Written Answers. - Child Abuse.
Liz O'Donnell
Ceist:
35
Ms O'Donnell
asked the
Minister for Health
his response to a recent report by the Mid-Western Health Board on child care and family services which shows that the number of reported cases of child abuse in north Tipperary and east Limerick has increased more than tenfold over a period of four years; and if he will make a statement on the matter.
I presume the Deputy is referring to the review of child care and family support services prepared by the Mid-Western Health Board under section 8 of the Child Care Act, 1991.
The report actually indicates that there was a ten-fold increase in the number of confirmed cases of child abuse in North Tipperary and East Limerick during the period in question, up from 14 in 1989 to 150 in 1992. There was a threefold increase in the number of reported cases during the same period, from 58 to 181.
It might be noted that the most significant increase in both cases reported and cases confirmed were in the categories of physical abuse and neglect. These forms of abuse accounted for more than half the increase in the total number of confirmed cases between 1991 and 1992.
I have been informed by the Mid-Western Health Board that among the factors which have contributed to these increases are: the increased public awareness in recent years of the problem of child abuse and the heightening of the vigilance of health care professionals, the appointment in 1992 of two community based child care workers in Limerick city and North Tipperary has resulted in a significant increase in the reporting of cases, the establishment in 1992 of a locally-based child abuse assessment service in the area has also contributed significantly to the number of cases confirmed and a series of training workshops for community care nursing and social work staff early in 1992 has led to improved liaison between the two disciplines and a subsequent increase in reported and referred cases of abuse.
The report makes a number of recommendations for improving the health board's child protection services. These recommendations are being pursued by the board in the context of its overall programme for developing child care and family support services in accordance with the requirements of the Child Care Act.
Pat Cox
Ceist:
36
Mr. Cox
asked the
Minister for Health
if he will give details of the additional permanent and temporary consultant and junior medical staff taken on to provide services under the 1993 waiting list initiative; and the number of these temporary employees who have since been let go.
Martin Cullen
Ceist:
38
Mr. Cullen
asked the
Minister for Health
if any funding allocated under the 1993 waiting list initiative was taken back from any hospital or health board for failing to meet its targets; and if he will make a statement on the matter.
John Bruton
Ceist:
46
Mr. J. Bruton
asked the
Minister for Health
the agreed additional activity targets set for the North-Eastern Health Board in regard to extra operations on patients under his waiting list initiative; and the way in which he was able to set these additional activity targets in the absence of information on the average cost of operations in different hospitals.
Pat Cox
Ceist:
55
Mr. Cox
asked the
Minister for Health
where funding which was taken back from health agencies under the waiting list initiative was redirected.
Michael McDowell
Ceist:
83
Mr. M. McDowell
asked the
Minister for Health
if any funding allocated to the Western Health Board for an additional 600 plastic surgery procedures under the 1993 waiting list initiative, was withdrawn or redirected, given that only 273 of the operations were carried out; and if he will make a statement on the matter.
Michael McDowell
Ceist:
91
Mr. M. McDowell
asked the
Minister for Health
the total waiting list for hospital admission at present.
Desmond J. O'Malley
Ceist:
96
Mr. O'Malley
asked the
Minister for Health
if he will give details of the hospitals and health boards, if any, which had funding allocated under the waiting list initiative, taken back for failing to meet their targets.
Mary Harney
Ceist:
98
Mary Harney
asked the
Minister for Health
the amount paid in overtime to medical personnel in each hospital and health board to carry out the 1993 waiting list initiative.
I propose to take Questions Nos. 36, 38, 46, 55, 83, 91, 96 and 98 together.
As set out in the Programme for a Partnership Government, the Waiting List Initiative, which I launched in May of last year, was targeted specifically at those areas of hospital treatment where long waiting times were causing the greatest hardships. These included:— Orthopaedics (hip replacement and other); Ophthalmology (cataracts and others); Ear, Nose and Throat; Cardiac Surgery (by-pass operation); Vascular Surgery (varicose veins) and Plastic Surgery.
At the time, I also voiced my concern about lengthening waiting times in:— General Surgery (including gynaecology and urology).
The overall aim was to eliminate waiting lists in excess of 12 months for adults in these particular specialities and to set a maximum period of 6 months for children awaiting ENT or eye treatment. Under the Initiative, my Department entered into agreements with health boards and voluntary hospitals throughout the country for additional 17,254 procedures to be completed by the end of 1993.
Two agencies were unable to meet their agreed targets and their allocations under the Waiting List Initiative 1993 were adjusted accordingly. The Midland Health Board's allocation was reduced by £50,000 and the allocation to Our Lady's Hospital, Crumlin was reduced by £78,000.
In framing the original allocation of Waiting List Funds for the Eastern Health Board, a provision of £500,000 was included in anticipation of a seasonal requirement to transfer long stay patients occupying acute beds to more appropriate accommodation. In the event, approximately £250,000 of this provision was required in 1993. The remaining £250,000 became available for re-allocation to other agencies to enable additional waiting list procedures to be carried out.
The South Infirmary-Victoria Hospital in Cork planned some capital works associated with the Waiting List Initiative but subsequently did not proceed with this work and £120,000 of its allocation was re-directed.
Under the Initiative, the Western Health Board was allocated a sum of £2,242,600 to perform an additional 1,884 procedures. Of the 1,884 procedures contracted for, 600 were to be carried out in plastic surgery.
Due to difficulties in recruiting staff for plastic surgery, the Board advised my Department it would not be able to meet its target of 600 procedures.
It was agreed that the Board would increase its activity in other areas where capacity allowed and, therefore, the question of withdrawal of funds did not arise. I am glad to report that the Western Health Board surpassed its overall target of 1,884 procedures and performed a total of 2,111 additional procedures under the Initiative.
Following discussions with various agencies throughout the country which were in a position to carry out further additional procedures, the following agencies had their original allocations increased: the Mid-Western Health Board; the North-Western Health Board; the South-Eastern Health Board; the Western Health Board; Beaumont Hospital; the Coombe Hospital; the Mater Hospital; the Meath Hospital; the National Children's Hospital, Harcourt Street; Our Lady of Lourdes Hospital, Drogheda; the Rotunda Hospital; the Royal Victoria Eye and Ear Hospital; St. James's Hospital and St. Michael's Hospital.
As a result of the extra agreements entered into, my Department revised upwards the number of additional procedures contracted for under the Initiative from 17,254 to 18,293. I am pleased to report to the House that the revised target was exceeded. The overall number of additional procedures performed in 1993 was 18,768.
Under the Initiative, the North-Eastern Health Board was allocated a sum of £671,750 to perform an additional 237 orthopaedic procedures, including 82 hip replacement operations.
As I have already indicated in my reply on 16 December, 1993 (P.Q. No. 14, Ref. Vol. 437 No. 4), my Department does not collect information on the average cost of specific operations on a routine basis.
Negotiations with the North-Eastern Health Board and each agency involved in the Initiative, took into account various factors such as staffing, accommodation, equipment and other infrastructure requirements. The Deputy will appreciate that the marginal cost of an additional procedure is influenced by these factors and, as such will vary from one agency to another.
The information requested regarding the number of medical personnel taken on by health boards and voluntary hospitals under the Initiative and the numbers of such staff since let go is not available within my Department.
The Deputy will appreciate that in order to achieve the increased level of activity under the Initiative, agencies were allowed flexibility to employ additional temporary staff as required for the purposes of the Initiative. The level of personnel employed in this way varied from agency to agency and within agencies themselves depending on the arrangements necessary to achieve additional procedures and the availability of other infrastructural resources.
Information regarding overtime payments made to medical personnel under the Initiative is not available within my Department.
In June 1993, there was 40,130 people awaiting admission to acute hospitals nationally. At the end of December 1993, this figure had been reduced by 14,757 to 25,373, a reduction of 37 per cent.
The large reduction in numbers waiting has been brought about following the success of the Government's Initiative during the latter half of 1993.
At the launch of the Initiative 14,624 adults and children had been waiting for periods in excess of 12 months for adults and 6 months for children in the problem specialties. This figure has been reduced by 8,384 to 6,240, a reduction of 57 per cent.
The Government is anxious to build on the success of the 1993 Initiative. The continuation of the Initiative in 1994 with the special allocation of £10 million announced in the budget will enable further inroads to be made in problem areas.
The principal objective will continue to be the elimination of waiting times in excess of 12 months for adults in the problem specialties and 6 months for children in ENT and Ophthalmology.
A detailed review is underway on the experience gained during 1993 and the Department will be discussing with the health agencies in the coming weeks the arrangements to be put in place during 1994 to further reduce waiting times.
