The gross non-capital provision in the Estimate amounts to £1,713,417 million. Allowing for non-capital appropriations-in-aid of £220.090 million, the net non-capital vote provision is £1,493.327 million, of which £28.806 million is national lottery-funded. The net non-capital provision represents almost 22 per cent of total Government spending on supply services in the current year and shows an increase of £177.014 million of 13.4 per cent over the original 1991 Estimate.
On the basis of the subhead provisions in the Estimate, the level of non-capital expenditure approvable amounts to £1,720 million. When account is taken of the income generated directly by health agencies, the total projected expenditure for 1992 amounts to £1,846.6 million.
Last year £28.135 million national lottery money was spent mainly on services for the elderly, child services and services for the mentally and physically handicapped. The 1992 national lottery allocation is £39.8 million of which £11 million is for the hospitals building programme. A sum of £6 million is for the payment of compensation to haemophiliacs infected with the AIDS virus. Substantial assistance will continue to be provided from the national lottery to services for the elderly, child care and services for the mentally handicapped and the physically disabled. A total of £1.6 million will be allocated to the health boards for distribution by them to local voluntary agencies operating within their areas.
The 1992 capital provision is £43 million. This allocation provides for all contractual obligations and other priority commitments. Provision is being made for the continuation of the major projects at Ardkeen Hospitals, Waterford, Sligo General Hospital and the Rotunda Hospital and for the commencement of construction at St. Luke's Hospital, Kilkenny, the development of the laboratory and psychiatric unit at the Mater Hospital, Dublin and the bone marrow unit at St. James's Hospital, Dublin. Provision will also be made for the purchase of urgent replacement equipment and for a number of fire-precaution and asset renewal schemes.
In line with the recommendations contained in the report on the development of the psychiatric services Planning for the Future, the policy of targeting resources in the area of community psychiatric services will be continued in 1992. Hostels, day hospitals, day-care centres and other community facilities are being planned. A new mental health centre will be built at Longford in 1992. Construction will also commence on a new centre for autistic persons at St. Vincent's Hospital, Fairview.
The 1992 capital provision for physical disability and mental handicap will also be concentrated on the provision of community-based services. A capital contribution is being made towards the cost of the new Cheshire Homes at Monkstown and Sligo. Funding is also being made available for an acute unit and new residential facilities for mentally handicapped persons at St. Vincent's, Navan Road, Dublin. Funding will also be provided for a number of projects in the child care area, including the provision of a group home for children at Shanakiel in Cork.
An Bord Altranais are currently conducting a comprehensive review of the nurse training system. Such a review in respect of the training of any discipline would be significant but it is given added importance by the pivotal role of the nursing profession within the provision of health services. The review process is itself a complex issue and is, I know, being pursued in a thorough and comprehensive manner. I look forward to studying the outcome and I shall sympathetically consider the recommendations that will emerge in the context of available resources.
My Department have commissioned a nursing requirements study which is being undertaken by management consultants. This study will draw together on a scientific basis a detailed picture of projected nursing skill deficits and the measures necessary to deal with these. Taken together with the results of the training review, the resulting data will provide a sound base-line from which to address any existing or potential imbalances in nursing manpower which could otherwise have an adverse effect on services.
The nursing profession is one area of the health services upon which there is a particular impact arising from the harmonisation of training criteria in member countries of the EC. I am pleased to report that we have made good progress in making the necessary arrangements to ensure full compliance with the Directive on general nursing.
A further aspect of current initiatives in regard to nursing which I would like to mention is the 1985 Nurses Act, which is the governing legislation in respect of nurse training and registration. I know that some dissatisfaction has been voiced from within the profession regarding the structures and procedures put in place by the 1985 Act. My own view is that there is considerable merit now in reviewing the operation of the Act given that it has been in place for a number of years. I am now in the process of initiating such a review in consultation with interested parties.
I would like to refer briefly to the issue of pay determination. In line with the provisions of the Programme for Economic and Social Progress my Department, together with health service employer and union representatives, are presently exploring the potential of the local bargaining provision of the programme in the context of various pay claims which have been lodged by the staff side. The debate on this is taking place against a background in which the public service pay bill has increased very significantly in recent years and will again in 1993, taking account of existing commitments.
I would not wish to pre-empt the outcome of these discussions but I would like to stress that the policy the Government must adhere to in the health services, as elsewhere in the public services, is that any future special concessions in relation to pay or other conditions of employment will have to be funded on the basis of tangible productivity measures. The mechanism provided in the programme gives both sides a unique opportunity to look at all aspects of health services employment so as to optimise the output of the health system while providing for staff a secure and rewarding career structure. If approached in a positive frame of mind this process can open the way to a more constructive approach to the whole conduct of industrial relations in the health services. While the debate on this is at an early stage, I have every confidence that with some determination and ingenuity, solutions will emerge which will address the realistic aspirations of staff and give a fair deal to the ultimate paymaster — the taxpayer.
With regard to services for the mentally ill, the Government have decided to publish a Green Paper on mental health, which will consider policy issues and propose new mental treatment legislation. The printing of the Green Paper is under way and it will shortly be published and circulated for consideration. I am conscious of the need to provide those who wish to offer suggestions on improving the delivery of services to the mentally ill an opportunity to put forward their opinions.
The fundamental shift from an institutional to a community-oriented model of care for the mentally ill is now established in each health board area and resources will be allocated to ensure that this direction in the delivery of care will be maintained. More community facilities for the care of the mentally ill, such as hostel accommodation and day care facilities, were provided in 1991 and notable achievements were the opening of new 30 bed psychiatric units attached to Roscommon and Naas general hospitals. Work on the provision of an acute psychiatric unit at the Mater Hosptial, Dublin, has commenced and will be completed by the end of this year. Planning of the psychiatric unit at the Mercy Hospital, Cork, is ongoing.
I am particularly anxious to ensure that the alternative community-based services should be of the highest quality and I am asking the inspector of mental hospitals and his staff to pay particular attention to this aspect of the service at this vital stage of development and allocation of resources.
This year I have been able to continue the considerable developments started in 1990 and 1991 for the elderly in community based and hospital services. The objective of Government health policy, as set out in the report of the working group on services of the elderly, The Years Ahead, is to support the care of dependent elderly people at home for as long as possible and to ensure that, when the elderly can no longer be cared for at home, there are appropriate specialist and extended care facilities to meet their needs.
The priorities of service development at present are to strengthen the capacity of the health services to care for the person at home, to provide more specialist facilities in acute hospitals and to meet the needs of the increasing numbers of elderly mentally infirm. Significant progress has been made towards implementing the recommendations of The Years Ahead. In the past two years £8 million has been made available to the health boards. This funding has enabled the health boards to expand home nursing facilities, to provide day centres and hospitals, to increase the number of physiotherapists and speech therapists in the community and to develop services for the old with dementia.
This year I have provided funding to both the Meath and Mater hospitals to establish special units for the elderly and these units should soon be fully operational with consultant and back-up staff in place. With the additional £1 million made available in this year's budget. I intend to provide more extended care places for the elderly, particularly in the Eastern Health Board area where there is the greatest need for such places.
The drafting of regulations to implement the Health (Nursing Homes) Act, 1990, is at an advanced stage. These regulations will be discussed with interested parties in the nursing home sector in the near future with a view to their implementation as soon as possible.
One of my priorities in the current year is to expand facilities and services for people with mental handicap and their families to keep abreast of the needs of the growing and ageing population. This said, however, direct funding to agencies for the mentally handicapped is now 56 per cent higher than it was in 1986, and expenditure by the health boards has also increased significantly. A total of about £170 million was spent on services for people with mental handicap in 1991. The additional funds allocated in 1992 represent the single largest annual investment ever in these services and I am very pleased to have been able to achieve this.
The past three years have seen a consistent effort by the Government to expand and improve services for people with mental handicap. All Deputies agree this should be done. In 1990 the Government made a special allocation of £2 million available for the development of mental handicap services. In 1991 the Government provided a further £1 million to continue the expansion of services. Funding was provided to open 20 places in Cheeverstown House and 27 places in Aras Attracta, Swinford, County Mayo, as well as additional respite services in each health board area. This year an additional £5 million of revenue funding and a further £1 million capital has been made available to develop a range of new services, which will include additional residential places, day places and increased respite care facilities. Provision has also been made for the establishment of a genetic counselling service at Our Lady's Hospital, Crumlin.
I have referred to the provision of the commissioning of additional places at Cheeverstown House. The impasse which prevented the opening of these additional places has been a matter of some concern on all sides of the House and I would like to avail of this opportunity to pay tribute to those who contributed to the resolution of that dispute. I am happy to report that both the Eastern Health Board and the board of Cheeverstown House are now working to the agreement negotiated by the federation of bodies providing services for people with mental handicap.
I would like to refer here to the report of the review group on mental handicap services Needs and Abilities, which confirms the correctness of many of the principles which underlie the present provision of services for people with a mental handicap. It indicates that with adequate support services, the overwhelming majority of people with a mental handicap can live in the community. It attaches great importance to the early identification of children with delayed intellectual development. If the abilities of these children are to be developed, their needs must be identified as soon as possible. I am glad to say that the Government have accepted in principle the recommendations of the report and are committed to their implementation under the Programme for Economic and Social Progress.
A special allocation of £3 million was made available in the 1991 budget specifically for the development of dental and orthodontic services and the 1992 allocations to health boards retains the special provision enabling the boards to provide for the continuing development of these services.
As Deputies will be aware, there is a continuing high level of demand for orthodontic treatment. Cases requiring treatment have been categorised depending on the severity of their condition in accordance with guidelines issued by my Department. I can make copies of these guidelines available to Deputies who wish to see them. Approximately 12,000 children are currently receiving specialist orthodontic treatment and it is estimated that a further 4,000 children are receiving treatment at primary care level. Following a review of the salary and conditions of the post, a number of health boards have been successful in recruiting consultant orthodontists. This will allow for further improvements in service levels. I am urgently looking at ways in which the services can be further developed in a manner consistent with the cost-effective use of resources.
Policy reviews have been carried out in recent years on the services for people with a mental handicap and for those with a mental illness. The development of these services has benefited considerably from the debate generated by these reports. There has been no similar initiative in relation to services for persons with physical disabilities. Since taking office I have been concerned that services for people with physical disabilities have not been receiving the attention they deserve. There is a need for an in-depth examination of this area. Accordingly, I am at present finalising the establishment of a review group to make recommendations for the expansion and improvement of services for people with a physical disability within the framework of the commitments in relation to the physically disabled contained in the Programme for Economic and Social Progress.
As a result of discussions with the Irish Medical Organisation on the recently submitted report, Community Medicine and Public Health — The Future, the Hickey report, I have agreed in principle to the establishment of a regional public health function in all health boards to be headed by a director of public health who will be a member of the health board management team. It is intended to open discussions with the relevant staff organisations in relation to this matter in the near future.
A committee on cervical screening were established in 1988 to review the cervical screening service. This committee have produced a very constructive interim report which was circulated to all the relevant hospitals, organisations and individuals. I will gladly make a copy of the report available to Deputies. I reconvened the committee in accordance with the undertaking given in the Programme for Economic and Social Progress and they will be meeting shortly. One of the major items to be included in their terms of reference will be a review of the operational efficiency of the test notification procedures. I can assure the House that I am fully committed to ensuring that the service available is both comprehensive and effective.
The Estimate provides for a wide range of important service improvements in acute hospital services, throughout the country. I should like to refer briefly to a number of these items. The commissioning of phase 1C in St James's Hospital was completed in January this year. The theatres, recovery area, burns unit and ward blocks, 279 beds, are now open. I would advise Deputies to visit the hospital to see these facilities which I believe surpass those available in London hospitals. These facilities replaced substandard accommodation on the site. In addition, I have announced the provision of capital funds to begin construction of a new oncology-bone marrow transplant unit to be built.
I have made special provision this year for the development of a medical genetics service at Our Lady's Hospital, Crumlin in line with the recommendations for a medical genetics service in Ireland made by a special committee. Funds have also been provided for the appointment of an additional consultant cardiologist. The recently opened oncology unit will also be brought up to full strength in the near future, with the appointment of a second consultant oncologist and some 15 support staff for the unit. Provision has also been made to enable Our Lady's Hospital to continue to train medical and nursing staff associated with the new national liver transplant centre. Special funds have also been allocated to enable the hospital to provide services for children affected with the HIV virus and AIDS related complaints.
A specific provision has also been made for the liver transplant programme at St. Vincent's Hospital to allow the current arrangements with King's College Hospital in London to continue with a view to returning the programme to Ireland later this year. Special funding has been set aside to enable the establishment of a joint department of anaesthesia serving all the hospitals in the south Dublin area. Funding has also been provided for further development of the oncology service at St. Vincent's Hospital with the appointment of a further consultant oncologist.
Funding for ultrasound equipment to carry out cordocentesis, a procedure to detect blood flow within the foetus and to identify blood vessels from which to take samples, has been provided in the National Maternity Hospital. This means that babies who previously had to be referred abroad for the treatment can now be treated in Ireland.
To date no public hospital has acquired it own magnetic resonance imaging facilities. MRI scanning has been available to public patients only through private hospitals with the fee being paid by the referring hospital or health board. Agreement was recently reached with the Northern Ireland health authorities on a joint purchase arrangement for MRI equipment and, as a result, MRI facilities are to be located at the Royal Victoria Hospital, Belfast and Beaumont Hospital, Dublin. The provision of the equipment, including building work at Beaumont Hospital will cost approximately £2 million and it is expected that commissioning should be completed before the end of 1992.
Deputies will be aware of the Government decision announced last September to prepare legislation to provide for a single new authority who will be responsible for all health and personal social services in the Eastern Health Board area. Because of the range and complexity of the services, and their vital importance to the community, I have to be satisfied that any changes will be based on the most careful, thorough and informed study of all the relevant issues. The process began with the work of the Commission on Health Funding. Following publication of their report, the Dublin Hospital Initiative Group and the Hospital Efficiency Review Group were set up to examine the specific problems in the Dublin region and in the acute hospital sector. The failings identified in the existing system included the lack of co-ordination between hospital and community-based services, the resultant over involvement of the Department of Health in the management of individual services and the lost opportunities for achieving efficiencies through greater cooperation between agencies, both statutory and non-statutory.