Written Answers. - Hospital Services.
Pádraic McCormack
Ceist:
72
Mr. McCormack
asked the
Minister for Health and Children
the action, if any, he proposes to take to redress the decision by the Western Health Board to close two wards and one theatre until 1 January 1999; and if he will make a statement on the matter.
[22404/98]
Pádraic McCormack
Ceist:
89
Mr. McCormack
asked the
Minister for Health and Children
if he will investigate the operation of the Western Health Board to establish the reason they have had to close wards and a theatre at University College Hospital, Galway, to avoid over spending its budget.
[22405/98]
Alan Shatter
Ceist:
143
Mr. Shatter
asked the
Minister for Health and Children
the steps, if any, being taken to ensure that Galway University College Hospital is fully operational for the remainder of 1998; and the action, if any, taken by him during the course of the past ten days to prevent ward and theatre closures.
[23956/98]
I propose to take Questions Nos. 72, 89 and 143 together.
As the Deputies are aware, the Health (Amendment) (No. 3) Act came into force under the previous Government in 1996. This Act obliges health boards to agree and adopt an annual service plan on the basis of a level of approved net expenditure that should not exceed the non-capital determination notified to the board by my Department for that year. Prior to issuing letters of determination for 1998 I met with each health board and explained the basis on which 1998 funding would be provided. This was confirmed and clarified in the official letter of determination to each board, which stated that it had been agreed with the Minister for Finance that, in relation to 1998 and subsequent years, Supplementary Estimates would be granted only on an exceptional basis and only then in relation to specific categories of expenditure, which in 1998 were confined to four headings.
This places an 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. Where a health board is projecting a year-end deficit on the basis of activity in a particular area exceeding service plan targets, it becomes necessary, therefore, for that board to take measures to control this activity in order to remain within budget. Otherwise, the carry-over of deficits could become cumulative over the years, with drastic effects on an agency's budgetary management and its capacity to deliver core services It is a matter for local health board management to determine the most appropriate and effective measures in such circumstances. The ward and theatre closures currently proposed for University College Hospital, Galway, are a response by the Western Health Board management, in fulfilment of their legislative responsibilities, to a projected year-end budgetary deficit of some £1.9 million on their acute hospital programme.
Under the legislation, health board manage-ment are responsible for achieving the agreed activity targets set out in the board's service plan. It is important to note, in this context, that the Western Health Board have confirmed that the activity targets agreed in their 1998 service plan for University College Hospital, Galway, will be achieved. In other words, the hospital will provide the level of treatment to patients in the region that it undertook to provide at the beginning of this year.
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 considered. This is the more relevant indicator because the number of in-patient beds available does not reflect the complete picture of activity in modern hospitals due to trends in modern medical practice for reduced average lengths of stay and a marked shift in care from in-patient to day case level. This is strongly reflected in activity at UCHG, where for the first nine months of this 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. In the circumstances, I am satisfied that the manage-ment of the Western Health Board is appropriately discharging its responsibilities in implementing its service plan for University College Hospital, Galway.
