Dáil Éireann díospóireacht -
Wednesday, 4 Nov 1998

Vol. 496 No. 1

Adjournment Debate. - Hospital Waiting Lists.

Mr. McCormack

I wish to brief the Minister on the worsening crisis at University College Hospital Galway because of the threatened closure of two wards and the laying off of 45 nurses. It must be borne in mind that these closures are on top of 110 bed closures five weeks earlier in the year. The hospital has had the greatest increase in waiting lists of any health board hospital. Between June 1997 and June 1998 the waiting lists increased from 2,079 to 2,891, an increase of 812 or 39 per cent.

When the Government came to power, a public representative from the constituency became Minister of State at the Department of Health and Children. At the time, there were 1,386 people on the waiting lists who, 12 months later, are still on the waiting list. There is now a waiting list to get on the waiting list. The closure of the surgical ward will now add another 800 to the waiting list before the end of the year.

Does the Minister realise the worry, chaos and hardship he is causing by allowing the wards to close and nurses to be laid off? I expect he will tell me in his prepared reply that it is the function of the management to stay within its budget but it is the duty and responsibility of the Minister to provide adequate funding to run the health board services. The acting chief executive officer maintains that the Western Health Board is £1 million short of a budget and that, if he had the money, the wards and theatres could be kept open and the nurses kept on. There is a legitimate case for the £1 million to be given to the Western Health Board. The Minister only gave it an increase this year of 1.5 per cent whereas inflation is running at 3 per cent. Had the board been allocated a budget in line with inflation, it would have received an additional £750,000.

Another extra cost on the health board this year was the cleaning costs attached to the refurbishment of the hospital, which were £300,000. This money, if returned to the health board, would keep the wards open. The Minister may make play of the 1996 Act which states that health boards should stay within their budgets. The Act was agreed by all parties. At that time, the Minister for Health provided money to clear a deficit of £3.8 million in the Western Health Board region.

There is nothing in law to stop the Minister introducing a Supplementary Estimate to deal with this problem. The Minister for Justice, Equality and Law Reform yesterday introduced such an Estimate of £81 million to deal with excess expenditure in his Department. There are several other precedents for Supplementary Estimates. The introduction of such to allow for a payment of £1 million to the Western Health Board, which the Minister short changed earlier this year, would restore some normality to the serious situation now developing at University College Hospital. I appeal to the Minister to seek that Supplementary Estimate so that his commitments to the health board can be met.

Mr. U. Burke

I thank the Chair for selecting the item and the Minister for his presence. I am glad to have the opportunity to express on behalf of many people in Galway city and county my complete disgust and anger at the Minister of State at the Department of Health, Deputy Fahey, for his callous and dismissive statements regarding the closure of the two wards and one theatre at University College Hospital Galway and the consequent dismissal of 45 nursing staff. Is he aware of the hardship such action has caused within the community in County Galway? He has discredited the Department of Health and Children by his careless and unconsidered comments and allegations. He has taken the easy option for himself to save what remains of his own credibility in the matter, which is now seriously in decline. He has blamed management once again for creating the problems. He commented on local radio that there was bad management and bad bed and patient management at University College Hospital. He said the problems were fundamental management ones and that new management structures put in place were not working. He also said there was no point in throwing good money after bad. This is a terrible indictment of all involved, from management to nursing and other professionals.

I challenge the Minister of State, through the Minister, to withdraw or substantiate these scurrilous statements, which damn the very people delivering a service at the hospital. It is a shortage of funds which is causing the problem. He has ignored the fact that, while he was a Senator trying to get elected to the Dáil, he declared himself a people's candidate and made funding and facilities at the hospital an election issue. He even brought radio programmes to the casualty unit at the hospital, which shows how professionally unethical he can be to achieve his own end. Now he has turned his back on them and says there is nothing he can do. He even blames legislation by the former Minister to save his bacon.

I appeal to the Minister to provide the extra funding and not allow the closure of the two wards and theatre, especially St. Pius's ward, which is one of the main surgical wards in the hospital. It will add further to an already unacceptable waiting list at the hospital. We already have the worst waiting lists in the country. Will the Minister meet with the health board to undo some of the damage done by the Minister of State, Deputy Fahey, to the morale of the management, the nursing staff and the professional people who have always in the past put health care as their priority? I appeal to the Minister to act on behalf of the people.

Mr. Cowen

I am pleased with the opportunity afforded to me this evening by Deputies Ulick Burke and McCormack to address the House on the issues raised by the temporary closure of beds and an operating theatre at University College Hospital Galway.

The Health (Amendment) (No. 3) Act came into force under the previous Administration in 1996. It obliges health boards to agree to adopt an annual service plan on the basis of a level of approved net expenditure which should not exceed the non-capital determination notified to the board by my Department for that year. This legislation places a legal obligation on health boards to deliver service plans within budget as any overrun on expenditure will translate into a first charge on the following year's allocation. Responsible management dictates that, where a health board is projecting a year-end deficit on the basis of activity in a particular area exceeding service plan targets, it should take measures to control this activity to remain within budget. It is a matter for local health board management to make a judgment on what are the most appropriate and effective measures in such circumstances. To fail to act would be to present the health board with a significantly greater problem in the following year with a consequent potentially severe impact on service provision.

Under the legislation health board management is responsible for achieving the agreed activity targets set out in the service plan. Ideally, activities should be planned and controlled over the full 12 months to ensure this is done, although, as Deputies will appreciate, orderly planning of activity in the acute hospital sector is complicated by the level of emergency admissions.

It is within this overall context that Western Health Board management has decided to engage in the measures being undertaken at University College Hospital, Galway. These are a response, in fulfilment of its legislative responsibilities, to a projected yearend budgetary deficit of £1.9 million on the acute hospital programme. The Western Health Board has confirmed that the activity targets agreed in the 1998 service plan for University College Hospital, Galway will be achieved. In other words, the temporary closures do not represent cuts in service provision. The hospital will treat the number of patients that it set out to treat at the beginning of the year. The measures are aimed not at achieving cuts but at aligning activity levels with the service plan targets which are based on the financial allocation available to the hospital. The allocation available this year is £45.4 million, an increase of more than £5.4 million on the overall allocation in 1997 which was provided by the previous Administration.

It is on the overall level of activity delivered rather than the number of overnight beds available that the performance of University College Hospital, Galway should be judged. This is because the number of in-patient beds available does not reflect the complete picture of activity in modern hospitals. This is due to trends in modern medical practice for a marked shift in care from in-patient to day case level, a trend strongly reflected at University College Hospital, Galway where for the first nine months of the year day case activity has been running at 13 per cent above 1997 levels while in-patient admissions are down 6 per cent over the same period last year.

On the laying off of temporary nursing staff, I am assured by health board management that it will do all that is possible to ensure it is not necessary to take this course of action and towards this end I understand the health board is engaged in discussions with the nursing unions locally with a view to ensuring that with their co-operation the temporary closures can proceed without any temporary loss of jobs. This would largely be achieved through permanent staff availing of annual leave and job-sharing opportunities.

Mr. U. Burke

Forced leave.

Mr. Cowen

I hope the co-operation of the unions locally will be forthcoming in ensuring this can be achieved.

Deputies will be aware that University College Hospital, Galway is entering a phase of major capital development that will transform the level and range of acute hospital services available to people in the west in the medium and long term. I recognised the need for this when on taking office I approved the preparation of a development control plan for the hospital. Phase 2 of the major capital development is in planning at a capital cost of more than £40 million. We are engaged in a phased programme of commissioning the new units being completed under phase 1. I hope to accelerate this process in 1999.

These developments are aimed at ensuring the needs of this region are addressed in a structured and comprehensive manner and underline my commitment and that of the Minister of State, Deputy Fahey, to the enhancement of hospital services in Galway. Unlike the party of the Deputies opposite which did nothing when in office, the Minister of State has delivered.

Mr. McCormack

We started the process.

Mr. Cowen

The necessary commitment of revenue funding that is required to provide the people of Galway and the west with access to a quality hospital service that is unsurpassed anywhere will be made in the context of the new capacity that this major construction programme will bring.

Western Health Board management is acutely aware of the opportunities that lie ahead in this major capital development. In the meantime there is an onus on it to ensure it is positioned to avail of these by ensuring it discharges its legislative duties in the implementation of the service plan for University College Hospital, Galway. I reminded health board members of their legislative duties last December before the allocation was made. I am satisfied the board will provide the level of service for the people of Galway that it set out to provide in the service plan and it is a matter for it to ensure this is managed within budget. Board members must not shirk their legal responsibilities.

Mr. McCormack

It is the Minister's responsibility to provide health services.

Mr. Cowen

The Deputy should do his job as a member of the board or get out.