Vol. 399 No. 7
7 Mr. Byrne asked the Minister for Health if his attention has been drawn to the recent call made by the Catholic Bishops Council for Social Welfare for the Government to publish a White Paper setting out their proposals for the future of the health service; and if he will make a statement on the matter
129 Mr. B. Allen asked the Minister for Health, in view of the report of the Commission on Health Funding which was published some time ago, if he will draw up a White Paper on the health services which will include his plans for the health services for the future.
I propose to take Questions Nos. 7 and 129 together.
The Council for Social Welfare's call for a White Paper on the Health Services is contained in its response to the Report of the Commission on Health Funding. I have already announced a wide series of measures to develop and improve the efficiency of the health services as the first phase of the Government's response to the commission's report.
I have also indicated that the Government will announce their proposals on the future administrative arrangements for the health services in the near future. Further decisions on funding and eligibility issues covered in the commission's report will be announced when the Government have had an opportunity to consider the forthcoming report on the conditions of employment of consultants.
The Government's plans on the future direction of the health services are, therefore, proceeding. The question of the format in which Government policy will be announced will be considered at the appropriate time.
I should not perhaps refer to the discussion that took place on the previous question but it is a fairly good indication of what is happening in the health services and the urgent need for a white paper. All we have experienced over the last four or five years are health services on an ad hoc basis as has been stated time and time again. In view of the Minister saying earlier this year that he had to provide an extra £3 million for one section or another, it is being done on an ad hoc basis whether it is in the acute hospital services system, dental, ophthalmic, community care or psychiatric services, and consequently there is an urgent need for a white paper on the health services. The question of administration is not the major issue but the delivery of services. Would the Minister agree that that is urgent and that he should bring in a white paper?
I have an open mind on whether there should be a white paper. I would remind the House that in February I announced a number of initiatives, many of which are already in place. These include an efficiency review of the health agencies beginning with acute hospitals conducted by Mr. Noel Fox, an initiative on hospital services and the delivery of services, hospital services and procedures in the Dublin area, including an examination of admissions policies and patient arrangements and discharge arrangements for patients who require community support or long stay care after hospitalisation that is the David Kennedy co-ordinating group. Also included are initiatives to improve patient care and the introduction of an effective appointments system, a hospital code of conduct and a patient feedback mechanism in each hospital, the establishment of a formal appeals procedure on eligibility for medical cards, the introduction of measures to develop and improve health services management including the development of better information systems and the strengthening of the management role of consultants through a pilot exercise on departmental budgeting. These are some of the initiatives that are in place.
I would like to ask the Minister if he would explain to the House what he meant when he said that in a couple of weeks he would make major announcements on the future reorganisation of the health services of the country? Will he confirm that on the same occasion he stated that there will be no change in the structures of the health boards? Has he any proposals other than commissioning more reports and making further announcements? Has he any proposals to make in this session of the Dáil regarding reorganising the health services?
I take it from those remarks that Deputy Yates is not in favour of a white paper which he would probably see as another report. What I said at the association of health boards meeting was exactly what I said in the Dáil in February, that I would be making a statement before the end of the session about our view on the structures by which the service should be administered.
In view of the fact that the Minister is now over three years in office, that he has established the best part of 30 committees of investigation in those three years and that the only action he has taken has been to reduce the quality of service significantly, I would suggest that what is required is a white paper outlining a set of proposals and legislative measures on the funding and structures of health authorities that the Government will now implement. When can we expect to hear from the Minister on that? The Minister indicated what he has done in relation to the commission on health funding so far. He has established two more committees and an appeals mechanism which has yet to see the light of day.
The Deputy is wrong on all counts. I did not establish 30 committees.
I did not say that. I said almost 30—25 or 26.
Let us hear the Minister's reply. Questions have been asked, let us hear the reply.
This is typical of this Minister.
Most of the committees to which Deputy Howlin refers were in place when I came into office. Most are ongoing committees.
How many did the Minister establish?
I make absolutely no apology for any committee which I established. Most of them have already reported to me.
When is the Minister going to act on them?
I have already acted on them.
What has the Minister done?
This cannot continue.
I am the first to admit that I do not have the wisdom of Deputy Howlin who has an answer to every question off the top of his head irrespective of whether he has any expertise in the field.
That is scurrilous.
Is the Deputy saying that there should be no committees?
I said no such thing. I said it is time the Minister implemented the recommendations.
We have had a very orderly Question Time up to now. Let us keep it so. There is no need for disorder.
I established a small working group to look at the system of computerisation in the health service which was in a mess in the four years when the Deputy's colleague was Minister for Health and not a thing was done about it I suppose, again, because the wisdom was there but there was no expert to look at it. I had the computerisation of the health service looked at by an expert group. Within six weeks they reported to me and I adopted their recommendations immediately. I am glad to say this year, for the first time, we have a special subhead for computers and also we have a policy on computers which is acceptable to all the agencies and keeps us in line with the most modern thinking on the subject.
In regard to the other two groups the Deputy mentions, the David Kennedy co-ordinating group and the Noel Fox group who are looking at the efficiency measures in hospitals, these are not committees making their report. I have explained this in the House time and time again. If the Deputy would take the time to inquire what they are doing he would realise that they are action groups. Mr. Noel Fox is a professional management consultant who is being paid to do a job. Mr. David Kennedy will see that action is taken in the Dublin hospitals and I am sure all Members will agree that action is needed in regard to them. They are five major and totally independent agencies providing services but there was no co-ordination and his group are there to see that there is co-ordination and not just preparing reports as the Deputy alleges.
