Written Answers. - Health Service Programmes.
Bernard J. Durkan
Ceist:
63
Mr. Durkan
asked the
Minister for Health
the extent of the expansion or curtailment of services under the control of his Department in the past four years with particular reference to special hospital care, general hospital services and community care; and if he will make a statement on the matter.
I presume that the Deputy is interested in obtaining information on the general trends in each of the main programmes in the health services during the last four years. If he wishes to obtain more detailed information on any particular aspect of the services, perhaps he would communicate further with me.
In general, there has not been any curtailment of services during the past four years. Indeed, there has been a significant development of services during that period, involving considerable capital investment and additional non-capital expenditure.
Gross non-capital expenditure has increased from £1,425 million in 1989 to £2,088 million in the current year. This represents an increase from 5.84 per cent to 6.85 per cent (estd.) in the proportion of GDP devoted to health services. In the same period, the number of people employed in the services has increased from 58,438 whole time equivalent of 59,497 WTE in 1991.
This increase in resources is reflected in the developments which have taken place in each of the three programmes referred to by the Deputy. The principal developments in each of the programmes are summarised beneath.
General Hospital Services
The Government set the approved number of acute hospital beds at approximately 12,000 in 1990 and gave a commitment that, apart from normal seasonal closures, this level of bed availability would be maintained. That commitment continues to be honoured.
The level of activity on acute hospitals has risen significantly over the past number of years. The number of admissions rose from 600,409 in 1987 to 665,092 in 1991. Attendances at out-patient departments rose from 1.5 million to 1.75 million over the same period, and visits to casualty departments increased by 112,000 to over 1.12 million between 1988 and 1991.
The Deputy will be aware that I recently launched a £20 million Action Programme to tackle hospital in-patient waiting lists. This Action Programme is being specifically targeted at those areas of hospital treatment where long waiting times are causing the greatest hardship. These include orthopaedics, ophthalmology, ear, nose and throat services, cardiac surgery, vascular surgery and plastic surgery.
As agreed in theProgramme for Economic and Social Progress, a new structure of eligibility was implemented with effect from 1 June 1991. This has simplified the system greatly, abolishing the income limit for public consultant services and has extended eligibility for public consultant services to the whole population. A new system of designating public and private beds to improve equity of access has been approved and some 80 per cent of beds have been designated for public use. Public patients will benefit in two ways from the new bed designations:
(a) the number of public beds has been increased,
(b) private non-emergency patients cease to occupy public beds, guaranteeing their availability for public patients.
Special Hospital Care
Admissions to public psychiatric hospitals and units is more or less static, with 24,299 admissions in 1988, whilst in 1990 the admissions were 23,576. Approximately one third of admissions are to psychiatric units attached to general hospitals.
The number of patients being cared for in public psychiatric hospitals continues to fall, from 11,613 patients in December 1984 to 7,050 at the end of March, 1991. The fall in the numbers of patients in hospitals has been brought about by a reduction in admissions to psychiatric hospitals, and by the transfer of many patients from hospital to independent community living or to community residences.
The number of community residences and training hostels has increased from just over 121 in 1984 to 295 in 1990. The number of places in these residences and hostels has also increased from just over 900 to 2,143 in the same period. Day hospitals and day centres for the mentally ill have also been established to cater for patients living in the community and to prevent admissions to hospitals which might otherwise have taken place.
Additional funding for the development of services for people with mental handicap has been provided in each of the last four years as follows: 1990, £2 million; 1991, £1 million; 1992, £6 million; 1993, £8.5 million (including £2.5 million in capital expenditure).
This funding has enabled an additional 413 residential, emergency and respite places and 859 day care places to be put in place and has facilitated the transfer of people with mental handicap from psychiatric hospitals. A further 90 residential and 200 day care places will be provided in 1993.
Early intervention and child education and development services have also been expanded. In 1992 a home support service was initiated which was specifically targeted at those persons who have no services or an inadequate one. This service provided support to over 1,000 families.
A Review Group onPhysical and Sensory Disability has been established to recommend on the expansion and improvement of services to people with physical handicap disabilities with the framework of the commitments of the Programme for Economic and Social Progress.
Additional funding of £1.5 million (including £.5 million in capital expenditure) has again been made available in the current year for persons with physical handicap.
Community Care
Services for the elderly are being improved by the establishment of departments of medicine of the elderly in some major hospitals while more extended care places will be provided particularly in the Eastern Health Board area where the need is greatest. During 1990 to 1992 an additional £9 million had been made available to health boards to extend home nursing, provide day centres and increase the number of nurses, speech therapists and physiotherapists in the community.
In this year an extra £4 million will be provided in order to proceed with the implementation of the Nursing Home Act.
As I have previously announced I have obtained the agreement of the Government to implement all the remaining sections of the Child Care Act and to provide the resources to put in place the necessary staff, services and facilities required to implement it. The task of recruiting the key personnel, putting the required arrangements in place, providing training and the myriad of other tasks to be undertaken to implement the Act is commencing immediately.
The Government has determined that this major task must be completed within three years commencing now and to this end has decided that in 1993 an additional £5 million will be provided, amounting to £10 million in a full year. An investment of the same scale will be made in each of the next 3 years.
The full implementation of the Child Care Act is the single biggest contribution which we can make towards promoting the welfare of children and protecting those who are at risk.
An advisory committee on Women's Health has been established within my Department and in addition, the Health Promotion Unit is co-operating closely with the Council for the Status of Women and other interested groups on matters relevant to women's health.
In 1992 a sum of £3.3 million was allocated for the provision of services for drug misusers and persons who have HIV/AIDS. An additional sum of £1.6 million was provided in 1993 to allow for the consolidation of services set up in 1992 and for some further service development. These included the phased implementation of a comprehensive HIV Surveillance System, the development of a palliative care service for persons with advanced and terminal AIDS, the provision of funds to a number of voluntary agencies working in the field and the further development of primary care clinics for persons with HIV/AIDS in the Dublin area. A feature of the extension of the services is the filling of the consultant post in Infectious Diseases in the Mater/Beaumont Hospitals to provide a Consultant-led Hospital service for persons with HIV/AIDS.
The new contract with general practitioners which was introduced in 1989 provided for a range of features aimed at improving services for medical card patients. These included a capitation based payment structure to encourage more comprehensive consultants, payment for out-of-hours visits, contributions towards the cost of practice nurses and secretaries, and payment for a range of special services which had not previously been the subject of special payment.
Arising from the 1992 GMS Review, the Government made available a fund for the further development of general practice in 1993 and 1994. Specific payments are being made out of this fund for improved rostering and out-of-hours arrangements within general practice, practice maintenance, equipment and development and additional contributions towards the employment of practice nurses and secretaries. Resources have also been earmarked for the establishment of new structures in each health board area which will facilitate the development of general practice at local level.
