Dáil Éireann díospóireacht -
Wednesday, 9 May 1990

Vol. 398 No. 5

Private Members' Business. - Cork Regional Hospital Funding.

Mr. Creed

I am sorry the Minister has not seen fit to remain in the Chamber to listen to the points I want to make in regard to Cork Regional Hospital. I am very pleased to have been given the opportunity to highlight the very serious problems which confront the Southern Health Board in the provision of an effective medical service at the Cork Regional Hospital.

It must be said that it is only because of the persistent failure of the Minister to listen to the problems which have been related to him on numerous occasions by the Southern Health Board and by the staff of the hospital by way of an emergency press conference which was held on Thursday, 22 February, that I feel obliged to remind him once again of the very serious problems in that hospital.

In a nutshell, the Southern Health Board need money for equipment and consultant staff and teams in the Cork Regional Hospital. The Fox Report will not relieve the Minister of his obligation to deal with what is now nothing short of an emergency in the Cork Regional Hospital. Indeed, such is the crisis in the hospital that in The Cork Examiner today it was reported that conditions in the hospital have deterioriated to such an extent that the health of the staff is being affected resulting in increased sick leave while morale is at an all time low.

The Cork Regional Hospital should be the flagship of medical care in the south. It can offer not only regional but many national medical specialities to the public. However, because of under-funding by the Department of Health over the past three years, the ability of the hospital to carry out these duties has been eroded and the public are suffering as a result.

As I have said, the kernel of the problem is under-funding. In their letter of allocation to the Southern Health Board the Department of Health requested the board to maintain the service at the Cork Regional Hospital at 1989 levels. However, the Southern Health Board have been under-funded by £3 million which meant that the allocation to the Cork Regional Hospital has been reduced by £1.166 million.

Public representatives from all parties, medical opinion both on and outside the board, management from CEO level down, and the suffering public, know only too well that the level of services in the Cork Regional Hospital cannot be maintained at 1989 levels given the level of funding which the Southern Health Board have received. The Minister has met the chairman and chief executive officer of the board who have put their case to him on more than one occasion but he failed to respond to them. I can only hope that the Department of Health have not closed their minds to these matters and that a favourable decision will be forthcoming immediately.

A comprehensive response is needed to restore the Cork Regional Hospital to its former position. Over 50 beds have been closed in the hospital and there is a two year waiting list for some orthopaedic operations. The hospital has not received a specific capital allocation for equipment replacement since 1983. Because of the Minister's failure to provide a capital allocation, the board now propose to divert scarce resouces from their revenue account to purchase new equipment. If equipment is not operable, the closure of further beds will be inevitable. No sanction was given by the Department for the purchase of equipment in 1990. The following are essential to the continued operation of the hospital — telementry, which will cost £120,000; anaesthetic equipment, £120,000; a Gamma camera, £180,000; laboratory equipment, £110,000 and an electrical stand-by system, £80,000, giving a total of £610,000. This money is urgently required by the Cork Regional Hospital. In addition, the x-ray equipment is near the end of its normal working life and a capital allocation of £400,000 is needed to replace it. Staff and patients are frustrated at equipment breaking down and if this life saving equipment is not replaced, it will lead to unnecessary suffering and even death.

Key staff shortages are also a major problem. In October 1989 the board submitted a number of priority developments for 1990 to the Minister. This included six consultant posts — a cardio-thoracic surgeon, a cardiologist, an anaesthetist, an orthopaedic surgeon, an urologist and a consultant in accident and emergency. The filling of these posts would open up 35 additional beds and would reduce many of the long and unacceptable waiting lists.

I have no doubt that Mr. Fox will not find fault with Cork Regional Hospital or its management team. If anything, they have been penalised to date for their efficiency and ingenuity by an annual reduction in their allocation. I appeal to the Minister to lift the siege at the Cork Regional Hospital, to fill the key consultant posts and to give them a capital allocation for equipment.

I have spent some time contemplating the Minister's reply. I expect that he will refer to the Fox report, which I believe is a smokescreen the Minister can hide behind for not giving a reasonable allocation for the replacement of equipment and the filling of consultant posts at Cork Regional Hospital. I also expect the Minister to tell me that there has been an 8 per cent gross increase in the allocation to the Cork Regional Hospital. In effect, there will be only a 1 per cent net increase available to the board, unless the Minister has it in mind that we should renege on our responsibilities to pay and not to take account of the annual rate of inflation.

The number of in-patients in the hospital in 1989 increased by 10 per cent while the accident and emergency numbers increased by 48 per cent. I have figures which suggest that in comparison to hospitals of a similar size Cork Regional Hospital is not getting its fair share from the Department of Health. Three hospitals in the Dublin area, the same size as Cork General Hospital and offering similar services, received gross increases in their 1990 allocations from 16 to 19 per cent. In his letter of allocation to the Southern Health Board for 1990 the Minister requested them to maintain services at the Cork Regional Hospital at their 1989 level. To public representatives, medical opinion, the management of the Southern Health Board, their chief executive officer to the programme manager for the general hospitals section, to every member of the general public in the Southern Health Board area who has dealings with Cork Regional Hospital it is obvious that it is not possible — given the current level of allocation — to maintain that level of services. It is likely that the level of activity in the Cork Regional Hospital will be significantly reduced because of the Minister's failure to sanction a number of consultancy posts, for which application has been with the Minister's Department a considerable time or to sanction the capital allocation necessary for replacement of essential medical equipment at Cork Regional Hospital.

There is also a necessity for a capital allocation for the replacement of equipment at Mallow General Hospital. In the interests of the health and welfare of the public who have dealings with Cork Regional Hospital I appeal to the Minister to respond favourably to this appeal, to effect an urgent capital allocation to the Southern Health Board in order to alleviate the position obtaining there.

Mr. Sherlock

If I may, a Leas-Cheann Comhairle, I have two important matters to raise.

An Leas-Cheann Comhairle

If the Minister of State is agreeable.

Mr. N. Treacy

I am.

Mr. Sherlock

I want to highlight two issues in relation to the present finances of the Southern Health Board. According to reports issued as recently as Monday last the revenue position vis-à-vis the level of service being provided is inadequate but would about break even if the Minister would make available the £340,000 approximately which he promised the board in respect of the influenza epidemic which occurred earlier in the year. It is unfair of the Minister not to make that finance available immediately to the Southern Health Board.

The second point I want to raise is that there has been no agreement reached with the banks with regard to the colossal interest paid to them, which is on the revenue side. On the capital side, as was pointed out by the previous speaker, there is need for a further investment in order to maintain an efficient level of service. It must be remembered that the hospital will only be as good as the staff running it and as good as the equipment with which they are provided to treat their patients. That service cannot be maintained if such equipment is outdated and in need of replacement. In such circumstances the Minister is obliged to make the necessary capital funding available. That capital funding is not being made available. We are told that it is being allocated to the larger hospitals such as those in Cavan and Waterford, and in all the major hospitals that have been built.

I want to stress the absolute urgency of providing equipment in Mallow General Hospital, requests for which have been with the Department since 1980, the main one being the provision of a generator and screening unit for barium meal x-rays for elderly people who have not been provided with this service because that unit has been out of commission since December last. Those people will not go to Cork city and are, therefore, being denied that service. I appeal to the Minister to give the House an assurance that that service will be provided. There are also two posts remaining to be filled at Mallow General Hospital.

Mr. N. Treacy

First, let me say we are aware of the difficulties facing the Southern Health Board charged with primary responsibility for services at Cork Regional Hospital.

Current personnel policy in the health services is that health agencies have autonomy to make necessary appointments within approved employment ceilings and financial allocations and, in the case of consultant posts, following approval by Comhairle na nOspidéal.

The organisation and provision of services in a large flagship hospital is not an easy task. As Deputies will know, however, it is a matter for the Southern Health Board, in the first instance, to determine the level of funds made available to the Cork Regional Hospital from within their allocation. The allocation notified to the Southern Health Board for 1990 is £143 million, a very substantial sum. Having received their allocation it is then a matter for the Southern Health Board to distribute resources in accordance with the board's priority. The budget allocated to Cork Regional Hospital by the Southern Health Board for 1990 is at present £31.608 million——

Mr. Creed

Where is the autonomy in that?

Mr. N. Treacy

That is autonomy to the Southern Health Board to decide their priority. I should say I did not interrupt Deputy Creed. I reiterate that that is autonomy devolved to the Southern Health Board to distribute the funds according to their priorities within their area of jurisdiction. I might add that is the third highest allocation to any hospital in the country, that an extra £130 million was allocated to the health services in 1990 and that the Southern Health Board got their rightful, equitable and fair share of that huge increase. In the past the impression has been given that Cork Regional Hospital received little or no capital funds from my Department in recent years. I should like to outline briefly the extent of the capital funds which have been made available to the Southern Health Board for requirements at that hospital within the past two years, more particularly since the appointment of Dr. O'Hanlon as Minister for Health.

There was a new regional ophthalmic unit opened at the Cork Regional Hospital late in 1988. The unit building costs alone amounted to £1 million with an additional £250,000 being provided for equipment. I stress, a total of £1.25 million——

Mr. Creed

Much of that was provided by way of voluntary subscription.

Mr. N. Treacy

That is additionality. I am talking about Exchequer investment. A total of £800,000 was provided for a new C.T. Scanner and ultrasound equipment. Also a capital grant of £200,000 was made available for neurosurgical equipment. The purchase of other items of equipment at a cost of £144,500 was also approved. In addition, in the last few weeks the Minister sanctioned capital funds of almost £185,000 for the purchase of a Gamma camera. All of that amounts to over £2.5 million. Therefore, the House will agree that that constitutes a significant investment by the Department of Health in the Cork Regional Hospital, that in very difficult financial circumstances.

However, we acknowledge there are still some equipment requirements at Cork Regional Hospital. I might point out that the Government are preparing a five-year capital programme, the main objectives of which will be to ensure that the physical infrastructure is in place to meet the service goals we have set ourselves while ensuring that the fabric of existing services is maintained. The position with regard to Cork Regional Hospital will be considered in that context, within the totality of similar demands from other hospitals and health care institutions throughout the country.

I want to assure the Deputy and the House that neither the Minister nor myself or indeed the Department will hide behind any smoke screen, will not produce any manipulative statistics to sustain the standard facts that are there — showing that we have made a large investment in our health services and demonstrating that the Southern Health Board, and the Cork Regional Hospital, in particular, has got its fair share.

In response to Deputy Sherlock I should say that we are aware of the position obtaining in Mallow General Hospital. We appreciate the positive attitude adopted by the staff, consultants, medical and paramedical staff of the hospital and of the local people of Mallow. We are examining that position and will ascertain what we can do about it.

I might add that this year this Government will invest £1.4 billion, or 21 per cent of our Exchequer budget, in the health services. That is positive proof of our commitment to ensuring that we will have a constant, modern health care service for all our people.