I move:
That Seanad Éireann approves the following Regulations in draft:—
Health Contributions (Yearly Reckonable Incomes) (Variation) Regulations, 1990
a copy of which Regulations in draft was laid before the House on 1st March, 1990.
Health Contributions Regulations: Motion.
I am very pleased to be in Seanad Éireann to introduce our annual adjustment to the income ceiling for health contributions.
Subsection (3) of section 9 of the Health Contribution Act, 1979, provides that the Minister for Health may vary the income ceiling which determines the amount payable by an individual, in a particular contribution year. Subsection (5) of section 9 of the Act requires that a draft of the proposed regulations shall be laid before both Houses of the Oireachtas and that the regulations shall not be made until a resolution has been passed, by each House, approving of the draft regulations. The draft regulations now before the House shall apply in relation to the contribution year commencing on 6 April 1990.
The income ceiling is at present £16,000, and it is proposed to increase this to £16,700. In determining the proposed increase in the income ceiling the Minister for Health has taken into account, as required by the Act, the most recent information available regarding the average earnings of workers in the transportable goods industries since the last income ceiling was adopted. The latest recorded information on average weekly earnings in those industries relates to March 1989, when the average figure was £208.79, which was an increase of 4.41 per cent on the March 1988 figure of £199.97. When this percentage increase is applied to the current £16,000 ceiling a figure of £16,705 emerges. It is proposed therefore to set the new ceiling at £16,700, an increase of £700.
Following upon the increase in the ceiling, the maximum contribution payable by any individual will be £212.50, that is, 1,25 per cent of £16,700. Persons with incomes of £16,000, or less, will not be affected by the increase. Those with incomes over £16,000 will pay at most, an additional £8.75 in the coming contribution year.
The additional income which is expected as a result of the proposed increase in the income ceiling will be approximately £1.5 million in the contribution year 1990-91. Most of this will accrue to the Exchequer in the first quarter of 1991.
The Revenue Commissioners have been responsible for the collection of current health contributions from all sectors since 6 April 1984. The health boards remain responsible for the collection of arrears due from farmers, for periods up to that date. Health boards can retain these arrears as additional revenue for local health needs.
The total amount owned by farmers to health boards at 31 December 1989 was about £3.9 million. The amount outstanding at 31 December 1988 was £4.6 million. While the amount which is still outstanding is a cause for concern, I am pleased that this amount has been reduced by approximately three-quarters of a million pounds in the past year.
The Health (Hospital In-Patient Charges) Regulations, 1984, came into effect on 1 June 1984.
These regulations allowed for an admission charge of £100 to be levied on persons admitted for hospital in-patient treatment in a public hospital who were in arrears with health contributions.
This amount was increased to £150 from 1 July 1986. This has proved to be quite an effective measure in inducing defaulters to pay their health contributions. However, it is important to mention that persons in arrears are not refused admission to hospitals, but the collection of the admission charge and the arrears is pursued later.
I am anxious that outstanding arrears should be collected as soon as possible as it is clearly unfair that those who do not honour their obligations with regard to health contributions should continue to obtain health services at the expense of others. Health boards are continuing their efforts to recover these arrears. It has been necessary for them to initiate legal proceedings in some cases.
The Minister for Health will be reviewing shortly the income limit for free consultants' services. The latter income limit is based on income distribution data which only becomes available around this time of the year. Consequently, I am not as yet in a position to say what the limit will be. The proposals before you are a routine yearly measure. I now ask the House to approve the regulations before it in draft.
I want at the outset to say that my party will not be opposing the regulations as such. We will be facilitating the enactment of the regulations but I do want to say that, while we are so facilitating enactment and will not be formally opposing, we must draw the attention of the House and the Minister once again to the fact that these regulations are being passed against a background of continuing crisis in the health service, a background of continuing crisis in patient care, in staffing and in general medical care.
I want, first of all, to bring to the Minister's attention a very startling and a very dramatic case that has been brought to my attention recently. I suggest to the Minister that it is not a unique case. Last Friday night a lady was taken into the Meath Hospital in Dublin for surgery on the following Saturday morning. She fasted overnight and on Saturday was told that there were no facilities to go ahead with the surgery. She left the hospital. One can imagine that for an elderly person it was a traumatic experience. She went home, and was readmitted to the hospital on Sunday for surgery on Monday. The person who drew this case to my attention is an extremely responsible individual and telephoned me yesterday evening about it. It is possible that they are not right but all evidence would suggest that they are. I did my best to double check. On the Monday the lady was refused surgery again on the grounds that there was no facilities or that there were not adequate staffing arrangements at the time. She then stayed in hospital and had the operation yesterday, Wednesday.
I want to draw that case to the Minister's attention and to say that it is an appalling one. I am aware of similar cases in Blanchardstown Hospital and in my local hospital and around the country. It is an horrendous, unacceptable state of affairs. The trauma involved for an old person, the harassment they enduce in having surgery at the appointed time is bad enough.
There is a waiting list for hip operations of about three to four years and there is a waiting list for cataract operations.
I would ask the Senator to keep to the Health Regulations. He seems to be going around them.
Yes, but it is important in the context of the regulations to draw the attention of the House and the Minister to the fact that good value and good hospital care are not being delivered to patients. The 1988 debate provided a precedent for broader discussion. I will do my best to be as specific as possible.
The final point I was making is that people are waiting for cataract operations for a period of up to two years. People are waiting for orthodontic treatment for long periods to the extent that the illness is irreparable when treatment is started. There is no proper programme of dental care for public health patients and no evidence of one being instigated.
The Southern Health Board have lost 818 beds in the last three years. These figures were ascertained in a reply to questions to the Minister for Health in the Dáil. The Midland Health Board lost 508 beds in the last three years; the Western Health Board lost 615 beds and the North Eastern Health Board lost 147 beds. In St. Phelim's Geriatric Hospital in Cavan a waiting patient has to depend on the death of an inmate in order to gain admission. I am not being colourful about that. There is no room. That presented problems during the particularly bad weather this year and the outbreak of flu. There is a crisis about availability of hospital beds. There is a crisis with regard to staffing levels. In the period from 1986 to 1989 there has been a reduction of 6,124 medical staff employed by the Department of Health, including nursing and general medical staff.
Another matter that requires urgent attention is care of the aged. Because of demographic patterns there is an obvious increase in the number of aged persons in our community. If an adequate care structure is not provided soon problems will arise. There will be 7.4 percentage points increase in persons over the age of 65 in the period from now until the year 20001.
A study has been done called The Years Ahead pointing out that there will be a major increase in the number of the aged and it would be my contention that the question of care has not been addressed adequately. The recent cutbacks have affected people suffering a whole multitude of illnesses. I await the Minister's response because I have to say, in fairness to this Minister, that the last time he was in the Seanad he was extremely constructive and helpful in addressing the questions raised on the health services and I hope he will do so today in reply. I have to say to the Minister that it is my party's contention that we are developing a two — tier health service in the broad sense that only those who are members of the VHI or who can afford private treatment can have a reasonable expectation of a proper health service. There is a two-tier health service. That is a bad situation which needs reversal.
The problems of the health service are specifically manifested in the waiting lists, particularly for hip and cataract operations. They are certainly manifested in understaffing and in cases, such as I have drawn attention to, of persons being released from hospital without surgery. The Government, and indeed all Governments over the last number of years, have said that community health care must be the vanguard of the health service, the jewel in the crown, the method by which we reduce expenditure in that better community care prevents hospitalisation.
There is no evidence that the Government are about to instigate a proper programme of community care. There is a tremendous need for extra public health nurses. There is a definite need to increase the allowance for home help which is at the discretion of individual health boards. In my area a home help is paid £1.20 per hour. We need extra public health nurses, we need increased payment for home help. We made a mistake when we got rid of the Health Education Bureau because we must——
I do not like to interrupt Senator O'Reilly but we are on very narrow regulations. I would love to be able to stand up after Senator O'Reilly and make a contribution on health. I feel as strongly as Senator O'Reilly feels about this.
I have given the Senator a lot of latitude but the Senator did not really make a point of order. Having said that I take the Senator's point and I would hope that Senator O'Reilly would keep himself within the terms of reference.
I know that Senator Honan makes the point in good faith but if we are enacting regulations in the health area which involve financial commitment and contributions we must discuss the value of the contributions and the ultimate results and the kind of health service emanating from them.
I was making some concluding remarks but I will return to community care for a moment. We need an increased number of community care and public health nurses and extra allowance for home help.
I was making the point that we should not have abolished the Health Education Bureau because by prevention and education of people we can limit the number of hospitaised cases. While we will not oppose these particular regulations, my party remain alarmed at the crisis in the health service, at the level of personal hardship being suffered.
Acting Chairman
If the Senator would listen to me one moment I would like to remind him that the subject of this discussion is the issue of varying the income ceiling which determines the amount payable by an individual. I would like the Senator to stay fairly closely to that point.
In conclusion, my party remain alarmed and can miss no opportunity to remind the House of our concern and alarm at the failure of Government to address the fact that we are developing a two-tiered health service, that there is great injustice and great personal suffering. I am reminding the House that we consider these things in the context of our Christian philosophy as a nation and ask ourselves to what degree is the kind of health service we are developing now in tandem with our supposed Christian commitment.
First, it was with absolute sincerity that I intervened. It is a matter that both Senator O'Reilly and I feel strongly about.
The Health Contributions Act provides for an annual increase in the ceiling on contributions in order to keep pace with the rise in the average earnings. These regulations before us today are a routine procedure and give effect to that provision. The regulations raise the question of efficient savings and the value of money in the health services. We have to be careful that we maintain the service and get effective and efficient savings and value for money.
Like Senator O'Reilly I think some of the problems in health and the worries and deep concerns about efficient spending of money arise from mistakes made in past years. No party, least of all my party, has a great record on that. We all made mistakes and I put that on the record.
The increase in the limit means an additional income of about £1.5 million in the health services. As Senators know, there are many calls on the resources available to the Minister. I appreciate deeply Senator O'Reilly's and Fine Gael's support in not opposing the regulations. If I remember correctly, the regulations were opposed last year. We have to be careful that the money is spent wisely and that we keep the confidence of our people in the service that is in place, which is an excellent service.
Confusion is caused by all the hype about cuts. The budget for health is £1.4 billion and the Exchequer amount is £1.24 billion. Comparison could be made with the cost in 1974, which was, £174 million. The health contribution is small but very important and will bring in about £128 million or roughly around 10 per cent of the total cost of the health service.
I understand that the Revenue Commissioners are responsible for collection since 1984 and the health boards are responsible for collecting arrears. I had intended to ask questions but he answered them in his early address to the Seanad when he said some arrears are still outstanding. Have they succeeded in getting more of that money? As in every other section certain taxpayers are responsible and pay the contribution while others have no conscience about not paying. Unfortunately the contributions make very little impact on the cost of the health services today. We must ask if we are getting value for the money being spent on health. This increase in the limit will not involve hardship. Anyone earning up to £16,000 a year does not pay the contribution. Persons earning £16,700 per annum will have to pay £8.75 a year. So a person earning over £16,700 per annum is being asked to pay 20p a week. Any increase is another increase in taxation.
I, like Senator O'Reilly, would like a longer debate on this subject some time. I pay tribute to the Minister Treacy because the last day he was in this House on health he was excellent and I hope when he comes again he will have this long awaited debate on health. I am grateful to Senator O'Reilly for his support of the draft regulations.
I would like to sincerely thank Senators O'Reilly and Honan for their very positive contributions to this important debate on a regulatory change and we appreciate the unanimous support it has got.
Senator O'Reilly referred to some general issues concerning hospital services. I do not think it would be appropriate for me to deal with such matters in today's debate which after all is concerned only with the income limit for health contributions. However, Senators will be aware of the action programme for the health boards and health services announced recently by the Minister which includes the following:
An efficiency drive for health boards and hospitals headed up by Mr. Noel Foxe of Spicer, Oppenheim, Consultants. This will be done in conjunction with the efficiency added group and will review efficiency in all acute hospitals throughout the country. The Dublin hospitals' initiative to promote integration of Dublin hospital services is headed up by Mr. David Kennedy, former chief executive of Aer Lingus. This will include an initiative on admission policies, out patient arrangements and discharge arrangements for the patients needing support outside of hospitals; a new emphasis on the patient as a consumer which will require hospitals to operate efficient appointment systems, a patient's charter ensuring more information before, during and after treatment, a new appeal system for medical card holders.
The Minister for Health, my colleague Deputy O'Hanlon, announced that recently and we believe it will have a major impact on the management of the health services in the years ahead, particularly in the acute hospitals and in the Dublin area where a vast amount of resources are being expended providing services for our people.
Senator O'Reilly also talked about the fact that health boards have lost a lot of beds. Perhaps they have lost beds in particular areas but if examined in detail it will be found that many of these beds have been transformed and allocated to the geriatric area in particular, and perhaps the mentally handicapped area so that the total number of beds available for health services has remained virtually the same over the last few years.
He also spoke about the need for orthodontics. I would like to remind the House that over the past four months we have allocated £3.3 million for the dental services and a good percentage of this is for orthodontics. He also spoke about the need for care of the aged. I would remind the House that we included £5 million in our recent budget specifically for geriatric care.
Senator O'Reilly talked about extra public health nurses and extra money for home helps and so on. We would all love to be able to pay more money to home helps and to provide vast resources both by way of personnel and facilities and expenditure. As Senator Honan said, we are spending £1.4 billion on health services this year. This is in stark contrast to 1974 when the health services only cost £174 million. While we would all love to provide more resources the fact that we are spending 21.5 per cent of our Exchequer resources on the health services this year is positive proof of the commitment of this Government to maintain a modern health care service for the people.
Senator O'Reilly spoke about the abolition of the Health Education Bureau. As somebody who had doubts about that when it happened and now find myself in the Department of Health, I am delighted to say that one of the most positive public service agencies in the country, and one of the agencies doing the best job in the country at this time, is the new Health Promotion Unit in the Department, which is strategically located, which is headed up by very good people and which is doing an excellent job. It is flexible and innovative in the job it is doing. It is doing tremendous work for health promotion and health education throughout the country.
The fact that the Health Education Bureau has been replaced by the Health Promotion Unit is only of greater significance in the creation of a better and more informed public and in the promotion of our health services. I am sure Senator O'Reilly is pleased with the performance of my Government colleague, the Minister for Health, Deputy O'Hanlon, who is one of his constituency colleagues. He is a very caring, calm and compassionate man who is doing an excellent job as Minister for Health. I am very proud to be working with him.
I thank Senator Honan also for her contribution. We are committed to collecting the arrears of health contributions. We have reduced the arrears by approximately £.75 million in the past year and we hope that the health boards will be in a position to increase that further over the next year. The Minister and the Department have agreed, in conjunction with the Minister for Finance, that any moneys collected by way of arrears for health contributions will go directly to the local health board as local funding. It is very important that everybody would pay their way, that the money that should be paid for health services is paid by those who owe it, that we can maintain our services and make sure that there is equalisation in the delivery of service to everybody and that everybody pay their way for the services that are needed.
I sincerely thank the House for their very positive contributions. I am very grateful that Senators have accepted these regulations unanimously, I know they will be to the benefit of our health services.
Question put and agreed to.
Acting Chairman
When is it proposed to sit again?
At 2.30 p.m. on Wednesday, 21 March 1990.