent out for a service, it would be his opinion that would count. As regards the rate of charge, that has not yet been decided. There will be legislation before this House in the near future, when we can debate the matter.
I want to make some progress on other questions. Deputy Flaherty is also offering. I call Deputy Naughten.
May I take it that it is going to be a decision of the GP as to where he sends that patient?
It will be a matter for the general practitioner and the consultant to decide on whether such service is or is not available. Obviously, the consultant and the doctor would have to have regard to services such as the facility for the removal of an appendix when they are making the decision.
A final supplementary, Deputy Flaherty, please.
Can the Minister tell the House which health boards are complaining of this difficulty? If he cannot give us specific figures, can he indicate the extent of the problem these health boards believe they have which has led to the Minister indicating he is going to take a legislative initiative? Is he not aware that waiting lists for many operations are at the two year level and that the situation for coronary by-pass operations in Dublin's Mater Hospital is extremely serious, with people waiting close on two years for, questionably, nonemergency operations?
I do not accept the length of waiting lists as outlined by Deputy Flaherty. The waiting list for coronary by-pass operations is not over two years. Indeed, we carry out more coronary by-pass procedures per thousand of the population that is the case in the United Kingdom. The two health boards that raised this issue are the Western and the North-Western Health Boards.
