Dáil Éireann díospóireacht -
Wednesday, 26 Feb 2003

Vol. 562 No. 2

Hospital Services.

Ms McManus

By any stretch of the imagination, the cost-saving measures proposed by the management of Beaumont Hospital are deeply disturbing. They constitute a series of cuts that the hospital, its staff and patients cannot sustain and which has been opposed publicly by the medical board which represents the hospital consultants.

The measures being proposed are unprecedented. I have never before seen a memo from a senior hospital manager that proposes measures that we know will damage the welfare of patients. It is wrong that our major hospitals have been driven to this. I call on the Minister to tell us what financial instructions have been given to Beaumont Hospital, St. Vincent's Hospital, the Mater Hospital and St. James's Hospital. We need to know what they have been told about their financial allocations for the coming year. We also need to know the deficits already accumulated by them as they struggle to provide a decent level and quality of service. We are entitled to this information.

I also call on the Minister to send for the list of proposals made by each of the hospitals in response to their financial allocations. It is not enough for the Minister to tell us that this is a matter between the health authority and the hospitals concerned. There are two reasons the Minister must get involved in the crisis. First, the hospitals, in many cases, provide national services far beyond their immediate catchment areas or that of the ERHA. Many of the patients who depend on the staff and services of Beaumont Hospital, for example, come from beyond its catchment area. Second, I understand that in discussions that have already taken place between the hospital and the ERHA, the authority is taking the position that it will not make decisions on what services should be cut. The hospital has been told that, as far as the ERHA is concerned, it must make whatever decisions are necessary to live within its allocation.

The nephrologist in Beaumont Hospital, Mr. Peter Conlon, made it clear on RTE radio today that 60 or 70 patients who depend on night dialysis shifts in Beaumont could die if the service is closed down and if there is no other way of providing such a service for them. His attitude, which reflects that of the vast majority of the medical staff in the hospital, is that cuts like these will simply not be tolerated. We have reason to be grateful to Mr. Conlon and his colleagues for their forthright approach and determination to represent the patients. It is clear we cannot rely on the Government to do anything more than wash its hands of the matter.

The closure of the dialysis night shift is only one of the cost-cutting measures proposed by the hospital. Altogether, 41 measures have been proposed, ranging in severity from cuts that will threaten the lives and well-being of patients to cuts that will damage the reputation of Beaumont for having a decent standard of patient care. The measures include reductions in overtime, on-call and weekend allowances, reductions of on-call pathology and radiology services, filling of beds by returning patients from nursing homes, capping of major services including cancer and dialysis services, elimination of certain devices that are used in treatment care, restriction of locum cover, maternity cover and sick leave, closure of 65 beds with almost immediate effect, and charging for appliances that were previously free.

We have debated in the House today whether the Government should buy or lease its ministerial transport and whether there should be one, two or three executive jets. It is hard to imagine anything more obscene than a debate about those kinds of choices when, at the same time, our major hospitals are struggling with Government-imposed instructions that involve choices which are matters of life or death.

Will the Minister of State provide an honest account of the extent of the crisis faced by our major hospitals? In view of the Taoiseach's remarks this morning, will he clarify that there will be no witch hunt against any staff member in Beaumont Hospital as a result of these revelations?

Mr. B. Lenihan

I am replying on behalf of the Minister for Health and Children, Deputy Martin. As Deputy McManus is aware, the Eastern Regional Health Authority is charged with responsibility for commissioning health and personal social services on behalf of the population of the region, and on behalf of those outside the region who are referred for specialist treatment. The approved level of spending nationally for health services in 2003 is in excess of €9 billion. Of this, more than €500 million relates to capital spending, leaving in excess of €8.5 billion available for revenue spending.

This level of expenditure represents an increase of almost 9% on the figure for 2002, which allowed the Minister to allocate funding to the authority and the health boards approximately 9% higher than that provided for in the 2002 letters of determination. This is a very significant level of funding, and the authority and the boards have been requested to look for the most efficient and effective means to maintain services at the 2002 approved levels.

We are all aware of the speech of the Minister for Finance on Budget Day regarding the funding available for public services. While we would all like additional funding, we must be cognisant of the economic climate that will prevail for the next few years and work to develop our services within the parameters set down by Government.

While acknowledging that €9 billion is a very significant funding base, the authority and the health boards will have to make some difficult decisions this year on their service provision and priorities, given the many competing demands for funding. Nevertheless, it must be recognised that, once again, the health services received the largest increases of any Government agency. That reflects the Government's commitment to maintaining the quantity and quality of services nationally in a difficult economic climate. The Eastern Regional Health Authority is in discussions with all providers in the region, including the major acute hospitals in the Dublin area, to finalise the level of services to be provided in 2003. These discussions are expected to conclude within the next two weeks and the Minister for Health and Children, Deputy Martin, has asked the ERHA to report back to the Department on the outcome.

The priority in 2003 will be the consolidation of services approved and funded in recent years as it is on this basis that the authority developed and agreed its service plan for the year. The authority accepts that 2003 will be a difficult year for the acute hospitals sector as increases in funding over last year will be limited. There is a clear need for tight management of costs and activity in 2003 in the context of working within available resources. Provision has been made in the authority's service plan for the completion of major initiatives which commenced in 2002. These initiatives include the introduction under the Government's bed capacity initiative of over 300 additional acute hospital beds at St. James's Hospital, St. Vincent's Hospital, St. Michael's Hospital, St. Joseph's Hospital, Raheny, Naas General Hospital, Beaumont Hospital, Temple Street Hospital and Tallaght Hospital. An additional 35 beds are being provided at Beaumont Hospital. Funding of €31 million has been provided to meet the additional cost in 2003 of over 200 beds already commissioned by the authority while €9 million is being provided to fund the beds which are planned for 2003.

The authority has received additional funding of €9.45 million to support the consolidation of acute hospital services. This funding will be allocated to service providers to help them meet the increased costs of current levels of activity and to fund service developments initiated in 2002. This funding includes an additional €1.4 million for the continued provision of national specialty services. Additional funding of €4.5 million has been provided to meet the cost in 2003 of developing the new national lung transplant programme at the Mater Hospital. Funding has also been provided to meet the costs associated with the recruitment of additional consultants in emergency medicine and consultant anaesthetists, as well as for cancer, cardiology and renal dialysis services. The authority has worked closely with the national treatment purchase fund and its providers to enable almost 800 patients to be referred and treated under the scheme in 2002. The authority will continue to work with the fund to achieve the maximum possible reduction in waiting times in its region. The Department will continue to monitor the authority's performance in the context of its service plan to ensure that services continue to be delivered in line with objectives and within existing spending parameters.

I am aware of today's media publicity in relation to the accident and emergency department and other services at Beaumont Hospital. In common with the other major Dublin hospitals, the casualty department at Beaumont Hospital is under significantly more pressure at this time of year than at other times. I do not consider it appropriate to comment on individual cases, but I must point out that patients requiring admission to hospital from accident and emergency departments are prioritised according to clinical condition. My Department is advised that while the person concerned was in Beaumont Hospital a significant number of acutely ill patients required emergency admission. As the person concerned was given a lower priority in terms of his clinical condition it was, unfortunately, not possible to allocate a bed to him. The patient was under constant observation by medical and nursing staff.

I accept that there is a bed shortage at Beaumont Hospital, but, as I have indicated to the Deputy, 35 additional beds are being provided under the Government's bed capacity initiative. Funding for these beds has already been notified to the authority. The hospital has advised that the beds will be made available in the near future. Over the next fortnight, it is anticipated that the authority will conclude its provider plan discussions with Beaumont Hospital and the other major teaching hospitals in the region. It will be a matter for the authority and each of the hospitals to agree any specific measures to ensure that each hospital continues to maintain a high level of service within available resources. In relation to Beaumont Hospital, I emphasise that no decisions have been taken to make cuts in services and that the proposals contained in the leaked document referred to in the House today have not been adopted by the board of the hospital or agreed with the ERHA.

The Dáil adjourned at 9.30 p.m. until 10.30 a.m. on Thursday, 27 February 2003.