I welcome the Minister for Health and Children, Deputy Cowen, and his officials. The meeting will consider the Estimates coming within the remit of the Department of Health and Children, namely, Vote 33. We have circulated a proposed timetable for consideration which allows for opening statements by the Minister and Opposition spokespersons followed by an open discussion on individual subheads through a question and answer session. Is that agreed? Agreed.
Estimates for Public Services, 1998.
Vote 33 - Department of Health and Children (Revised).
This is my first visit to the committee and I am delighted to have the opportunity to meet Members to discuss the Estimates and update them on progress.
First, I reiterate my continuing personal commitment and that of the Government to the orderly and sustained development of the health services in line with the Government's An Action Programme for the Millennium which highlights the need to create a customer focused health care service and targets key health care areas for special attention.
I acknowledge the many useful contributions made last week during the Private Members debate on the future development of the health services. I am now in the middle of the Estimates campaign for 1999, including the multi-annual budgets for the years 2000 to 2001, and many of the issues raised during last week's debate will be taken up and addressed during this process.
The 1998 Estimate is designed to achieve further progress in meeting the targets set out in An Action Programme for the Millennium. Deputies will recall that last year the Estimates were at an advanced stage when the Government came into office. We began to address the deficiencies in our health services almost immediately on taking office. We were faced with a number of very urgent service needs in the health area and I was happy last year to agree a package of measures with my colleague, the Minister for Finance, in the 1997 Supplementary Estimate. This provided a very significant injection of supplementary funds for a range of health services in the areas of greatest need.
The 1998 Estimate, which includes the largest capital Estimate, reflects the continued development of the health services as set out by the Government. It is a solid step forward in improving health services.
The Government in its programme is committed to creating an inclusive society and making an all out assault on disadvantage. We are seeking to establish a society where all citizens have the opportunity and incentive to participate fully in social and economic life and share in the benefits of the growth of our economy. The continued strong growth in the economy has enabled us provide resources for improvements in services for the more disadvantaged members of our community. Last year's budget and the 1998 Estimate clearly indicate the Government's intention to live up to those commitments.
As Minister for Health and Children I am aware of the inevitable conflict between available resources and competing demands for ever increasing expenditure on health and social services. In providing the level of funding made available to the health services this year, the Government is balancing the genuine need for increased funding with the need to adhere to its fiscal targets and maintain the conditions to enable us join EMU so as to ensure our continued economic wellbeing.
As every Member is acutely aware, the Government faces very strict targets in relation to public expenditure arising from our entry into Economic and Monetary Union. This has implications for all parts of public expenditure, including expenditure on health services. However, I am pleased to inform the committee that within the limitations imposed by the policy in relation to the management of public finances, the resources provided will enable significant progress to be achieved in developing services, particularly for children at risk, the mentally handicapped, the physically disabled, the elderly and other groups with special needs. It has also been possible to provide for additional developments in the acute hospital sector to meet the critical service pressures on these services and to provide smaller sums for other necessary areas.
There is much to be proud of in the core health service and I do not wish to deny that problems exist in specific areas. However, this Government will not walk away from addressing those issues. The Government has set out clearly in its programme its resolve to address in a targeted fashion the improvement of key aspects of our health and personal social services. Significant increases in both capital and non-capital funding were provided in 1998. These increases have allowed me to make significant progress in implementing the programme.
Further funding will be required over the life of the Government to achieve all that we have set out. I welcome the general support for an increase in the resources devoted to our health services. As a Government we are determined to carefully manage the economy and our success in this area should allow us to plan for increased resources being made available to health. Continued economic success is the key to improving our social services since this will supply the base on which progress can be sustained over the medium term.
The OECD carried out and published a review of the Irish health services in 1997. It found that our system with its mixture of public and private funding has resulted in the provision of a good service at relatively low cost to the taxpayer. On the services side, the report refers to the increased productivity in the system, despite a reduction in the number of acute hospital beds. Patient activity has increased while, at the same time, significant progress has been achieved in the area of day case work.
On the challenges facing the health services, it is worth noting that important developments have taken place across the board in the provision of health services. As part of this progress, health service providers are ever conscious that greater efficiency and effectiveness within the system continues to be one of the major goals for the future. The situation is made more challenging having regard to the need for absolute adherence to the Government's public expenditure policy. In meeting this challenge, I anticipate the full co-operation of all those charged with the responsibility for delivering and managing the services.
Our health services, in common with those in all other European countries, are facing new challenges as we approach the millennium. New technology and expensive new drugs, coupled with an insatiable demand for services, are constantly challenging the health care system. In addition, over the next two decades the working population in this country will stabilise and then start reducing while, at the same time, the number of those over 65 years is increasing. The figures show, that there will be a significant increase in the number of over 65 years and over 80 year olds in the next ten years. The increase in the number of older people has already had a major impact on our health services and the trends I just mentioned will have an even more profound impact on these services in future years.
I will now outline the principal features of the Estimate. The 1998 gross Health Vote is just over £3.125 billion which represents nearly one-fifth of all Government spending on supply services this year. In terms of net expenditure, this is the single largest Estimate in both revenue and capital terms, which emphasises, on the one hand, the commitment of Government to devote a greater share of resources to the health services and, on the other, the need to achieve greater efficiency and effectiveness in health service delivery.
It is important to point out that there have been significant changes in the process of financial accountability and expenditure control in relation to health spending. The Health (Amendment) Act, 1996, known as the accountability legislation, came into full operation in the health services on 1 January this year. We have all subscribed to this new legislation and parties on all sides of the House have a responsibility to make it work. Health boards and agencies have responded very positively in terms of service planning, which links service and financial planning and allowing boards to prioritise developments. Board members responded positively to the clear definition of the roles and responsibilities of the board members and management teams as the key players in the system.
In drafting this Estimate, I was conscious of maintaining the funding for core services thereby allowing for the continued provision of approved service levels. In this regard, the Estimate fully provides for pay and non-pay requirements. I do not propose to go into the details of the Estimate as our time this evening is limited. I would, however, like to touch on some of the main aspects.
This has been the first full year in which this Government was able to address the necessary improvement of our health services. The net non-capital £2,675.546 million provision for health in 1998 shows a 10 per cent increase over and above the 1997 outturn. Further progress has also been made in relation to the capital programme. The 1998 figure of £147.25m is a 12 per cent increase over the 1997 outturn. I do not have sufficient time to set out all the progress that this has allowed during 1998. However, I wish to refer to some of the areas to assure the committee that this Government is already committed to addressing urgent issues. I might remind the committee again that it is regrettable that this Government is confronted by so many urgent problems due to the fact that the parties in Opposition benches failed to address these areas when they were in government during a period of unprecedented economic buoyancy.
On acute hospitals, additional non-capital funding of approximately £30 million has been provided in 1998 in respect of acute hospital services, not including the new Tallaght Hospital. This funding will meet the additional costs of developments initiated in recent years and allow for further developments in relation to the ambulance services, the cancer strategy, the opening of new units which are ready to be commissioned, development of accident and emergency services and increased funding for the waiting list initiative.
I suggest we adjourn this meeting for 15 minutes for the division in the Dáil.
Sitting suspended at 5.15 p.m. and resumed at 5.40 p.m.
When I became Minister I increased funding for the waiting list initiative to £12 million for 1998, which represents a 50 per cent increase on last year's allocation. I also established a review group to advise on how best the waiting list funding could be utilised. That should report in the next month or so.
The Government has been conscious of the need to achieve reasonable self-sufficiency and in that respect will proceed with the implementation of the national cancer strategy and the provision of consultant oncology and haematology services. I have also announced that a cardiovascular strategy would be prepared and work is well under way. I also announced plans for the provision of cardiac surgery and radiotherapy in Galway as evidence of my commitment to regional self-sufficiency. Similarly, major capital projects are at various stages of development throughout the country.
Some £8 million additional non-capital funding and £5 million for capital purposes is available in 1998 to further develop child care services. The Government's amendments to the Children Bill, 1996, are currently being finalised and the Bill has been restored to the Order Paper.
A White Paper is being prepared on the complex issue of mandatory reporting while services to address child begging, child homelessness and child prostitution are being improved. The problem is especially acute in the Eastern Health Board area, where most of the resources have been concentrated. Additional posts have also been approved for the child care policy unit in my Department, which was much needed.
With regard to services for persons with a mental handicap, I have made available a sum of £16 million to allow for the expansions of funding, both capital and non-capital, in this area. We have agreed a major capital programme of £30 million for mental handicap services to be invested over the next five years, with £5.25 million capital funding being provided this year.
On services for the elderly, it is estimated that between the years 1981 and 2006 there will have been a 20 per cent increase in the number of people over 75 years of age and a 28 per cent increase in the number over 80 years of age. The challenge is to reorganise existing services and develop new services in this area. As part of the continuing development of these services significant additional funding has been allocated to further develop community nursing units, day centres and community services for the elderly.
Other additional funding involves £4 million for nursing home regulations, £4.5 million for mental health, £5.4 million for physical and sensory disability, £3.5 million for dental services, £1 million for ophthalmology, £1.5 million for health and safety, £10.3 million for nurse training and continuing education, £5.4 million for management development and information management and £2.2 million for hepatitis services and a commitment to research in that area. The commitment of this level of funding is a start in the phased process of development for a number of the above services and initiatives.
On capital expenditures we have seen a significant increase of 14 per cent on the 1997 outturn with corresponding allocations for 1999 and 2000 being £155 million and £165 million, respectively. A new feature is the provision of money for equipment replacement and maintenance. For the first time this year's letters of determination from my Department to the agencies set out the budgets for the replacement of priority equipment, maintenance backlogs and fire precaution works. I believe that is money well spent.
I am determined to ensure that continuing care services, which cover areas such as psychiatry, mental and physical handicap, services for the elderly and children will get a fair share of the increased capital funding. In that regard I have committed £30 million in capital funding over the next four years to the area of mental handicap. New acute psychiatric units will be provided and there will also be provision of vocational training centres and associated support facilities for people with handicap. There is also increased provision for information technology and there will be increased investment in health centres and public analyst laboratories. New premises will also be provided for the BTSB.
We are providing more funding for financial systems to improve budgetary costing and materials management modules together with patient administration systems. On the commissioning of new units I was able to allocate a total of £5 million in 1998, which has facilitated the opening of facilities at 11 hospitals throughout the country.
There is a changing managerial environment which we all recognise as a result of the new accountability legislation. It frees the Department to concentrate on more appropriate macro management issues. Key among these are monitoring and evaluation. We have seen the establishment in recent years of regional departments of public health and the development of a public health information system which monitors health status. From that type of feedback we can target our resources and should over time see how we perform with regard to our ultimate aim of improving the health status of our community.
We are also working with the health boards to encourage a more critical examination of their performance in specific areas of service deliveries. The service plans reflect that and allow for continuing discussion between my Department and health boards during the course of the year. Health boards are being encouraged to undertake audits and studies of quality of care with a view to disseminating best practice. There is a growing consumer consciousness in health care which is increasingly demanding this. I commend the Estimate to the committee.
In the short period of time available it is not possible to go into as much detail as one may wish. To some extent this debate is repetitive in the context of the recent Private Members' motion on the health service. It is the commitment and view of the Fine Gael Party that we do not have a two tier health system. The disturbing aspect of the current system is that, despite all the money put into it over the years, we currently have a two tier system in practical terms. Speed of access to essential health care is largely determined in different parts of the country in the context of specific specialities by whether one is a private health patient with the VHI or BUPA or one is covered under the public hospital schemes. In the context of essential operations, such as hip replacements and heart bypass, anybody who can use the facility of the private medical system can have access to surgery within days and in some instances within 24 hours. By contrast, they may have to wait many months and on occasions years under the public health system.
We must address this problem. I do not pretend it is easy. Successive Governments have had to confront the type of difficulty the Minister rightly described in determining allocations of resources and priorities. It must be our objective to ensure that people's financial backgrounds do not determine the level of health care available to them and that there is equal access of all to health care with equal speed of access. On occasions decisions are made that people do not require urgent intervention without fully acknowledging the degree of suffering they may endure for an extended period that would not occur had they access to private medicine.
We still have substantial difficulties with the accident and emergency areas in a number of our hospitals. The facilities are Dickensian. People are left to lie on inappropriate beds and they are not admitted as rapidly as they should be. This difficulty has not yet been adequately and properly addressed.
In the context of the child care system we know that, especially within the Eastern Health Board area, the problems of large numbers of children who have been reported to be the victims of abuse have not been investigated or assessed and that they remain at risk. That continues to be a problem despite recurrent attempts by Members on the Opposition benches to raise it. The Minister and Minister of State have not yet properly come to terms with it. For example, it takes far too long to get up-to-date accurate information about the state of our child care services.
The Adoption Board has called for new consolidated legislation and has asked the Department of Health and Children and the Minister to address a variety of areas, including the need for proper procedures to allow birth parents and adoptive children to have contact. This issue encompasses the whole area of foster care and unofficial adoptions which occurred prior to 1952. The Government has been extraordinarily lethargic in introducing necessary legislation in this regard.
The Minister made reference to the Children Bill; all the Government has done in the past 12 months is to restore it to the Order Paper. The Bill appears in the same form as when originally published by the previous Government. We do not know what amendments the Minister is proposing to it but it appears it will not make any progress during this Dáil session and is unlikely to progress this side of the Christmas recess. That is unacceptable.
The Minister and I have had a number of exchanges in the Dáil about Tallaght Hospital. Members on both sides of the House want to see the hospital open and succeeding and want to see the enhanced services it was constructed to provide brought on stream rapidly. One of the greatest gaps in the Estimate is the shortfall in the current funding allocation for the hospital which means that when it opens, only five of the possible 12 operating theatres will function and only seven dialysis units will be operative. A number of other parts of the hospital designed to provide essential services will not be in commission at all in 1998 and there is no guarantee they will be in commission in 1999. I hope we can return to that in the question and answer session.
I want to make one comment which is not intended as a criticism of the current Minister or any past Ministers; rather it is a criticism of the manner in which hospitals are planned. That matter must be addressed if we have a true commitment to efficiency in the public service. Too many things have gone wrong in regard to the construction of Tallaght Hospital and the Minister is well aware of the difficulties which have arisen. Operating theatres have been constructed, deconstructed and reconstructed. The same has applied to the accident and emergency and dialysis units. Something went amiss in the procedures put in place to ensure public money was properly spent in a manner which guaranteed the hospital would be of a design required to provide the services for which it was intended. I feel the matter should be fully investigated by the Comptroller and Auditor General.
Tallaght Hospital is the most expensive hospital development in the history of the State but does not have a proper administrative wing or basic facilities for non-consultant hospital doctors. This situation should never have arisen, although it is not the fault of the current Minister. The problems may date back to the time when Deputy O'Rourke was Minister for Health. The C & AG must investigate the matter to ensure we never again experience these problems which are replications of those which occurred in relation to Cork Regional Hospital and Beaumont Hospital.
I want to make some general comments about health spending. We all accept that there is probably an unending demand for spending in the health area and that the Department of Health and Children is one of the highest spending Departments. As I stated in the Dáil when I tabled a motion on this issue, health spending is closely related to economic performance. We are all aware of what happened during the 1980s there were severe cutbacks in all aspects of the health services but our current spending on these services is not commensurate with the economic boom the country is experiencing.
As public representatives, we are only too well aware of the huge unmet needs in the community. If we are not able to meet those needs in a time of plenty when will be able to meet them? I am strongly of the view that we need to put health spending on a firm footing and provide some kind of framework so that it is not dependent on the whims of a particular Government or Minister for Finance. A close correlation must be established between health spending and economic performance. Ireland's level of health spending is lower than that in many other OECD countries.
We need to peg health spending to a percentage of GDP. I appeal to the Minister to reconsider that; my objective in tabling the Private Members' motion was not to get at the Minister, but simply to urge him to consider some means whereby we could ensure that as our economy grew, spending on health would grow too. Unfortunately, that is not what has happened to date. The Government has choices to make about spending at budget time but the choices made in the most recent budget unfortunately overlooked the huge unmet needs in the health area. The choices taken favoured putting money back into the pockets of those people who were already doing reasonably well and certainly did not take account of the enormous hardship caused to others through lack of access to proper health services.
I welcome the trend towards multi-annual budgeting which is long overdue. This will assist the health boards to plan their services. Budgeting should not be the hand to mouth exercise it was in the past; we should be examining population and social trends and the implementation of plans to meet emerging needs.
I apologise for interrupting the Deputy but I must suspend the meeting as there is a division in the Dáil.
Sitting suspended at 6 p.m. and resumed at 6.10 p.m.
I am concerned about the way the hospitals are still run on a consultant led basis. We should provide a greater role for hospital management. I thought party politics were bad until I got to know the health services. There are many vested interests in the health services and that nettle must be grasped. Greater accountability must be introduced to the hospitals. We do not know how much operations cost in different hospitals. There is a tendency to treat consultants as gods, we may depend on them but they should be accountable to hospital management.
There is an urgent need to change the career structures for hospital doctors. There is no middle management, you are either junior or senior. If that were changed it would improve the delivery of hospital services.
The main point of contention in the health services is between spending money on hospital care or in the community. There has been a major problem with this in the Eastern Health Board area - the large voluntary hospitals had the ear of the Minister of the day and fared better. That system is not sustainable and there is an urgent need to introduce the Health (Amendment) Bill to restructure the health services within the Eastern Health Board area and bring the voluntary hospitals in so that rational decisions can be taken at the lowest possible level on health board spending between the hospitals and community services.
I regret that disability has slipped down the agenda. Mental and physical disability have done poorly and there is grave disappointment among people who had great expectations of this Government. I ask the Minister to give that area some consideration as it is one of huge need.
The Minister of State has already said that £100 million is required for children's services. That is an accurate figure. We talk about improving services, yet there was a lack of willingness to pay decent wages to the staff of day nurseries who were running services in the most socially disadvantaged areas. We are not taking adequate account of our aging population. The Eastern Health Board published a report yesterday which states that it will cost £250 million to put in place services which are required over the next ten years. We need forward planning and provision for these much needed services in the budget.
The double act between this Minister and the Minister for Finance is wearing thin. The Minister is inclined to talk about his concerns and desire to increase funding for health but he should lobby the Minister for Finance. Surely the merits of the case for improved health spending speak for themselves? Surely the Government recognises those needs? It is not just the Minister who is batting for his Department. Is the Government not committed to increasing spending in these key areas?
It is disappointing that only one Bill has been published by the Department in almost one year. I have already referred to the Health (Amendment) Bill to restructure the Eastern Health Board, which is long overdue. The staff are prepared for it, the task force has done its work and everyone has been waiting for it to be published since 1 January, yet there is no sign of it. Why is priority not being given to it? The mental health Bill and the adoption contact register were also promised but they have not been introduced. It has been a disappointing year as regards productivity in the Department of Health and Children.
I thank the Minister for his comprehensive statement. It is over a year since the last general election. Most major initiatives are taken in the first year of a Government's term of office particularly if they are to be realised during its lifetime but there does not seem to be any progress in tackling the crisis in hospital waiting lists, substantially improving mental health and autistic services and reviewing medical card eligibility for large families, despite the fact these are three key priorities in the Government programme. I or anyone directly affected by these services cannot see any substantial change, apart from statements and press releases.
I welcome the three year planning approach which makes sense and the introduction of better management structures in terms of service plans in hospitals in the Eastern Health Board region. However, the Minister is refusing to address the basic inequalities, particularly in our acute hospital service. This is the biggest challenge facing the Minister and it requires resources. This challenge has not been met by previous Governments but our current economic circumstances, which are unprecedented, put an onus on the Minister to meet this requirement. There must also be rationalisation of hospitals across the country. This is a thorny political issue but the Minister needs to address it if we want value for money and shorter waiting lists.
While I understand the emphasis placed on financial accountability, monthly statements and expenditure budgets in directions given to health boards, there must also be accountability in terms of the service provided. We should know on a monthly basis the waiting list for each speciality in any particular hospital. It is extraordinary that Deputies cannot get basic information on waiting lists, particularly when it is available through information technology. General practitioners should be able to access information as a matter of course when they decide to refer a patient to a consultant. They should be able to find out how long the waiting list is for an individual consultant. It is an ad hoc affair at present so general practitioners may unwittingly add to the waiting lists for particular consultants because they do not have that vital information. We are living in an age of freedom of information and strategic management initiatives but we must change the practice as regards information on and assessment of the delivery of services, including those provided by consultants. We must change the service which is consultant led rather than specialist provided.
The Minister has set up a forum to discuss these issues but I thought it was clear what needed to be done. There are too few consultants and they are working in an inappropriate and archaic way with no accountability that is no longer in tune with the modern world. The Government must show it is committed to equality. The Minister will have the support of the Opposition if he transforms the staffing situation in hospitals and the proportional representation of junior hospital doctors to consultants in the public service.
I ask the Minister to outline what accommodation is available for children at risk. I welcome the Minister's decision to increase the number of staff. However, I have been told that social workers cannot get accommodation for children at serious risk of abuse, neglect or violence. What are the Minister's plans in this regard?
Will there be a Supplementary Estimate for the Food Safety Authority because that is vital?
When considering the Estimates, Members may discuss issues relevant to the various subheads but they may not recommend increases or decreases in the Estimates. Do Members want to examine each subheadseparately or would they prefer a generalquestion and answer session on all the subheads?
We will have a general question and answer session provided we are allowed to ask questions across the range of subheads.
Is that agreed? Agreed.
There are a number of problems with the administration of the health service. I agree that we need a customised service which regards the consumer as having priority. We are all consumers of the health service. Why has the Department failed in the basic service of answering written parliamentary questions which it is required to provide in the context of administering its functions and for which the Minister has particular responsibility? The response to written parliamentary questions tabled in the House should normally be available to Deputies on the completion of oral questions which, at the latest, is approximately 4.30 p.m. It is now 6.30 p.m. and, as of five minutes ago, the Minister's Department had not replied to any of the written questions on the Order Paper. That is and has been the pattern since the Minister took office. We are fortunate to have replies to questions from his Department before 7 p.m. This is a very poor service to Deputies and in the context of providing the public with information. As Deputy McManus rightly said, in accessing basic, simple information about the functioning of the health service it is frequently necessary to table questions because the information is not efficiently obtainable in any other way. The information is not being provided efficiently now.
Perhaps the Minister will clarify if it is policy in his Department to deliberately delay filing replies to parliamentary questions until late in the evening in case controversial information is provided or is it simple inefficiency? The only two Departments which regularly provide written answers to parliamentary questions after 6.30 p.m. are his Department and the Department of Justice, Equality and Law Reform. This matter should be addressed in the interests of the proper functioning of the House.
There are extraordinary delays in producing the basic statistical information about hospital waiting lists. Both Deputy McManus and I have put down questions in the last couple of weeks seeking up-to-date information on waiting lists. Quarterly figures are supposed to be provided. We should have had the figures for 31 March by the beginning of May but the only figures so far available are for 31 December. When does the Department get this information? What is the delay and what are the difficulties in furnishing it? The information should be available more quickly if the Minister, his officials and Members of the House wish to properly monitor the efficiency of the health service and if there are difficulties within individual specialities.
There is no deliberate policy of delay in my Department regarding parliamentary questions. This matter has not been brought to my attention by any other Deputy since I became Minister. If a Deputy has a legitimate complaint regarding delays I will deal with it personally. I am not aware of the position outlined by Deputy Shatter. There has not been a level of complaint which would suggest to me that questions are not cleared in time. Questions for my attention are cleared by me before the allotted time. Any other questions are dealt with in the normal way by the Secretary-General or policy advisers in the Department. They do not have to bring every question to my attention because there could be as many as 50 or 60 questions on any given day and I would spend half my day reading replies that do not require my approval or input.
I will look into the matter and revert to the Deputy. It is not the policy of my Department not to facilitate Deputies. I am sure there are reasons for instances of individual delays. However, I accept Deputies are entitled to answers to their questions not later than 5 p.m. That would allow for any delays if I am in the House and there are questions which I need to see.
It is a regular problem with the General Office. The Minister's Department has become notorious with the staff within the General Office dealing with parliamentary questions.
It has never been brought to my attention as being an endemic problem. All Deputies are equally entitled to receive replies, especially spokespersons, who should have this information when it is supposed to be available. I will check into the matter.
On the question of waiting lists——
The same questions arise regarding statistics on child abuse. There seems to be a huge gap in time before the information becomes available.
Funding has only recently been available to health boards in trying to provide updated information systems. When I was in Opposition I had the same difficulty as the Deputy on waiting lists. The problem is that much of the information is not collated. There is usually approximately a three month delay. Even now, my information is that some hospitals are still outstanding with regard to the March figures, which must then be validated, a process that was in place when my predecessors were in office.
The indications are there was a huge increase in hospital admissions over the winter. Problems with the blood supply has affected elective procedures. Very little work is done in the hospitals in the first three months in any event. The waiting list initiative is most effective during the summer months. A problem in the past has been the inability to get the relevant funding until August or September. The hospitals do not have that excuse this time because we gave them the money in January. However, I understand there is not much of a change in the figures. If anything, they may be slightly be up.
We are undertaking a timely review of the waiting lists. I have increased the budget by 50 per cent. A consideration of the first three months is not the best way to judge the performance of the hospitals. They should be judged over the year. I would expect an improvement because if they have the money they have a better opportunity to plan.
Unfortunately, we do not have touch button technology which would give us the information we need. I would like to know on 1 April what the situation was on 31 March. We have only begun an investment in management systems and information technology. We are not up to date. For example, some of the allocations made recently are designed to bring basic telephone technology to hospitals, let alone establish information systems to ascertain, say, the number of outstanding hip replacement operations. We must get our priorities right.
I understand there will be a division on this matter in the Dáil at 7 p.m. I suggest we reconvene at 7.10 p.m. Is that agreed? Agreed.
Sitting suspended at 6.40 p.m. and resumed at 7.10 p.m.
If we include information technology we have a better chance of getting results sooner. We do not want hospital administrators and managers rechecking figures on a monthly basis rather than getting lists down and the job done.
Can we raise questions on any aspect, Chairman?
We agreed that we would take general questions across the various subheads.
I will start with the administration budget, specifically concerning the planning unit in the Department. I concur with the points made by Deputy Shatter. When tabling parliamentary questions on, for example, the number of patients in nursing homes or children in care, I regularly receive replies stating that such information is not available and will have to be sought from the health boards. Subsequently I may or may not receive a reply. What is the planning unit doing and why is such basic data not available? How can one plan for services unless one has such basic data? It seems that much of the planning is left to the health boards. For strategic reasons it would be better if many of these decisions were taken at departmental level.
There are two issues involved. As Members of the House we are all guilty of using parliamentary questions to obtain information which is readily available from health boards. We cannot have it every way. We have said that we want to devolve functions and responsibilities to health boards. We also want the Department to become more involved in strategic planning but where can we get the data to achieve this? On numerous occasions Deputies ask a parliamentary question seeking, for example, the number of people on a waiting list from 10 June 1997 to 10 June 1998. The statistics prepared are based on particular times, usually the calendar year, bi-monthly or six monthly. We spend a lot of time collating data to reply to questions. This can involve contacting every hospital and health board to find out the position from, for example, 31 March to 10 June. That involves a lot of wasted time and it is unhelpful. At the same it is a Deputy's right to table a question.
With a health framework as dispersed as ours, which comprises voluntary and statutory hospitals and private nursing homes, and while we have general statistics available to us from the Central Statistics Office and other agencies outside the Department, Deputies are sometimes unrealistic in expecting a reply within two days to the questions they ask. I am not moving from the basic point the Deputy made and we must try to make improvements, but it is a fact that Deputies use the parliamentary question system to inquire about constituency issues dealt with by the health boards. Rather than involving the Department in finding that information which is readily available by using the phone rather than tabling a PQ, I suggest that many of the matters could be referred to the health board as that is where the information can be obtained.
I am not talking about us seeking data up to last Friday but about general care areas, such as service for the elderly. I tabled a PQ recently seeking the number of health board nursing home places, the number of contract nursing home places and the numbers on waiting lists for those places at the end of last year. That data was not available. How can future provision be planned if the current one is not known?
The planning unit is involved in strategy development and that is a recent phenomenon. Deputy Noonan, when he was what was then known as the Minister for Health, had a cancer strategy; I have a cardiovascular strategy which is multi-annual. We are trying to ensure matters are dealt with on a multi-annual basis but only in the past two years have we embarked on multi-annual budgeting. Before this, the Department was involved in an Estimates campaign with the Department of Finance every year which was conducted at different times depending on the Administration in place, the availability of personnel and on political decisions. That did not allow the Department to be involved in strategic macro-management. However, that has begun now.
There are still tensions between the Department of Health and Children and the Department of Finance. The Deputy suggested that it was an argument which wears thin but, unfortunately, it is a reality for every Minister for Health and Children. We develop and obtain approval for strategies but, when it comes to the Estimates, the Department of Finance attempts to revisit those issues which we would understand as having already been agreed. I understand the Department of Finance has a case to make but the push for multi-annual budgeting is greatest from that Department. Sometimes it is necessary to remind its officials during an Estimates campaign that a cardiovascular strategy has been agreed for the next three to four years and that they cannot revisit the strategy and attempt to reshape it because of another problem.
The planning unit has a strategy development function for the development of evaluation systems, co-ordination of policy issues arising across Departments, co-ordination and development of value for money strategies - which have been good - and international data and health statistics. Regarding health statistics, we have depended upon not just the Department but also on other agencies which are not part of the Department, such as the CSO which collects statistics on a range of matters. The veracity of those statistics, the methodologies used and whether the Central Statistics Office is sufficiently equipped are issues which have bedevilled successive Governments, but I understand there have been improvements in the area.
I am not saying there is no validity to the points the Deputy makes but the Department and the running of the health service have been subject to scrutiny by the OECD and others and we emerge favourably. Other Departments, such as the Department of Finance, probably hoped we would not emerge favourably because it would have increased their leverage in stating that too much was being spent on health. No one here believes that.
In terms of planning for the future, any strategies devised are based on good data but the Department is different to others in that it has devolved functions and responsibilities to local level. Health boards are doing good work because they have the personnel to get involved in research and the collection of statistics. Better results would be achieved if health boards were to be involved rather than the Department because it must ask the health boards for the information in the first place.
Deputies made the point that they are dissatisfied and believe the statistics are not as readily available as they should be. I will investigate that further and return to them with a more detailed reply. However, they must take cognisance of the manner in which the health services developed historically. It was not a simple, incremental, organic growth across the health board areas. There are different levels of service in each health board area but that is the price to be paid for devolving functions to the local level.
This is a critique of the administration of health boards; we are not levelling political charges against the Minister. Each of his predecessors could be regarded as equally responsible for these problems.
There is a problem and I do not see how a planning unit, such as that in place, can provide planning strategies without having at its fingertips up to date information across the broad range of services provided by the Department. I appreciate the unit may address individual areas, such as the cardiovascular area mentioned by the Minister and the cancer strategy of his predecessor, but an essential tool of the implementation of any strategy is that what is happening is known.
Up to date information systems in health boards and hospitals are not a luxury but an essential tool to ensure the strategies put in place are not addressing issues 18 months out of date and that the right priorities are being made. While each of the health boards has an independent function, it is the Department of Health which has the central supervising function in a number of areas to ensure the health boards comply with statutory duties and the boards have certain reporting obligations.
In that context, there has been a great deal of controversy and difficulty in the child care area in the past 12 months. There has been an uncertainty as to the level of reporting of child abuse or child neglect and various statistics have been used. The Taoiseach told the Dáil six months ago that the cases of over 1,000 children awaited investigation; at a social worker conference the number was said to be 2,400. A parliamentary question to which I was anxious to obtain a reply before the start of this session showed that, on 31 December 1997 and based on statistics provided, there were 7,312 reported cases of child abuse in the health board areas; they were a mixture of physical, sexual and emotional abuse of children and neglect. There were 2,659 confirmed cases and, as of the end of February, 568 cases awaited investigation. What is extraordinary about this statistic is that, six months after the information should have been provided to the Department, information is still incomplete because those figures apply to seven health boards.
The Southern Health Board informed the Department that it cannot provide the Minister with any such information at present because it is reviewing the way it gathers statistics. It is outrageous and unacceptable that a large health board which has a statutory responsibility for the care of children and under the Child Care Act, 1991, is obliged to report to the Department on the manner in which it is conducting its functions, can blithely inform the Department that it does not have the information because it is reviewing its system for collating statistics.
The Minister, apparently, is not entitled to that information, nor am I as a public representative. We do not know if there were 400 cases of alleged child abuse in that health board area or half that number or how many cases have been confirmed or how many cases await investigation. That is an outrage. It is not the way a health board should conduct its business. There was also a difficulty getting this information from the Eastern Health Board. The Minister of the day, at an administrative level, should seek through his or her officials to ensure that the health boards are collating this information in a systematic way so that it can contribute to the manner in which policy is administered.
This committee needs answers to certain basic questions. I do not know if the Minister is allocating sufficient funds this year to the Southern Health Board to deal with child care. I have a view about other health boards and the level of outstanding cases that must be addressed. We are now aware of the different burdens and reports the health boards are tackling. Of the health boards which have provided the Minister with information, the Eastern Health Board has the largest number of outstanding cases at 379. That is significantly lower than the numbers that were quoted in the past. I do not know how accurate the statistics are.
This is not simply a matter of Deputies acquiring statistics for the sake of a line in a newspaper about the number of cases and political statements about how terrible the problem is. It is about examining whether the health boards can properly fulfil their statutory functions. What systems must be put in place to ensure they are fulfilling them? Do they need additional social workers? Are the people in the health board sufficiently trained to cope with the level of work? In the case of the Southern Health Board we do not know the answers to these questions.
In previous years I put down similar questions for the Minister's predecessors. There were difficulties on occasion and long delays in getting responses but I am almost certain that the Southern Health Board collated statistics of this nature. I do not understand why they are not available this year. These are not simply statistics, they are figures of the number of children at risk. We do not know how many have been abused or neglected in that health board area or how many might be at risk at present. That is not good enough.
If health boards cannot deal with an issue such as this in an efficient manner, public confidence in their capacity to fulfil their statutory role with regard to children is undermined. The Minister has an obligation to use a big stick and to inform the health boards that they must have proper systems in place. I hope the reply I received will be followed up by the Department. While it is important that there are proper systems in place, the Southern Health Board should be told that a review of a system is not an excuse for not being able to give information on this matter as of December 1997. The board's response is not acceptable; it is the type of response one might expect from a banana state which lacked a coherent bureaucracy or administration.
I am not criticising the Minister for this but I hope the Department will indicate to the Southern Health Board that its reply is not good enough. The board must be required to produce this information so we can determine the policy difficulties in the health board area for dealing with child care issues.
I accept some of the Deputy's points and I will be in touch with the health board. With due respect to the people who were trying to work with little resources in this area, there was no child care division until now. I have secured approval for the appointment of an extra 16 people to develop a child care division. Now that we have the personnel we have a better chance of dealing with the points made by the Deputy and of monitoring what is happening in each health board area.
The Oireachtas enacts a great deal of legislation but in many cases it takes a long time to put systems in place to implement it and to ensure that people meet their obligations. There probably is concern in the health board about definitions and whether the comparative figures are correct but I accept the point that some degree of response is required. If the board cannot have a response within three days of the parliamentary question being put down, it should give an indication of its situation and provide the answer as soon as possible after that, which means within a further few days. If the precise figure cannot be given, an explanation should be given why the precise figure is not available.
The Deputy has raised a specific issue and we will deal with it. However, I was anxious to explain that the Department now has a large number of personnel devoted to this issue, which demonstrates the seriousness of our intent.
The fact that the health boards do not have personnel to gather data also underlines the extent to which the child care services are seriously underfunded. All staff are carrying heavy caseloads.
My questions relate to value for money. The various drugs schemes cost over £250 million but it was recently brought to my attention that there is a major discrepancy between the cost of similar drugs under different schemes. Drugs which are prescribed under the GMS scheme are significantly cheaper than those prescribed under the long-term illnesses scheme or the drugs costs subsidisation scheme. Can the Minister explain that? It is hard to understand why that is the case but I was given data by a pharmacist which indicates that there are huge variations in the costs under the two schemes.
My second question relates to value for money vis-à-vis hospital waiting lists and the initiative undertaken by the Minister. He spoke about the additional funding allocated to hospitals in this regard but we do not know what is being done with it or the impact it is making. I hope that information will be available soon. What were the conditions under which the additional funding was given? On a previous occasion a Minister sought to ask hospitals to tender for operations.
One sometimes gets a sense that hospitals are black holes with regard to waiting lists. Money is being given to hospitals but we do not know if we are getting value for money or how many operations were carried out with that funding or how one hospital's costs compare with another. Will the Minister explain how he ensures that the Department is getting value for money for the increased funding?
The drugs schemes involve various agreements with the pharmaceutical industry. Recently I attended a function held by the industry at which its representatives berated the Department for doing such a keen deal on the cost of drugs. I will give the Deputy a detailed reply in writing because the Department has complex arrangements with the industry. Rather than make it up as I go along, I prefer to give the Deputy precise information on this matter.
With regard to waiting lists, we are aware of the need in each health board in terms of the specialties. The waiting list initiative allocation this year concentrates on waiting times rather than lists, that is, on finding out how long people are obliged to wait. It varies from one speciality to another. Orthopaedics is a particularly difficult speciality; more than 8,000 people are waiting for those services. We allocate on the basis of our assessment of which hospitals can provide the service. This is based on their capacity - the availability of surgeons and theatres - and so on. These vary from hospital to hospital. Our hospital services division is acutely aware of the different capacities of various hospitals.
In the review I was anxious to look at the practice of confining patients to their own health boards. Must a person on an Eastern Health Board waiting list be treated in the Eastern Health Board area or can that patient be treated elsewhere? The review attempts to address all these issues. There is considerable anecdotal evidence for the reasons for our failures. There is a problem with bed lockages and a need for more step-down facilities in or near particular hospitals which would allow for greater throughput. To what extent are accident and emergency departments taking up beds which had been allocated to patients on waiting lists for operations so that these operations are cancelled? How can we counteract these problems?
The criteria for allocating money for the reduction of waiting lists to individual hospitals included (i) the extent of spare capacity in each hospital, (ii) whether the hospitals with the longest waiting lists have the spare capacity, (iii) the price quoted by the hospital for targeted procedures and their relative efficiency in the targeted specialities and (iv) the track record of individual hospitals in delivering the agreed reductions. These criteria are quite rigorous.
Does the Minister have quoted prices from various hospitals? Can that price list be made available?
I do not think there is any problem with that in principle.
There is an issue of value for money and whether hospitals are providing services at the most competitive rates.
When comparing prices one is not always comparing like with like. Varying technologies are available in different hospitals and if that criterion were applied strictly, some hospitals who are awaiting capital investment for hospital improvement would be discriminated against. Such hospitals might have very capable surgeons who, if they had the necessary facilities, could improve their throughput. The knowledge and experience of the hospital services division enables allowances to be made in such cases. This does not breed inefficiency but tries to make sure there is fairness in the system.
I share the Minister's bias in favour of redressing the regional imbalances in the provision of hospital care and medical services. It is important that all regions are provided with the best possible medical services and that we do not have a Dublin orientated health system. Given that bias, in his reply to Deputy Shortall, the Minister came to a problem. There are areas of specialty in which the level of capital investment is so large - specialties are breaking up into several separate specialties - that regionalisation poses a risk of providing a fragmented and inefficient service. The perception can arise that there is regional inequality of access to health care when the medical technology available in some regions is superior to that available in others. For example, people who contract cancer or have cardiac problems may get a far superior service in a particular health board area because of the degree of advancement in technology and the number of specialists available there.
The Minister has been criticised by members of the medical profession working in cardiology for splintering the service. It may be advisable to concentrate a speciality to a more sophisticated degree so that a better service can be available although people have to travel to it. An illusion of regional care can be created because some hospitals are not being provided with the necessary resources to provide the most advanced medical technology. I would like to hear the Minister respond to that.
I wish to ask the Minister about the lack of MMR scanning equipment and the difficulties which result. There has been much criticism from the medical profession of the manner of dealing with certain injuries because our hospitals do not have the appropriate equipment and are forced to fund raise to provide it.
May I ask the Minister about orthodontic treatment? Dáil Questions are tabled daily about individual children who need orthodontic care. The reply is always that these services are the responsibility of health boards and that the Minister will ask the chief executive officer of the health board to write to the Deputy concerned. We have an illusion of providing this service. Children who are in extreme need of orthodontic care will get it but so called grade 2 cases can remain on waiting lists for years and miss out on the treatment altogether. If their parents have the financial means they get the treatment privately. This is to the detriment of many children. Can the Minister tell us approximately when all children - who are legally entitled to free orthodontic care - will be provided with it? If this will never happen, should we not revise the scheme making it clear that certain categories of orthodontic treatment will be provided by the State and others will not?
There is a problem in the orthodontic service. The demand for orthodontic services has far exceeded what was anticipated when the service was planned and budgeted for. The Department of Finance will say that they did not agree to provide the resources which are now found to be necessary. That is the problem. We are reviewing the guidelines in an attempt to deal with this issue. There is an orthodontic dental service in six of the eight health boards. Deputy Shatter's colleague, Deputy Ulick Burke, raised recently the appointment of an orthodontist in east Galway and I was delighted to be able to reply to a parliamentary question that an orthodontist had been appointed. However, the appointment did not last and the Deputy told me the following week that the person had left.
There is undoubtedly a problem. We will be reviewing the guidelines. The Deputy can take it that we will not be expanding it in the circumstances. We must reach conclusions on the matter. One of the ways huge lists in the Eastern Health Board area were reduced was by removing many of the adults who were over the age from the list. The Department and I acknowledge there is a problem but we are working against a difficult background.
The Deputy mentioned regional imbalances in cardiac services. There are cardiac units in Cork and Galway and two in Dublin. Heart disease is the second biggest killer in the country and our heart disease levels are way above European averages. It is not fair to compare us with other EU countries which do not have the same levels of the disease.
It is a fair point that can be made by specialists who are looking at the matter from a different perspective: why should a person in north Mayo or Donegal have to go to Dublin or Cork? It is not practical. It would be as easy to put them on a plane to Liverpool. It is our job to achieve balance. From one perspective it might be argued that all cases should be put in one unit, but there is another view against having a single super unit because there may be problems with MRA, etc. The best outcome may not be achieved through having one large unit.
The decision on Galway was made taking into account that view and the need to provide equity of access. The cardiovascular strategy is the best example of my attempt to eliminate a two tier system. The idea is to deal with this issue in a public way over three or four years. Once that is done there will be the capacity and infrastructure to ensure that those without the £5,000 or £10,000 needed to have a life saving operation can have it. However, this is being done in a way that will not overheat the system.
Paediatric cardiac surgery, heart lung transplant and spina bifida also present problems. I have met parents who have harrowing stories to tell. We are also making attempts to solve those problems by involving the Mater Hospital in an overall solution which will find favour with everyone, not because it disperses the problem but because it acknowledges the extent of it and how we might address it in planned way.
I am proud of the decision taken and I am grateful for Opposition support. There has been fair criticism about delays based on previous decisions but we have come up with a different solution which is better all round.
With regard to cancer and mammography, there has been a problem having adequate support of specialist personnel to read the data which emerges from the machinery used. With regard to the cardiovascular strategy and the previous Minister, Deputy Noonan's, cancer strategy, these are the first examples of adopting multi-annual approach planned properly. It is important, for example, to be prepared to take time with breast screening so that we do not end up with false positive results, as happened in the UK, and thereby undermine the system. We are in a position to meet the September start up date, hopefully in the three health boards where there is 50 per cent of the target population - the Eastern, North-Eastern and Midland Health Boards. There will also be mobile units.
Regional self-sufficiency provides the possibility of consultant outpatient facilities for other hospitals in a region. Deputy McManus made points which were surprising given her Democratic Left perspective about rationalisation in hospitals and closing some hospitals, as she would see it, to have better facilities but in fewer hospitals. Theoretically that may or may not be the case. The political reality is that we are reconfigurating activities in hospitals. For example, in the Western Health Board area there is a regional hospital in Galway; we have decided to carry out major investment in Castlebar, and Portiuncula and Roscommon hospitals, which were voluntary hospitals, will have sessional splits with an extra surgeon. Rather than having hospitals working in isolation we are developing a network.
I visited Roscommon hospital yesterday. It has been a bone of contention for many years but with good management, a new matron and new thinking it will have role to play. That may not be a role as the stand-alone regional facility envisaged 20 years ago but its future is secure on the basis that we can reconfigure and get co-operation to avoid duplication of service. The people of County Roscommon need the hospital but we want to be sure it is giving the right services. In the mid-1980s there were over 200 beds there and there are 116 now but the hospital now deals with about twice as many patients as in the past. We will develop day care capacity there to deal with cases. No one will get political support for suggesting that we return to the idyllic world of having eight rationalised hospitals in the country. We must be realistic.
I visited Now Ross hospital which is a small, community hospital run by a voluntary group. There are about 35 patients, most of whom are psycho-geriatric patients. I will give the hospital £70,000 to keep the 35 beds going which is good value for money. Medical theorists might argue that one cannot have such hospitals because they are not up to scratch. However, it does a job for its community. We should consider them as practical, local resources and not lose ourselves in theory.
The subject of regional self-sufficiency provides for a good discussion. Problems have arisen in some health board areas about how they will develop cancer services. Unfortunately, localised problems can take over. The National Cancer Forum is an advisory body with real expertise which can assess the role of health boards. This will be a lead hospital for cancer services but there will be cancer services also in other hospitals. For example, cancer services in Portlaoise Hospital will be enhanced under the original scheme and the service will continue in Mullingar.
The interest of patients is sometimes lost in the institutional arguments which are not always led by politicians but by medical people who can sometimes lead politicians. Politicians should not be led but should focus on what is in the interest of patients. We acknowledge the importance of community hospitals as local institutions that can provide a service. We can invigorate the service and come up with a reasonable policy which will ensure optimum patient care. The Department has a very clear view on this which it has shown in the areas of cancer and cardiovascular services. These are the two big killers apart from accidents.
What are the Minister's financial plans for Tallaght Hospital? In my view this year's expenditure for that hospital will fall about £20 million short of what the hospital requires. There are five operating theatres in operation in the hospital at the moment. When does the Minister envisage the other operating theatres will come on stream? When will the dialysis units be operating fully? I am concerned that a large section of the physiotherapy department has wooden flooring which was put down to provide for the storage of hospital records. I fear that in ten years time this department will still be storing the hospital records. Does the Minister now need to fight a battle with the Department of Finance to get the resources necessary for 1999 in order to ensure the entire hospital will then be functioning or is it agreed as a strategic issue that such funding will be provided? What will the position be following 21 June regarding the opening of other areas of the hospital during 1998?
This will be a great facility when everything is up and running. Five operating theatres will be operational on the opening of the hospital and ten will be operational by the end of 1998. This is part of the opening phase. Regarding the dialysis unit, 14 stations have been built. The initial opening of Tallaght Hospital is about transferring existing services and then building on that. The Meath Hospital has seven dialysis stations. These seven stations will be transferred to Tallaght Hospital and the additional seven stations will be phased in. I cannot say what the funding for 1999 will be until the Estimate is completed. I am hopeful of getting significant additional funding.
We are committed to fully completing and bringing on stream the most ambitious hospital project undertaken but because of the huge scale of the project, it is inevitable that there will be initial problems. I am getting day-to-day reports based on the schedules agreed and progress is being made. I am kept fully informed of what is happening because I am anxious that there will be a satisfactory opening of the hospital. It cannot be predicted how many patients will arrive in A&E on 23 June but we hope to be in a position to deal with whatever happens. This is what managers are for and we will deal with whatever happens on the day. Arrangements have been made for 60 beds in the Meath Hospital which will support Tallaght Hospital and St. James's Hospital for the next 12 months. It will probably continue beyond that in order to meet the inner city and south inner city needs. This is a fair response while waiting for the private bed complement. Some of the public bed complement will have to be private until the facility is built. Contingency plans are being put in place and we are anxious not to repeat experiences when new hospitals opened. However, we are not prepared to allow ourselves to be pushed into a certain position where more money must be expended.
When we got the submission from the Tallaght Regional Hospital Board in March 1997 we provided them with additional capital of £4.1 million for improvements to the outpatients department, intensive care unit, theatre recovery area, X-ray department, extension to the hospital sterile supplies department, orthopaedic, trauma and child health services. In 1998 an additional £4 million was provided to commission and open the hospital, together with an additional £1.7 million. This is 1.5 per cent of the overall cost. These additional funds do not allow us to open the additional facilities but it is intended to bring them on stream next year. The additional facilities include one theatre and theatre reception area, which will be required in 1999, the observation wards and adult A&E, segregated resuscitation unit, seven dialysis stations with four high dependency beds and three beds in the recovery area, age related day hospital, an extension of the autopsy service and radiology to ultra sound rooms. Now that this significant investment has been made, I am confident that there is agreement across departments to transfer existing services and deal with any problems that arise.
Members of the media who are not here today will be very anxious on 23 and 26 June to see what are the problems. There may be problems but they will be manageable. I am confident that Mr. McCutcheon and his staff are committed to making this hospital the best there is.
There was a great deal of speculation and I dealt with that as best I could without being too dogmatic. I met union representatives, staff interests and management. The selection of the date, 21 June, was not a political decision but was given to me by the board last December. Given that we spoke about opening the hospital in August 1997, anybody in my position would not postpone it but would hold their nerve and get into it. We will deal with the problems.
I thank the staff interests and the unions who are anxious to create a structure to deal with the major issues which have arisen - the HSCA, the Department and management will deal with them. We will not run around for six weeks while the problem deteriorates; I may be prepared to look at some issues. We will try to be as innovative as we can. The Department does not have a great deal of money at its disposal so we will use every opportunity to resolve these issues without it. Sometimes money is required as part of a temporary measure.
I hope all goes well with the Tallaght Hospital; we all have an interest in ensuring it succeeds. I am trepidatious about the timescale as regards the full services the hospital was constructed to provide. This is important as it would be a tragedy if, following the opening of the hospital, the enhanced services did not come into operation at an early stage.
I accept that this is a huge move, involving three and a half hospitals - if St. Loman's patients are included. Some time is needed for settling down, but this was not envisaged as a problem. However, there will be a huge problem if the Minister does not have and does not allocate the necessary resources to allow the fully enhanced services for which the hospital was designed to be provided. There will be difficulty in the area of elective surgery if the full complement of theatres is not functioning relatively quickly. The aim is that all but one of the theatres should be functioning before the end of December 1998. If other theatres are not functioning within four to six weeks of the hospital opening, the waiting list will grow and there will be a big problem which the Minister will have to address.
I hope the hospital is successful and that everything goes well. I hope the Minister does not have to confront a crisis following the opening. It is important that the public has confidence in the hospital's capacity to provide the health services for which it has been designed within the huge new community of Tallaght which has been ill-served for many years. This hospital is a vital component in the provision of essential services for a major part of County Dublin.
I agree. A great deal of planning has gone into facilitating the move and activity levels are up 12 per cent to allow for the fact that other theatres will come on stream later in the year. Even if Tallaght Hospital was not to open in 1998, the activity levels envisaged in the three constituent hospitals in terms of surgery, etc., would be the same. The commitment is to transfer existing services. By increasing activity levels before moving, we are allowing for the reduction in activity after the initial opening of the main hospital.
I thank Members who contributed to the discussion.