I move:
That a supplementary sum not exceeding £37,550,000 be granted to defray the charge which will come in course of payment during the year ending on the 31st day of December, 1990, for the salaries and expenses of the Office of the Minister for Health (including Oifig an Ard-Chláraitheora), and certain services administered by that Office, including grants to Health Boards, miscellaneous grants, and a grant-in-aid.
Deputies will have available to them details of this Supplementary Estimate and I do not propose to outline the provisions in detail. In the time available to me, I propose to highlight the four main aspects of this additional provision, namely, the additional provision £23.05 million in respect of acute hospital services; the provision of £13.251 million in respect of the general medical services scheme; an extra capital provision of £7 million and an injection of £9.749 million to improve the cash provision of the health agencies in 1990.
Deputies will recall that, in February last, I gave an understanding to meet the additional costs incurred by health boards and hospitals in dealing with the `flu epidemic, which occurred at the end of 1989 and the beginning of this year. I also gave an assurance that acute bed levels would be maintained at around 12,000 as compared to a figure of 11,200 in mid-1989, and that activity levels would be held at those prevailing in the latter half of 1989. I am glad I have been able to honour these commitments in full, and the provision included in this Estimate reflects the costs involved.
During 1988 and early 1989, the Government were severely criticised about waiting lists. Indeed, it became so pervasive that, at times, one would think that the health services had ceased to function. I made a particular point of tackling waiting lists as part of the programme of work undertaken with the additional funds which were made available to acute hospitals in 1989.
Waiting lists are a feature of all health systems throughout the world. Among the factors influencing waiting lists are the increasing demands from an ageing population and the development of new forms of treatment such as hip replacements. To some extent, they are a problem of success. In this country, the waiting lists for most specialities are not excessive but I accept that there are some areas which needed to be addressed, particularly orthopaedic and ENT.
I am satisfied that the additional £15 million which was provided for the health services in 1989 enabled a substantial increase in activity on the previous year's levels and, consequently, a significant reduction in long waiting times.
Steady progress has been made in a number of key areas and I am committed to building on that work. For example, the number of hip replacement operations performed nationally has increased from 1,624 in 1987 to 1,904 in 1989 and I am confident that the figure for 1990 will reflect a continued substantial increase in performance.
In relation to ENT, very satisfactory results are being achieved. The waiting list and waiting time for Temple Street Children's Hospital has shown very dramatic reductions over a short period. On 1 November 1989 the list was 1,228. On 1 November 1990 it was 550 — a reduction of 55 per cent. The throughput for the period 1 January 1990 to 30 September 1990 was 1,310 as against 913 for the same period last year — an increase in activity of 44 per cent.
The waiting time for ear procedures at the hospital at present is a standard four weeks. With the present rate of progress in relation to tonsillectomies, the waiting period will have been reduced to under two months by mid-1991. Another example of where significant improvement has been achieved is in the South Infirmary — Victoria Hospital, Cork. The ENT waitiing list there has been reduced by over 60 per cent in the period October 1989 to May 1990.
I have been particularly concerned by the problems of child deafness and I specifically targeted additional funds to alleviate this problem. I am pleased to report that as a result of these measures children needing grommets are attended to within a period of six months. These are specific tangible results which are being achieved as a result of initiatives taken last year and continued throughout 1990. They are part of an ongoing programme for reducing waiting times and I propose to continue to build on this progress.
There is a particular challenge to those who manage the considerble resources of acute hospitals to strive for efficiency in their use. It is my intention to pursue with all agencies a vigorous value-for-money programme throughout the system to ensure that the maximum benefit is achieved for every pound of public funds invested in the system. The reports furnished to me by Mr. David Kennedy and Mr. Noel Fox will be particularly helpful in achieving the results which are necessary and desirable. I would like to take this opportunity to thank them and their teams for the splendid work they have done during this year.
I look forward to working with health boards and hospitals in 1991 to achieve savings in those areas which have been identified as likely to yield results. I am committed to supporting agencies and their managements in this vital task and I am very pleased that all savings achieved in 1991 will be used in the system for the good of those who rely on it for services.
The additional provision of £13.251 million is required to meet the additional cash requirement of the general medical services (payments) board which will arise in the current year. While the revised remuneration package for participating general practitioners, introduced in 1989, has operated very satisfactorily, I remain concerned at the increasing cost of drugs. The increase in costs in 1990 has arisen not so much from the level of prescriptions written, although this is a contributory factor. Rather the increase is a function of the type of drug prescribed. While I accept that the ever increasing complexity of treatment and the fact that new drugs are available for the management of previously untreatable conditions, I feel that we can still obtain better value in the purchase and usage of drugs.
The new price agreement with the Federation of Irish Chemical Industries is working satisfactorily and a new drugs formulary will be issued shortly. The general practitioner will remain the key determiner in the control of drug costs, and this role will receive prominence in the ongoing review discussions with the doctors. I hope there can be early agreement on an effective arrangement for the containment of expenditure on drugs and medicines, consistent with the overriding need to provide appropriate therapy to each patient.
A total provision of £7 million has been made in this Estimate in respect of capital expenditure — £6.2 million for building and equipping and £0.8 million for the development of information systems. This will enable my Department to meet binding commitments which have arisen during 1990.
While there are many needs for capital to enable the existing service to be maintained and to allow for very desirable developments, it is not possible for the Government in the current financial climate to provide other than for contractual obligations and essential works, such as fire precautions. During 1990, I have conducted a very thorough review of the capital needs of the health services and I remain committed to introducing a five year programme for capital expenditure.
My priority is to ensure that the fabric of the existing service is maintained so that services can continue to be delivered in an effective and efficient manner. We must also ensure that each capital development is planned so that the revenue cost will be tolerable and that we strike a wise balance between what is desirable and what is affordable.
I am very pleased to provide some additional funding for the development of information systems. This investment is essential if we are to improve the management of acute hospitals, which are difficult and complex entities.
The Supplementary Estimate provides for an additional £9.749 million in respect of balances of grants for years prior to 1990. These balances represent a cash injection which have a permanent beneficial effect on the liquidity of health agencies. This injection will allow the agencies to improve their efficiency in the disbursement of cash and will result in more timely payment to creditors. The taking of credit from suppliers is often seen as "free goods", but this is far from the truth. Suppliers who are made to wait for payment inevitably reflect this in their prices.
Continuity and regularity of supplies is also critical in the health services and these can be threatened if suppliers can transfer to customers who can pay more promptly. The provision of an adequate level of cash in health agencies is essential, if progress is to be made in maximising efficiency from purchasing and the management of supplies.
The Supplementary Estimate also provides for a bonus payment of certain health cash allowances this month in line with the long term social welfare allowances. Provision has been made for an additional £1.45 million to be allocated to a range of minor subheads in the Health Vote. The increases are due to a variety of factors such as additional consultancy contracts, changes in exchange rates affecting contributions to international organisations and additional costs associated with the EC Presidency.
The original Estimates for appropriations-in-aid have been exceeded by £18 million and this sum can now be offset against the additional gross provision now sought. An additional £14.5 million is available from health contributions and this is a reflection of the buoyancy in incomes generally.
This country is a net beneficiary under EC regulations applying to migrant workers and additional receipts in this area will be £3.5 million. The buoyancy arises as a result of a number of factors including currency fluctuations.