I welcome the Minister. The proposed timetable for the meeting, which has been circulated, allows for an opening statement by the Minster and Opposition spokespersons, to be followed by an open discussion on the individual subheads by way of question and answer. Is that agreed? Agreed. I invite the Minister to make his opening statement. He has 15 minutes.
Estimates for Public Services, 2002.
Vote 33 - Department of Health and Children.
I thank you, Chairman, for giving me this opportunity.
This is the third occasion on which I have addressed the committee on my Department's Estimate. As on previous occasions, I am happy to report substantial increases in health spending of more than €1 billion, representing an overall increase of 17%. In ongoing revenue terms, the spending level for 2002 is almost €7.7 billion, representing an increase of almost €1.2 billion, or 18.2% on the equivalent figure in the 2001 Revised Estimates volume. On the capital side, the 2002 spending level is increasing by 44%, to €497 million.
At this point it is opportune to reflect on the Government's overall performance in the area of health care since taking office five years ago. It is a performance of which we can feel justly proud, not purely in relation to increased funding, which over the five year term has amounted to €4.3 billion, or an increase of 134%, but in almost every other aspect of health care provision. On taking office the Government recognised the need to improve the level of investment in both the continuing care and primary care programmes. I am privileged to record that we have achieved our goal, but more is required. Future policies are clearly set out in the national health strategy, in the new vision for primary care and in the review of bed capacity. I will, of course, continue these improvements throughout 2002.
As a percentage of GNP, gross non-capital health expenditure now stands at 7.8%, which is the highest figure in almost 20 years. Furthermore, when the past four years are considered it will be seen that the rate of increase in gross non-capital health expenditure has been outstripping the rate of increase in GNP by an average of 10.7% each year. These figures demonstrate more than any other the clear and sustained commitment of the Government since taking office five years ago to bring investment in the health services to a level never previously enjoyed by the citizens of this country.
Turning to the detail of the Estimate for 2002, I have secured a significant increase in funding for the health services. This will allow me to continue with substantial improvements in the services. The establishment by the Government of the national development plan represents the single most important event in the development of the health capital infrastructure. It will bring significant and tangible advances in delivering a more patient-centered and accessible service, a cornerstone of the health strategy, which is concerned with equality and fairness.
Already, under the plan, €668 million has been provided for the health sector. In 2002, funding of €496 million is available, the largest ever capital programme agreed by a Government for the health services. The 2002 funding represents a 33% increase on the 2001 outturn. This will allow for the progression of many major projects in the acute hospitals sector. In the non-acute sector, a wide range of initiatives will be progressed, including the Hospital of the Assumption in Thurles; the acute psychiatric units in Sligo General Hospital, St. Luke's Hospital in Kilkenny, Ennis General Hospital and Beaumont Hospital; services for the disabled at St. Ita's Hospital, Portrane, and Dingle Community Hospital; community nursing units for older persons and a health centre for Birr; and community care headquarters and health centre for Tralee. As part of the 2002 Estimate provision, additional funding was provided for an additional 62 beds at Naas General Hospital and the purchase of Portiuncula Hospital. The funding will also allow for the implementation of a number of high priority issues included in the national health strategy, such as disability services, older people's services, bed capacity, primary care model, primary care GP co-operatives, primary care diagnostics and ICT.
The staffing of our health services continues to be another of those critical issues affecting our ability to meet the increasing service demands across all programmes. The total staffing figures for the public health service have increased from approximately 68,000 in 1997 to approximately 86,000 at the end of 2001. As a consequence of the increased funding provided in this year's Estimate, this number will rise by approximately 6,000, to 92,000 overall. In addition, the Government, through the PPF and other agreements, has significantly increased the earnings of health sector staff. Coupled with initiatives on working time reductions and flexible employment facilities, the health service is becoming a more attractive environment in which to work.
The 2002 Estimate provides approximately €42 million to support the many initiatives in personnel management and development. In addition, I will shortly establish the health skills group. One of the key functions of the group, as highlighted in the health strategy, will be to assist the Department in developing the capacity for integrated workforce planning in the health service. The main benefit from the adoption of an integrated approach to workforce planning is the scope it provides for a greater alignment in the future of service developments with the human resources required to ensure there are sufficient trained and qualified personnel to deliver new and enhanced services.
The success around recruitment, and the indication from returns from agencies that retention initiatives are starting to bear fruit, demonstrate the extent to which the human resource function within the health service has improved in recent years. The picture will become clearer with the publication of the annual census, which is due in April. Despite the improvements made to date, there is still much more to be done.
The new nursing degree programme is one of the particular successes of our human resources initiatives. Last October the Government approved my proposals for the implementation of a new four year pre-registration degree programme for nursing students on a nationwide basis at the start of the next academic year. Some of the significant facts concerning the programme include a capital building and equipment programme totalling some €223 million overall, 13 higher education institutions nationwide and revenue funding of €5.65 million to cover the net additional costs arising in 2002.
Nurse training places will be increased in 2002. There will be 93 additional training places overall, including 40 in intellectual disability, 38 in psychiatric nursing and 15 in general nursing. This means a total of 1,640 places nationally will be available from this year on the new degree programme. This is an all-time record. The recruitment of nurses continued to run strongly ahead of the numbers leaving, with a net increase of 1,896 nurses as at 31 October 2001.
In respect of consultant posts, some 340 additional consultants are in place compared with the position in 1997. There is now one consultant per 1,200 of the population, compared with a ratio of 1:3,000 ten years ago.
Since coming into office the Government has placed heavy emphasis on the development of new accident and emergency services. A total of 16 major capital investment projects have been initiated, both in respect of new facilities or extensive refurbishment and enhancement of existing facilities. Some 1.2 million patients are now seen annually at accident and emergency departments. Funding of €7.3 million is provided in 2002 to continue with developments.
It is worth reflecting on the position with regard to waiting lists which pertained when the Government came into office in 1997. At that point there was the equivalent of just €10 million available to tackle waiting lists. My predecessor, Deputy Cowen, and I have increased this figure substantially each year and it now stands at almost €44 million. Last week I released the hospital waiting list figures as at December 2001. The total, at 26,126, represents a decrease of 1,731 or 16% in waiting list numbers relative to the comparable figure for December 2000. Furthermore, when compared with the figures for December 1997, the reduction is about 19%.
These figures should be viewed against the background of a hospital system which is continuing its high productivity. The number of people treated last year as in-patients or day cases in acute hospitals was 920,000. This is an increase of 6% over 2000 and represents an extra 52,000 persons treated over the period. This is the largest ever increase in hospital activity in any one year. When compared with the 786,000 people treated in 1997, the increase is 134,000 or 17%.
Since December 2000 there have been significant reductions in the waiting lists for target specialties. Cardiac surgery is down by 49%, ENT is down by 22%, gynaecology is down by 17%, vascular surgery is down by 12% and orthopaedics is down by 6%. The number of adults waiting for more than 12 months for treatment in the target specialties has fallen by 14% over the period December 2000 to December 2001. The number of children waiting for more than six months for treatment in the target specialties has fallen by 3% over the same period.
Some €65 million is provided - capital and revenue - to meet the first phase of a programme to provide a total of 3,000 new acute beds over the next ten years. Our target in the health strategy was to increase acute beds by 650 in 2002. As the committee will be aware, I was able to announce plans for an additional 709 beds in the current year and to provide funding for those beds. I am confident that these additional beds will bring much needed relief to the acute hospital system.
Some €30 million is provided in 2002 for the purchase of treatments for public patients. The treatments will be purchased from either private hospitals in Ireland or, if necessary, from abroad. I have appointed a person, Ms Maureen Lynott, to head up the team and consideration is being given to a number of options. Taken together with the waiting list initiative and bed capacity funding, significant improvement in access to acute hospital facilities can be achieved in 2002.
The Government has allocated more than €103 million to date to cancer services. Since 1997, 64 additional consultant posts have been created together with support staff. In recognition of the need to further develop cancer services, the national health strategy has identified the need for the preparation by the end of this year of a revised implementation plan for the national cancer strategy. This plan will be developed by my Department in conjunction with the National Cancer Forum and will set out the key investment areas to be targeted for the development of cancer services over the next seven years.
Since 2000 more than €14 million has been provided to develop renal services, including €2.8 million in 2002. The aim is to achieve a structured enhancement of the capacity of the system to meet existing and anticipated growth in demand and to ensure the equitable availability of treatment choices for patients throughout the country. The funding will assist the proper resourcing of regional centres, to provide consultant nephrology services in all regions and widen the availability of continuous ambulatory peritoneal dialysis, CAPD programmes.
Funding is also provided to continue a number of other developments in the acute hospital sector including: cardiac surgery infrastructure, €2.7 million; heart-lung transplantation programme, €1.8 million; accreditation, €1.8 million; breast screening and treatment, €2.8 million; and the winter initiative, €7.3 million.
The health strategy set out a clear approach to meeting the needs of older people over the next ten years. In the past five years some €237 million has been invested in services, including nursing home subventions. Some 1,300 additional staff have been appointed between 1997 and 2001. More than 550 additional beds have been provided in new community nursing units and more than 1,250 day places per week will have been provided in new day centres.
The additional €69 million made available in 2002 will allow more home help services and more hours; improvement in community support structures specifically to support older people in their homes; support for carers; support for the Alzheimer's Society of Ireland for the provision of day care; support to a number of voluntary groups; improvements in staffing ratios in extended care facilities; improvements in the nursing home scheme; implementation of the health strategy, including funding for voluntary organisations; and improved and enhanced existing services.
The nursing home scheme was introduced in 1993. There are now 7,500 people in receipt of subventions and the total available for the scheme in 2002 will be €122 million, of which additional funding in 2002 is €26.5 million. The number of people being subvented has increased by 230% since 1994, that is, 3,271, while the cost has increased by a massive 600%.
The community health programme provides for a wide range of services, numbering 19 in all. Services for which funding is provided range from family planning, the maternity and infant scheme, the Crisis Pregnancy Agency, cervical screening, immunisation-school booster programmes, AIDS and HIV services, meningitis C immunisation and health screening for asylum seekers.
On palliative care, almost €25 million was provided since 1997 for the improvement and enhancement of services including the development of consultant-led specialist services. The funding in 2002 of €6.6 million will be used to further implement the report of the national advisory committee in each health board area and in the ERHA.
Between 2000 and 2001, substantial additional revenue and capital funding has been put into services for persons with an intellectual disability and those with autism. This has provided around 840 new residential places, 296 new respite places and more than 1,500 new day places, in addition to the enhancement of other services. This year I have allocated an additional €51.525 million to services for persons with an intellectual disability and those with autism. This includes €13.825 million revenue to meet identified needs of existing services, €25 million revenue for new service developments and €12.7 million in capital funding. This level of funding will enable health boards and specialist service providers to continue to build on the very significant developments which have taken place in the services in the past two years in particular.
Funding allocated for physical and sensory disability services for the period mid-1997 to 2002 is more than €175 million. Additional developments in this area are listed in the copy of my speech and we can refer to them later. We have provided additional funding of up to €40 million between revenue and capital to physical and sensory disability. In addition, more than €10 million has been allocated to training services, support services and rehabilitative services for people with disabilities. More than €2 million has been provided for the physical and sensory database.
Recently I launched a new national strategy for Traveller health services and the Government has approved additional funding of €8.2 million for the strategy's implementation over the period 2002 to 2005. Funding is being provided this year for the implementation of that strategy. Additional funding of €6.492 million was provided in 2002 towards the implementation of Homelessness - An Integrated Strategy. A further €4 million is being made available to the ERHA, where the majority of problems relating to homelessness exists.
Substantial progress has been made in the area of mental health services. The Mental Health Act is now coming into play and we have appointed the Mental Health Commission as an independent body to oversee the implementation of that Act and the development of new standards. Since 1997, four new acute units have opened in Kilkenny and Ennis, as well as at the Mercy Hospital in Cork and Tallaght hospital in Dublin. A further two units are at an advanced stage in Portlaoise and Castlebar. The number of community residences has increased to in excess of 400 in 2002, providing more than 3,000 places overall.
In terms of child care and children's services, I refer Members to the script that has been circulated for details. Significant developments have occurred in the areas of high support, special care and foster care and youth homelessness and we look forward to the implementation of the Children Act and the national children's strategy. Substantial funding will be made available this year for the realisation of the objectives listed under the headings outlined in my script.
It is worth pointing out that, between 2000 and 2001, more than €84 million was spent in completing the meningitis C programme, which has had dramatic results. The National Disease Surveillance Centre indicates that in 2001, 35 cases of group C disease have been notified compared to 139 cases in 2000. That is a reduction of 75%. The most dramatic reductions were seen in the age groups targeted by the meningitis C vaccine, ranging from a 93% reduction in five to nine year olds to a 70% reduction in the ten to 14 year age group. This represents a very significant reduction and highlights the importance and success of the campaign to date. Further funding is being provided this year for the ongoing implementation of the programme, which illustrates the significant value and dividends we are obtaining from expenditure on the health services.
I commend the figures to the committee. The new health strategy recognises that further spending in health can come only in the context of improved efficiency and we are committed to achieving this. We have already identified a list of priorities for the next seven to ten years. The strategy emphasises the need to target investment, utilise evidence-based approaches in our health care initiatives and develop quality information systems and databases to underpin our work. The Government has delivered on its commitments to health care and has done so to an unprecedented extent.
The poorest of our citizens are being deliberately and grossly abused by the actions of the Minister for Health and Children. In my opinion, an independent judicial review would show this to be the case. The Sunday Tribune this week pointed to evidence of the Department of Finance confirming that medical card income limits being applied by the Department of Health and Children are too low. They are being kept low in order to pay for the extension of medical cards to the rich. The result is that only 29% of the population is now covered by medical cards. This is down from 37% when the Government took office. The current agreement with the Irish Medical Organisation allows for up to 40% of the population to be covered. However, a person living alone on €128 per week is over the limit because the Minister has used up the available resources giving cards to millionaires who vote, safe in the knowledge that the election turnout in poorer areas can be as low as 30%.
ESRI research shows that the death rate for males aged 55 and over is 32 per 1,000 among the poorest classes. This is three times the death rate among well paid males of the same age. Despite this, on the eve of a by-election last summer, the Minister for Health and Children extended medical card cover to everybody over 70 years of age irrespective of income. He paid the IMO five times the normal rate to overcome its resistance as it had been campaigning for an increase in the limit for the poor.
The scandal does not end there. The cost of the Minister's actions was forecast at £14.75 million. As it turns out, however, the amount is actually twice that estimate. The result is that there is no money left to fund medical cards for the poor and the Minister for Finance will not pay the new five-times higher rate for poorer people in respect of whom the Department of Health and Children caved in and paid for many who are rich.
Is it any wonder that accident and emergency departments are swamped by people who cannot afford to see their GPs? Patients' representative bodies should consider seeking a judicial review of this deliberate medical apartheid. It is a scandal of enormous proportions that health spending can be manipulated in this way for political benefit. I challenge the Minister for Health and Children to confirm or deny my statement and to debate this matter with me in order that members of the public may judge for themselves. Furthermore, I commit Fine Gael to doubling medical card income limits immediately on return to office as part of its detailed policy proposals to take pressure off secondary care hospitals by a targeted investment in primary care, GPs and pharmacies. Deliberate apartheid in the medical service is costing lives. Poorer people just do not know that it is happening to them.
The Minister referred to the waiting list figures and I will deal with these later. The Irish Examiner recently calculated that there are approximately 100,000 people waiting to get on the waiting lists. If we consider how the so-called waiting lists are being manipulated, we can see that there are thousands of people who cannot get to see consultants and, therefore, have their names placed on the lists. That is part of the reason for the so-called decline in the waiting lists. Such lists have declined in the past, but they always shoot up again when the election is over.
There is also a so-called verification process where hospitals send out cards to people. If these cards are not sent back, the names of the people to whom they were sent are taken off the lists. These people might have died, they might have had an operation carried out somewhere else at their own expense, their situations may have deteriorated to the extent that they are no longer in a position to attend for an operation because they have been waiting for so long, they may have developed other complications or they may have moved home. What happens? Their names are removed from the lists and the Minister states there has been a reduction in the numbers on those lists.
We are being asked to believe, on the eve of a general election, that services can be purchased in the private sector in order that people on the waiting lists will not have to work. The best that can be said about this is that it is a three card trick. Are we to believe that this capacity has existed within the health services for the past five years, a period of unprecedented wealth, and that the Government has refused to pay for such services for poor people, leaving them to live in pain? What sort of fools does the Minister take us for, putting forward such policies on the eve of an election?
In a few weeks' time, the people face a decision on whether to re-elect the current Administration or to elect an alternative Government in which Fine Gael will participate. The current Administration has stated that it has provided good Government, but I state that it has presided over chaos and has perpetuated and extended the policy of apartheid in our health services. Some of us who are on the inside track may feel smug, but we should remember that someday it may be us, our spouses, children, parents or siblings who may be left out. Those who are left out are someone's loved ones and we must ensure that when it comes to health services nobody is left out.
It is my responsibility to inform the committee that in the most basic function of the State, namely, the provision of an adequate health service, this Government has failed. I also wish to inform it that any Government in which my party participates will deliver an imaginative, costed reform package which will work and which will be our priority in Government.
The current Administration mistakes spending money for achieving results. It has informed us correctly that the Dáil has doubled health spending, but neglected to mention that it, with more resources than any of its predecessors, has failed dismally to improve the health system. The Taoiseach, like his mentor Mr. Haughey, was obviously unaware of the crisis facing our health services. He informed us before the Ballymascanlon Cabinet meeting on health that we had a first class health service. This was at a time when waiting lists at the Mater Hospital in the heart of his constituency were growing by nearly 50%.
This has been a great Government for making grand announcements but it has failed to follow through. The Minister, Deputy Martin, and his predecessor, the Minister for Foreign Affairs, Deputy Cowen, at last count had commissioned more than 107 task forces, fora, expert groups and implementation bodies but precious little has been delivered. I had thought the figure was just over 60, but I received a reply to a parliamentary question last week that 107 different bodies had been established. After five years and €30 billion in expenditure, that is the record on health of the Fianna Fáil-Progressive Democrats Government. There are more than 26,300 people suffering on public waiting lists and perhaps 100,000 more are waiting to get on to them. Ordinary, decent, hard-working people are being denied access to medical cards because the Government refuses to raise eligibility thresholds to a proper level and plans to spend hundreds of millions on the Bertie bowl.
A person who earns more than €130 gross per week is denied a medical card and some people face doctors' bills of €35 and medicine costs of up to €53 per month. As a result, people delay going to the doctor or attend grossly overburdened accident and emergency departments. There are delays of up to eight years for orthodontic treatment, even though a treatment purchase scheme was announced more than 12 months ago but still has not been delivered. The childhood vaccination programme is in chaos. Poor distribution systems and a totally inadequate public information campaign to address parental concerns have left our children vulnerable to preventable illness and death.
Pensioners in nursing homes had their pitiful savings illegally taken by the State and in some cases they have still not been repaid nine years later. Ireland has the lowest life expectancy in the EU. Grandchildren are deprived of the company of their grandparents earlier than anywhere else in Europe. We compare badly with Europe but Europe lags behind Canada. Why do we continue to accept these standards? Ireland has one of the highest rates of death from cancer but there is still no nationwide breast screening programme.
There is a nursing shortage, which has led to the loss of almost 66,000 bed days in our hospitals in the 18 months from January 2000 to June 2001, even though more than 20,000 qualified nurses are not working in the State health system but would be available if an attractive package was offered to them. The Minister responded to the nursing problem by establishing another forum. It is time for leadership, not prevarication.
The Attorney General recently outlined how the Government had achieved social justice. There is nothing socially just about a 68 year old man waiting for a hip replacement while his neighbour can pay and have it done tomorrow. There is nothing socially just about a couple with two children earning a little more than the national minimum wage of €178 per week having to pay €35 per doctor's visit and €53 a month for medication for their asthmatic child while a retired 70 year old banker receives free GP care. It is time for change and a Government committed to building a fair, efficient and accountable health service.
I have set out in our health proposals how we will construct such a service over the next five years where medical needs, not material circumstances, will determine access to care. A Fine Gael-led Government will invest in an enhanced primary care system, not just flagship primary care centres in urban areas, and will ensure access to primary care through the provision of medical cards to those in need. We will, on our return to Government, immediately double the current paltry income eligibility limits. I want a free GP service introduced in a targeted way for the lowest paid 60% of the population, children up to the age of 18 and beyond, if in full-time education, and those aged 65 and older.
Will that be free?
Yes, as part of a policy that will not leave out the poor.
I sought clarification. I would not have thought that, based on the Deputy's earlier comments.
The Minister's action in giving medical cards to wealthy people and leaving out the poor was a gross dereliction of duty and abuse of power.
I propose to introduce free GP services targeted at those most in need and to double the income limits for medical cards for the lowest paid 60% of the population, children up to the age of 18 and beyond, if in full-time education, and those aged 65 and older. I will not begin by giving medical cards to 70 year old retired bankers while leaving out people who live alone on an income of €128 per week.
But the Deputy will give them to 60 year-old bankers.
The Minister ought to be ashamed of himself. He has introduced the most disgraceful apartheid ever practised in Ireland and he has the hard neck to do it and come before the committee, smile and misrepresent the truth. The Minister's performance has been an absolute disgrace. His extension of apartheid in primary care is a resignation matter. It would not happen in Zambia or Zimbabwe under the current regime.
As we come to the end of the life of the Government, we must examine its record. It has been pretty disastrous in regard to health care. More money has been invested and the Minister is dependent on repeating that. Nobody argues with that, but the Minister for Finance recently said in the medical media: "This rate of increase is clearly unsustainable. Disturbingly, however, it has been accompanied by an unprecedented level of public dissatisfaction with the quantity and quality of Irish health provision".
One always expects the Opposition to make these points for political gain but it must be taken seriously in terms of the failure of the Government to adopt both a coherent and an effective approach to health. It is evident at the end of five years of unprecedented prosperity that the Government's record is dismal. The context of the debate on these Estimates is the struggle in accident and emergency departments where nurses are on a work to rule. Nurses have taken industrial action twice during the lifetime of the Government. The first action was an all-out strike, which was unheard of in the past, yet the lesson has been learned by health professionals that the only way to obtain a response from this Government is to take such radical action.
The Government set targets for itself in its programme at the beginning of its term in office. One was to tackle hospital waiting lists. The most recent figures published by the Minister show that 26,000 people are still on such lists. The figure increased during his term but it has reduced somewhat. However, during the last quarter for which figures are available the number of people on waiting lists had reduced by 214. Since the current industrial action began, 60 elective procedures have been cancelled per day in Dublin as well as many more around Ireland about which we do not know. That is unsustainable in terms of people's suffering.
Waiting lists are getting longer, morale among medical professionals is plummeting and problems remain unresolved within the health service even though the Government had five years, a lengthy term in the history of the State, to develop and deliver on policy. Instead, a hit and miss approach was adopted with an attempt made to throw money at problems that required much more than that. At the end of the day a health strategy was produced to blind people during the forthcoming general election campaign.
There was not a concentrated effort to focus on key needs in the health service, such as in accident and emergency departments. We recently concluded a totally unnecessary and divisive referendum campaign where much of the Minister's and the Department's energies were spent wastefully on a campaign that should never have been undertaken by the Government. It had no purpose and there was no advantage to be gained from it. The result of the referendum was a rejection of the Government's proposals rightly by the people and the position remains the same.
A sum of €3 million is provided in the Estimate for that campaign. That may not be a large sum in terms of the overall health budget but it is more than has been allocated for the mobility allowance for people with disabilities and is half the budget of the Crisis Pregnancy Agency provided in the Estimate. We could have added 50% to its budget, prevented a few abortions, forgotten about a referendum and allowed the Minister to get on with his proper work. That sum is almost twice the budget for the National Cancer Registry Board. I recently received a telephone call from a cancer patient, which I did not have an opportunity to verify. However, she maintained more money has been allocated to the GAA than to cancer services under the Government. She appeared to know what she was talking about. I found it hard to believe, but that was her view and she was able to quote references to it.
What is most interesting about these Estimates is that there is no clear dedicated funding for the implementation of the health strategy. We do not see targeted funding for initiatives which have been outlined in the strategy and have been given timeframes for delivery, such as those concerning men's and children's health or dealing with inequality or encouraging safe sexual practices. There is no dedicated funding in the Estimates. All we see is a top-up, primarily to deal with increases in pay, but not clearly dedicated to reaching targets for initiatives outlined in the health strategy. The major ones, such as the mental health commission, flow from legislation and have nothing to do with the health strategy. That was something the Minister had to do because the Oireachtas decided it needed to be done. It should be done and we support it, but that is the type of workaday task the Department has to carry out anyway.
On the general medical service, Deputy Gay Mitchell is correct. We see a major increase in the cost of this. The Minister will try to convince us that the increase relates to an increase in the cost of drugs. We recognise that, but the increase in the cost of the GMS is huge. It is not just for drugs but also for general practitioners and pharmacists. Some €63 million is provided for drugs, €19 million for GPs and €9 million for pharmacists. This is directly related to a decision of the Government to give medical cards to wealthy people over 70. We can argue whether that was a right priority, but in principle there is a certain amount of agreement that elderly people should have the protection of a medical card. The 20% at the top of the income bracket for the elderly may not be first in line, but they certainly exist.
The deal the Minister did with GPs was outrageous. They had the Minister over a barrel and he had no choice but to give in to them and give them what they sought. He did not have a leg to stand on and he created a new tier of inequality within the GMS. It was gratuitous. He did not have to do it. There was no reason he had to go that road, distort the GMS and make it difficult for his successor to deliver for lower income people who cannot afford to see their doctor. This is the Minister's legacy and that of the Government and that is why we can call it a disaster when it comes to quality and fairness. The health strategy has this title, but the practice of the Government is to negate what is set out in the health strategy in terms of equality. That is the legacy we see in the Estimates and which we will see in those to come.
I am interested to know about the primary care task force. The Minister gave a commitment that it would be up and running by January 2002. He should tell us what has happened to it. Why do we not see work being done by such a task force? We do not have confidence in any strategic approach taken by the Minister and the Department in terms of delivering in this regard. He has not addressed the serious deficiencies in his Department and the health boards which were revealed in the Deloitte & Touche report. I would have thought a serious Minister would have tried to have sorted out those problems before he began to make elaborate and invalid promises to the people in a strategy. If the Minister cannot get right the structure of how the system operates and will be developed strategically, he is not in a position to make these commitments. Already he is not delivering on the commitments made in the strategy and it is no more than a few months old. That is the message the electorate will get and absorb when a general election is called in a few weeks' time - grandiose promises and an inability to deliver even on simple commitments.
Denying people on low incomes the chance of a medical card is despicable when this country is so wealthy. It is wrong to deny young families especially their chance of proper medical care. Such an injustice was done away with generations ago in other EU member states, yet we still accept it here.
According to the Central Statistics Office, 6,500 new jobs were created in the health sector in the nine months up to June 2001. All of them happened to be women. Where are those jobs? How many nursing vacancies remain? What benefits do patients receive from those additional 6,500 jobs?
We come to the general discussion on the Estimates. I suggest that we proceed through them in order, that is, we begin with subhead A and avoid jumping from one to the next. Is that agreed?
I have a number of questions which I have no difficulty being answered in that way. That said, they could probably be dealt with together.
That is a matter for the committee.
Shall we put all our questions together?
Yes. We could go through the sections briefly.
That is the norm and that is agreed. Subhead A is the administrative budget. Do any questions arise under this subhead?
What is the breakdown of the additional 21% for salaries, wages and allowances? Does it comprise additional jobs?
It comprises pay and salary increases as well as pay for additional jobs. It is a combination of both. Additional staff will work in the area of health strategy implementation. We are getting an additional number of staff as a result of the health strategy. Implementing it at departmental level requires the establishment of an implementation team. The normal pay agreements which flow from national agreements apply.
Does it include Terry Prone?
No.
What heading does she come under?
That was dealt with already in the previous Estimate under consultancies.
We move on to subhead B - grants. Does anything arise from this?
On subhead B1.2, I want to ask about the illegal deduction of amounts from elderly people for nursing home costs and illegal assessments of their families' incomes. Have those refunds been made or has provision been made for them? What is the status of these refunds?
I take it the Deputy refers to the application by successive Governments between 1993 and 1999——
Perhaps the Minister has more than one illegal activity under consideration. I am aware of only one. Perhaps he would tell us about the others.
The Deputy referred to nursing home subventions——
It was an illegal activity.
May I answer the question? When he mentions illegal activity, obviously the Deputy refers to his party leader when he was Minister for Health. During that period, the regulations on means testing of families to determine their eligibility for nursing home subventions were enforced. The Deputy's party leader at the time supported the idea that people should make a contribution to their own care.
Is the Minister going to refund the money?
Deputy Howlin, who was the previous Minister for Health, did likewise. Funding has been provided in the Estimate to pay the arrears and the funding has been allocated to the health boards. In recent months the health boards went to great lengths to secure information for the purposes of paying the refunds. We are talking about applications going back to the commencement of the scheme in 1993. In essence the regulations were ultra vires from 1993 to 1999. My predecessor, Deputy Cowen, was the first Minister to cease applying the regulations.
Money was previously given to the health boards, but they did not give it to the people. They kept the money.
That was before my time.
We will blame Deputy Cowen as it was in his time.
It was during the period when the Deputy's party was in Government.
It was during Deputy Cowen's term.
It is outrageous that the Deputy should apply pejorative language to a different period. It was during the period when his party was in Government.
I am simply asking the Minister if he is going to do as the Ombudsman suggested last year and pay back the money.
We are paying the arrears. The health boards have been allocated the funding and the matter is in hand.
Like everything else we will find out later that what the Minister is saying is not true.
People are calling the clinics saying they have been paid and querying the calculations. Obviously there is a process on the ground and the money is being allocated. Some of it was allocated prior to December and the full amount will be allocated in 2002.
Any deal which is struck regarding the industrial action in accident and emergency departments will cost money. From where will that money come? Will hospitals be expected to take the money out of existing funding or will there be a top-up fund? If they have to take the money from existing funding and budgets, they will have to withdraw or reduce services in some way. Will the Minister comment on this point?
The Minister spoke about funding for bed capacity and he made a significant commitment for the coming year. What was the increase in acute hospital bed capacity in 2001? I also wish to ask a question which is pertinent to my constituency. Hospital waste has been found in significant quantities in illegal dumps in County Wicklow. There are major costs involved in stabilising sites, that is, making them safe so they do not pollute watercourses. Removal of waste is also an issue. Has the Minister considered whether hospitals may be culpable in this regard? If so, what is their likely liability as they are the polluters and the principle of the polluter pays now applies? Has the Minister allowed for this in the Estimates?
As regards my earlier points concerning the GMS, it is interesting that the increase envisaged in the drugs refund, cost, subsidisation and payment schemes is not large. There is an increase of about €15 million. However, there is a massive increase regarding the GMS, GPs and pharmacists. Presumably a large proportion of this is a result of the over 70s scheme. These are expensive patients to care for because they are elderly, but also because the Minister has given doctors such a fantastic deal. What proportion of this increase is due to the over 70s scheme?
I asked about the repayment.
I answered that and it has been paid. As regards the accident and emergency industrial relations issue which is at the Labour Relations Commission, over the past two years there have been fairly significant increases in staffing, upgradings and security of these departments. In the feedback I received from the health boards over the past few weeks there has been a noticeable increase in these facilities. That needs to be said and placed on the record.
When I met the Nursing Alliance about four weeks ago there was no major demand on the table regarding upgradings or additional staff. There was reference to upgradings and the need for them in the area of bed management. The picture has changed somewhat over the past three weeks, particularly towards the end of that two-week period. It is premature at this stage to assess the likely cost of any proposed deal. That is a matter to which the Government would have to give further consideration and we will have to await the outcome.
In the context of the Estimate we did not provide for additional expenditure over and above what is included. The Estimate would have included funding for upgradings and additional staff as per service plans in certain areas and out of certain funds that were provided for the acute hospital sector. However, a situation is now developing in terms of a dispute which is being discussed at the Labour Relations Commission. We do not have the outcome to those discussions to hand so it is not possible to give accurate figures in reply to the Deputy's question.
I am surprised that the Minister should say that at this stage. We are in the middle of industrial action and a deal has to be struck. We all know it will cost money. At the time of the "blue flu" the Minister for Justice, Equality and Law Reform made it clear that there was a contingency fund which he was going to avail of to protect funding in his Estimates. Is the Minister suggesting he cannot protect the funding in the Estimates and that it may be raided to meet the requirements of the deal?
I said no such thing. I simply said we do not have a deal at the moment.
The Minister knows he is going to have to make a deal.
The issue is currently with the Labour Relations Commission. We do not have a deal at this stage and we do not know the shape of that deal. The situation is currently in play.
I find that disturbing.
It is logical.
These Estimates will be meaningless in a week.
We are talking about an €8 billion Estimate. Let us have some sense of perspective. It is not as if one sub-area——
Much of that €8 billion is not reaching patients.
Much of it is reaching them.
What happens in acute hospitals does reach patients.
It is worth pointing out that attendances at accident and emergency departments in Dublin have not increased dramatically over the past two years.
Perhaps we should do without the nurses.
I did not say that. I made the point that there has been additional investment which has not been acknowledged to the degree that it should have been. I can make available the health boards' reports concerning the developments which have taken place. There are still pressures on these departments due to a number of factors, one of which is inappropriate attendances. This issue has emerged strongly in the past seven days.
The Minister announced 25 additional accident and emergency consultants.
We certainly did.
One year later only 14 temporary consultants are in place.
That is the largest ever increase in any specialty in one year.
Why did the Minister announce these appointments if there is no problem? Only 14 temporary consultants are in place.
I never said there was no problem.
That is what the Minister is implying.
I am not implying anything of the sort. There are pressures on these departments. I pointed out in my statement that an extra 52,000 people were treated this year over the previous year. Record numbers of people have been attending our hospitals year-on-year over the past four or five years. There have been dramatic increases in the numbers of people attending our hospitals on a day and in-patient basis. The largest increase in productivity in acute hospitals occurred this year - over 5% or 6%.
Many of these people should be going to their GPs, but the Minister will not let them do so because he placed the limit at €128.
I engaged with the Nursing Alliance which acknowledged that there had been significant engagement on all fronts. We are in the middle of talks and I am not in a position to give detailed figures regarding any costs which may emerge.
I am not asking for detailed figures. I am asking the Minister to outline how he will resolve the issue of funding the deal.
That is a matter for the Government and the Department to deal with subsequently. It is inappropriate to go into that detail in the middle of talks.
So it will depend on Deputy McCreevy.
About 100 additional beds were provided in 2001. The hospital waste issue is being determined by the respective regulatory authorities on the west side. Funding has not been provided for any issues that may arise because it would be far too premature to do so. In any event we have provided a new template for the treatment of hospital waste nationally. I regard it as unacceptable that hospital waste should end up in unauthorised dumps. This is a matter of great concern to me and everyone in the Oireachtas. However, investigations are currently taking place and a number of agencies and authorities must be accountable in this regard.
On the GMS scheme, approximately €20 million is allocated for the over 70s. We also did a deal with the IMO in April last year which dealt with issues pertaining to discretionary medical cards, asylum seekers and a whole host of other related issues prior to the over 70s deal, which will have a knock-on impact in 2002.
Is the money given to GPs for elderly people in nursing homes part of the €20 million?
It is included in the overall GMS budget.
Was that part of the deal on the over 70s?
Yes.
Is that included in the €20 million?
The €20 million is additional money over and above what we had last year.
Much has been said about the over 70s deal, some of which I find very difficult to take given that both Deputies opposite voted in the Dáil for the extension of medical cards to the over 70s. It seems to me that people want to play it both ways.
We did not vote for it.
They did not want to alienate——
No. The Minister is deliberately misleading the committee.
With respect, I have taken a lot from the Deputy.
The Minister is deliberately misleading the committee.
(Interruptions.)
We gave the Minister the legislative authority and he abused it behind our backs.
The Deputy voted for it. It was extraordinary to hear today someone calling for a judicial review to extend medical cards to the over 70s while in the same statement saying it is intended to give free medical cards to everyone over the age of 65. That ranks as utter political hypocrisy of the worst type.
The Minister is telling lies.
I have never come across such hypocrisy.
The Minister is telling lies.
On the one hand, the Deputy is saying not to give it to the over 70s——
(Interruptions.)
We said we would give it to poor people and extend it to older people as part of that. The Minister is telling lies.
Deputy Mitchell will have an opportunity to rebut when the Minister has concluded.
I must say that the response——
I wish to say on the record that the Minister is telling lies.
I honestly believe that older people deserve special treatment.
I agree but I do not say we should do it by excluding poor people.
Up to approximately 90%——
Has the Minister no shame to come in here and tell such bare faced lies at an Oireachtas committee? He ought to be ashamed of himself excluding poor people.
If we are to have a debate, let us have an orderly debate. The Minister is entitled to make his statement and the Deputy is entitled to rebut.
The Minister is telling those stories to an Oireachtas committee, which is absolutely outrageous.
I call Deputy Dennehy.
As someone who has campaigned for medical cards for all those over 65 I do not want to receive proscribed lists stating that because someone happens to be a banker they cannot get a medical card. I will be lobbying for the over 65s but I will not try to have it both ways.
I welcome the fact that grants to research bodies have increased by 26% this year. What is the relationship with the ring-fenced income from tobacco sales or is that to be used specifically for cancer research?
There is no specific allocation to research from tobacco receipts. Subhead B6 represents a very significant increase. Year on year, over the past two or three years, we have significantly increased research funding to the Health Research Board. The new health research strategy was launched, which aims to develop a very strong emphasis on cultural research both in the context of the Health Research Board and, more importantly, in the context of the health boards themselves so that they would develop an indigenous research culture in each health board area, including infrastructure, staffing and so on. They seem particularly pleased with the increased allocations. I was recently in a position to announce significant grants to individual clinical researchers with a strong emphasis on application to bedside use. In other words, it is not abstract research on its own but research that can be very much linked to clinical practice and patients in hospital beds. Dramatic individual grants in this regard were announced recently.
In terms of the cancer registry and so on, the National Cancer Registry Board has an ongoing programme of data collection. The data it collects feed research and the latest statistics were launched approximately one month ago.
On the question of individual research and the exchange, is it through the Department this will be done? A number of people referred to the exchange of accident and emergency consultants with Australia and so on. What is the formula in this regard?
We have no operational involvement in terms of the Health Research Board. The board utilises international pay review to allocate research grants. In other words, there is a transparent system in place whereby people get there on merit as opposed to who they know.
On the reference to the illegal actions of health boards and so on, are the formal applications made by the representatives of the eight health boards to the then Minister, Deputy Noonan, to modify the 1992 regulations formally presented and packaged on record? I am aware that the former Minister, Deputy Cowen, dealt with excluding family contributions. Is it on record in the Department that the application was made in 1994-95? Having being present when this took place and as one of the people who made the request at the request of probably every public representative, I find it a bit ironic for people to criticise delays in relation to paying back money. Can that issue be looked into because we need to nail this aspect if people are telling lies?
We will check whether records exist of communications from the chairpersons of health boards in 1994-5. From reading Dáil reports, it seems to me that throughout the 1990s successive Ministers for Health, from Deputies Howlin to Noonan, believed it was a subvention scheme at the time. My objective observation of the debate that ensued throughout the 1990s on the issue is that there was a general belief at the time that people should make a contribution. I will check if that is the case.
There may have been a formal meeting, not just a casual meeting in the Dáil bar. Were it not for the Ombudsman, perhaps no money would have been paid back. We need to know when these things happened and when they changed.
I want to raise an issue under this section.
I have not spoken for quite some time. The Chairman said I would get an opportunity to respond.
The Deputy will get an opportunity to speak but Deputy McManus is next in line to speak.
I have no difficulty with Deputy McManus getting back in but the Chairman said I would have an opportunity to respond to the absolute misrepresentations made. I do not recall a Minister putting such false statements on the record.
The Deputy will get an opportunity.
I have a question on subhead B8 regarding haemophiliacs. I am astonished that legislation has not yet been published to deal with one of the great tragedies which is still unresolved in terms of a Government response, even though the Minister made commitments in the past that the legislation would pass through the Dáil in terms of adapting the compensation system to allow for people who have had haemophilia or have suffered HIV infection.
There does not appear to be any provision made in the Estimates for what will clearly be a requirement for additional funding. What is the Minister doing about the haemophiliacs who have had to go public, who are extremely distressed about the delay and who can see this Government leaving office without this promise being delivered upon? This Administration has only a handful of days left. I am quite shocked because the Minister has made commitments, he understands the situation and these haemophiliacs have suffered at the hands of the State in the most terrible way that anyone could imagine. Yet we do not see evidence in the Estimates that the Minister will deliver on this before he leaves office.
I was quite shocked going back over the years that no attempt was made in this regard, even up to 1999. In 1991 the first assessment was made. Towards the end of 1999 this Government acknowledged that there needed to be a fairer and more equitable compensation scheme for haemophiliacs who contracted HIV. The Government of which Deputy McManus was a member made no such attempt that I know of and did not produce any compensation tribunal.
The Minister talks about this now. We can all sit by the fireside and talk about past battles. I am concerned about not wasting time.
I am not wasting time. The Deputy is wasting time by interrupting me.
These people have reached the end of the road. Let us talk about the present.
I think it is important.
Of course the Minister does, it is flim-flam.
The Deputy is very fast to start attacking people.
The Minister should tell us what he is going to do.
I am somewhat shocked that not only was there not a compensation scheme, there was not even a tribunal established by the Government of which the Deputy's party was a member to establish the issues pertaining to haemophiliacs. Some of the comments made by the Deputy on a range of issues are a bit rich given her own record.
This is not a big number.
We want to produce a compensation scheme and the Government, under my predecessor, Deputy Cowen, made a commitment to do so. At the time it was envisaged that the existing hepatitis C compensation scheme was going to be the template and if that had been the case, and was agreeable to all sides, it would have been in place a long time ago. The hepatitis C compensation tribunal is working quite well currently. About 1,417 cases have been heard now and about €446 million has been paid out. The scheme is working well with regard to people who have hepatitis C.
Regarding haemophiliacs, the IHS and its legal representatives brought forward other issues over and above what is available under the hepatitis C compensation tribunal and both sets of legal teams, representing the Department and the IHS, took some time. During the Lindsay tribunal time was lost because of the participation of both legal teams in the work involved, which I acknowledge. It occurred towards the latter half of this year, I intervened during the summer and both legal teams made some progress up to November. We have identified and isolated some of the issues, some of which break new ground in terms of civic liability schemes of precedence and so on. We have made progress, we are working on proposals and we will be in a position to have a legislative template ready very soon. That may not be agreeable.
It will not be passed before the Government falls.
That depends on whether we get agreement on the proposals.
The Minister only has four days left. It is not going to be passed.
That is what the Deputy says. I am not going to impose a particular solution on anybody. It would be easy for me, for example, tomorrow or next week to produce legislation, to say take it or leave it, rush it through the House and try to get a majority. I am not going to do that. We wanted to proceed with this by agreement. Unfortunately, the issue dragged on a little in terms of the respective legal teams. We are committed to bringing proposals to the IHS, discussing it with them and resolving it.
I have waited patiently to say that the Minister has been constantly getting away with what he has said today. I made it very clear that my objective is to double the income limits for medical card holders. It is extraordinary that somebody on €128 a week living alone should be left without a medical card while retired chief executives aged 70 have been given the medical card.
The Minister's comment was correct. My policy is to give a free GP service to those on the lowest 60% of income, to persons up to the age of 18 and beyond that in full-time education and to persons aged 65 and beyond. The problem, for which the Minister should be in the courts, is that he has left the poorer people out and has given to the wealthier people. According to disclosures under the Freedom of Information Act and reported in The Sunday Tribune this Sunday, even the Department of Finance considers these thresholds too low. The reason for this is that the Minister spent all the money the day before a by-election paying five times the rate to the IMO to get them to give up their argument for the poor and to buy off the elderly people who vote rather than the poor who do not. That is the truth, and it is a scandal. If the Minister wants to take me on over this issue he should show me that what I am saying is incorrect and not misrepresent me or put untruths on the record. I have never in my 20 years in the Dáil accused anyone of telling lies and I voluntarily withdraw the term “lies” and substitute the term “untruths”. I would notleave it on the record for anybody, even theMinister.
However, the way in which he is dealing with this matter is totally unjust, unfair and unacceptable.
But the Deputy voted for it.
We did not vote for it, we voted for an amendment to the Health (Miscellaneous Provisions) Act which empowered the Minister to extend it to people aged 70 and beyond in the belief that he was also going to do something for poor people, whom he left stranded. The Minister left them stranded because they do not vote, not because their health needs are not greater.
Regarding the general hospital programme, could the Minister tell us if there is a shortage of ambulances in the Eastern Regional Health Board area and if that applies anywhere else throughout the services? Is he considering a compensation scheme for psychiatric nurses under the mental health programme? Regarding the waiting lists for occupational therapy under the relevant headings in subhead B——
Which ones?
The waiting lists under health boards for occupational therapy for old people who are seeking rails, shower fittings and items of that kind. There are people waiting for over three years for assessment. They are the people who often end up in hospital because they fall down the stairs and yet they wait three years for assessment. Has the Minister any plans to cut this waiting list by allowing people to spend the money on the say-so of their GP, for example?
Regarding extending medical cards to those aged 70 and over, is it not true that the Department costed it at €14.75 million and that it is now going to cost twice that amount? When will the Commission on Assisted Human Reproduction complete its work? When will the forum on fluoridation complete its work? The Minister mentioned the Postgraduate Medical and Dental Board, which he is funding. Will he give some idea when the orthodontic waiting lists will be reduced and to what extent? Why is he providing only €30,000 for the hospital treatment purchase group?
The figure is €30 million.
Yes, €30 million which is about £24 million.
It is £25 million. We would be hard pressed to spend that €30 million this year.
The Minister is spending more giving medical cards to people over 70 than on this so-called wonder purchase system. It will cost £24 million.
On the question raised by Deputy McManus, the Minister has committed to introducing the legislation amending the Hepatitis C Compensation Tribunal Act. The Taoiseach told me in the Dáil several times already this year that the legislation would be introduced before the general election. Can the Minister confirm that and are there cost implications for that in the current year if it is to cover HIV cases?
Not under that subhead.
Is there a cost implication under any subhead?
Regarding availability and equity, I took a decision in framing the budget for 2002 that equity should underpin the range of services, not just medical card services. It is applicable to access to hospital beds, to better 24 hour access to GPs across the country, and so on. There is evidence that we need significant investment in GP infrastructure and I am making sure people have access to a meaningful, around the clock service. That is why in this Estimate we have prioritised the issue of 24 hour GP cover and provided an additional €10 million over and above the existing €7 million for new GP co-operatives across every health board area. That is a significant development and this year marks a significant step up in terms of the funding levels for GP co-operatives. This has not been acknowledged here - I do not expect it to be by the Opposition - but it is an important investment in primary care and we will see more incremental increases as we go on to the extent that entire regions will have 24 hour GP cover. That is one way of reducing pressure on accident and emergency departments and on acute hospital departments and is a key equity issue, as is the 709 hospital beds an equity issue in terms of access to and availability of services.
In relation to the psychiatric nurses and a compensation scheme, I had a constructive meeting recently with the Psychiatric Nurses Association. As a union it has articulated this issue for some time. There are wider implications and other nursing unions have identified the issue laterally as one of concern in certain departments of hospitals. I was impressed by the case made by the PNA. It is early days but these are issues following the meeting that we are reflecting on and we will return with proposals to them and the wider nursing alliance which has also raised the issue.
In terms of occupational therapy it is noticeable that there has been a dramatic increase in funding for aids and appliances for older people in particular which has created a backlog in waiting time for assessment. I do not have the waiting times. That is something we need to ask the health boards for but it goes across the various boards.
The report on assisted human reproduction could be another six months but it would be wrong to give an exact timeframe because the issues are complex as members are aware. We should have the fluoridation report within weeks. It has been proofed and is ready for the printers. In relation to the hospital treatment purchase fund, our view is that €30 million is more than adequate for 2002, given that there are start-up issues and that we have given £35 million for the hospital waiting lists initiative which, with the additional bed capacity, amounts to over €100 million in total. Secondary care and activity in hospitals receives by far the largest injection of funding in the acute hospital sector.
It is a pity it is not working.
We intend to allocate about €5 million of that to orthodontic waiting lists. The fund will be in a position to apply the concept of purchasing private treatment from private orthodontists and from those in Northern Ireland. Regarding Deputy Gay Mitchell's earlier comments, it is worth pointing out that buying private facilities is not a new development. We have dramatically reduced the waiting list for children awaiting cardiac operations for over six months by about 80% over the last two years as a result of purchasing treatment abroad for children with cardiac conditions.
How many children does that represent? Is it three or four?
No, it is much more than that. We are talking about up to 20 or 30. The waiting list is well down from where it was, largely due to the initiative taken by the team at Crumlin hospital going to the UK and the US. That is because they are awaiting their increased capacity which will arrive when they receive the £25 million that I have allocated and sanctioned to Crumlin and the project is under way. It will take another two years to complete but it is under construction and the contracts have been signed. That will give a 40% increase in operating capacity to Crumlin. However, until that is on stream we must look at the lists and see how we can best reduce them and we decided to do that by paying for treatment abroad.
It might interest the Deputy to know that other health boards are engaged in similar procedures on an ongoing basis. For example, in the Southern Health Board area, Tralee hospital has been purchasing cataract procedures from the Bon Secours Hospital with the result that Tralee hospital has the lowest waiting list in the country. There are other examples. The treatment fund represents a significant ramping up of that process as well as exploring the issues in terms of purchasing further treatments from abroad. Maureen Lynott is heading up that team and will be employed to oversee the allocation and purchase of the various treatments across the specialties.
Funding for the hepatitis C compensation tribunal, which will be necessitated by the amendment of the existing Act, will be provided but not under this subhead.
This committee has been conducting its own examination of orthodontics. The number of treatments has increased by over 3,000 since 1999. There was an historical situation which has not been helped by considerable conflict among and within the dental and orthodontic community. That has impacted negatively on developments. Substantial funding was provided in 2001 to try to kick-start a number of initiatives, some of which have been quite successful in the ERHA region, and there has been a significant increase in construction capacity in the Dublin region. In the Cork region, despite funding being provided, a professor of orthodontics is not yet in place and the second consultant has not yet taken up duty to the best of my knowledge. A third consultant or specialist for Tralee has not yet been appointed. The situation is improving but there is more work to be done. The real issue in the orthodontic community is that we need a greater coherence and an end to the ongoing turf wars. I am prepared to look at issues under that heading and I look forward to the report from this committee.
Deputy McManus asked about the health strategy in terms of the 2002 Estimates. Bed capacity is a cornerstone of the health strategy and there is an immediate investment of €65 million. The other major investment identified relates to older persons and disability, which is in line with the strategy. The GP and primary care co-operatives are significant targets of funding related to the strategy of moving ultimately towards the multi-disciplinary team. The human resource element of the strategy has been facilitated by this Estimate in funding for the establishment of the degree programmes in the institutes of technology and the universities and the movement on paramedical training in terms of new competitions for the establishment of new schools in the areas of speech and language, physiotherapy and occupational therapy.
I asked the Minister earlier about the primary care task force. Will he comment on that?
The primary care task force will be established in a matter of weeks or days. There are certain complexities involved in bringing together all the stakeholders in the right composition but it is working and we will have it up and running.
I have a few more questions. In relation to subhead F, Comhairle na nOspidéal, I do not have a problem with the money that is being allocated to it but I have a query relating to hospital consultants particularly in view of the fact that there has been correspondence in the newspapers between the Department of Health and Children and the Department of Finance which was published by The Irish Times. What exactly is the Minister’s approach in relation to consultants? He introduced the integrated initiative almost 18 months ago and it has taken until now to get 14 temporary consultants. It has taken many months and that is not the full complement. There is no commitment in practice to changing how consultants work in terms of being on call or covering. What is the Minister’s approach? He talked about changing the consultants’ contracts, which is in the health strategy, but there is no indication of a time frame. Will it occur this year or will it take a long time? The Minister has had much discussion but little progress.
Why will the Irish Medicines Board, which is supposed to be self-financing, receive a double increase in funding? Will the Minister explain the allocation of €1 billion to the State claims agency, which I presume is in response to new legislation on liability?
The Minister made claims about being tough on smoking, but in this Estimate the money from excise duties on tobacco is less if inflation is taken into account. This means that less money is available now to deal with the impact of cigarettes on people's health than in 2001. Why is that?
Funding exists in this Estimate, as in the previous one, for 25 A&E consultants. Comhairle na nOspidéal is legally and statutorily responsible for the regulation and appointment of consultants. When I announced the funding for 25 A&E consultants, comhairle had reservations and I had discussions with it which produced a compromise that sanction would be given for the appointment of 25 temporaries while it engaged in a wide ranging accident and emergency review. When the review is concluded, I anticipate that more consultants will be sought. The funding is there for 25 permanent posts which is a significant increase over what was there before and represents the biggest single increase in any one speciality in one year.
Under the health strategy, the national hospital agency will have a significant role in establishing a more streamlined and rational approach to the planning of acute hospital services.
How does that relate to Comhairle?
We will be working that out with it. The target date is the end of the year for establishing the new agency on an interim basis. It will embrace the relationship between the health boards, comhairle and the Department. Throughout the consultative process, which led to the health strategy, concerns were expressed about how the existing situation was working——
Or not.
——or not working. Hence the need for a new structure in the form of the national hospital agency to give a more centralised, broader and coherent approach to the planning and operation of acute hospital services nationwide.
Will the Minister leave comhairle in place and have another authority as well? That does not sound sensible.
No one has said that. Comhairle made a submission and we will discuss that with them.
Will the Minister tell us, the public representatives, about that?
It is in the health strategy. Anything that emerges will be brought before the Oireachtas, including this committee, for discussion.
The Irish Medicines Board was allocated €1.426 million for three areas - medical devices, an enforcement unit and controlled drugs. The board is the regulating body for those areas.
It is supposed to be self-financing.
It is for its core business but not its regulatory functions.
Extremely wealthy companies make good money out of these products. The least we can expect of them is that they finance the board that enables them to do this. Why should we subvent it?
It would not be correct for the pharmaceutical industry to fund the regulator.
It can fund it without controlling it, which is what is happening now.
We have given it additional functions regarding medical devices, an enforcement unit and controlled drugs.
We should not subvent the pharmaceutical companies to make money. I have regard for them and they are necessary, but they should at least fund these costs at a time when we are trying to meet patients' needs. Why should we diverge from the current practice which is that it is self-financing?
It is self-financing in its core business of licensing medicines, but we have provided the additional money for regulation and enforcement.
It is bad value for money.
The IMB report on herbal medical products has been submitted and it suggests allowing an interim licensing system. There will be further consultation with all those involved on these proposals. However, the 2002 funding for that is not significant.
Will the Minister comment on the additional €1 billion for liability?
That relates to medical indemnity and is a holding sum pending the establishment of a new regime. As the Deputy knows, there are discussions on establishing a single claims agency.
The key issue on smoking is the reluctance of the Department of Finance and the Government in general, because of concerns about inflation, which is just below 5%, to utilise increases in excise duties and tax on cigarettes to get extra revenue to fund health. I am on record as saying that this is one area which must be exploited more to provide additional funding and to pay for the health related harm caused by cigarettes, such as heart disease and cancer. When it was increased in 1999 for 2000 by 50 pence, it had a significant impact on the CPI, which rose by 0.8% and in turn impacted on the national wage negotiations and almost jeopardised the existing national agreement.
I had discussions with ICTU and IBEC to secure their agreement that as a society we would exclude the increase in cigarette prices from wage negotiations. At my most recent meeting ICTU indicated that it would be willing to place that on the agenda for the next partnership agreement. We must be able to increase the price of cigarettes without it having a negative impact on wage negotiations, which would give any future Minister significant leeway in raising revenue to pay for the harm caused by cigarette smoking and in deterring young people from commencing to smoke.
If the Minister achieved that he would receive widespread support. However, in the meantime, the Department of Finance could allocate more from excise duties. It does not account for all excise duty.
No, that is correct.
Why can that Department not support the Minister? Are relations so bad between this Minister and the Minister for Finance that he cannot——
That is not the case.
The Minister rightly makes a big issue of tobacco smoking and so why does he not get more funding from the Department to pay for the measures he seeks to implement?
We looked for a certain level of funding.
The funding decreased.
Government gets revenue which it spends. The bottom line is that we get money from other sorts of revenue. We get money from a variety of sources. It would be possible to move figures around and allocate a further €30 million or €40 million from excise duty on cigarettes by taking it from somewhere else. However the real issue is that Government revenue needs to increase.
Is the Minister saying these do not mean anything?
No, I am saying Government revenue needs to increase. If we want to increase health spending even more, obviously the issue is revenue generation and the performance of the economy. Cigarettes seem to be a source of potential further income for the Government. On the latest figures, health expenditure represents up to 80% of income tax, so the health budget is absorbing the vast majority of Government revenue.
The Minister will be aware that I acted as rapporteur for this committee on the tobacco report. In that we recommended that separate indices be kept for the CPI for the cost of tobacco, so I am glad that is on the agenda for discussion. However, the same report recommended a £20 million fund be set up to pay for an anti-smoking campaign geared towards youths and adults, given that almost half of all patients admitted to St. James’s Hospital have smoking related illnesses. Will the Minister pursue that £20 million campaign as recommended in that report to address the terrible burden smoking puts on people’s health and on the Exchequer?
We do not have £20 million this year for a specific anti-smoking campaign, although we invested significantly in the NICO advertisement which was aimed at young teenagers, particularly girls. That advertisement was quite costly to produce. We should constantly review the money we spend on nationwide advertising and radio and television campaigns and be prepared to look at alternative ways of funding preventative programmes and targeting people. Investing in preventative programmes at community level in key targeted areas particularly those with social deprivation might be a better way of trying to rearrange the budgets in the years ahead. It is important to have a presence in the major fora of advertising. We are evaluating the NICO advertisement to assess its impact on the target population. We will be working with our counterparts in Northern Ireland to try to save costs and utilise both facilities and resources. An important route forward is to go into specific communities with a broader range of preventative programmes which might yield particular results.
I had intended to mention this item and I am somewhat surprised to hear any questioning of the figure. I have been looking at things like this since 1987 and I never before heard of the Department of Finance agreeing to money going anywhere other than central coffers. This is the first tranche of money ever identified and given specifically for an area like this. I compliment the Minister on achieving that. If we want to sell more cigarettes and tobacco to take in more money, so be it.
Apropos of the point made by Deputy Mitchell, I want to ask about the delay regarding occupational therapists. I know this is included under subhead K1, capital services. Has there been any progress in getting a second school or training facility for the therapies and specifically occupational therapies?
I understand in the Eastern Regional Health Authority area, there are 3,000 people waiting for assessment in their homes for things like stair rails, seats and shower fittings. Some of them end up in hospital because they do not get them. They can wait for up to three years. While we are waiting for the training referred to by Deputy Dennehy, can we have some sort of short-term measure to clear the arrears?
The defence made of the requirement for a therapist's report is that they will help the person involved. They can do more than just checking and it is a waste of very scarce talent. It should not be necessary for somebody to spend two or three days inspecting a house in order to issue a GP's certificate that a stair facility, an extra kitchen or ground floor accommodation is required. I am very concerned about that requirement.
I understand that can be removed.
It could only be removed by the Department.
I understood that the Minister, Deputy Molloy, indicated that provision was being removed.
Local authorities, like Cork Corporation, are now buying sessions from private specialists.
We always end up talking about Cork.
It is the same in Dublin.
Practitioners are now being taken out of areas to which they should be giving priority. I know this is a requirement of the Department of the Environment and Local Government and not of the Department of Health and Children, but could we lobby for that to be removed and have a medical certificate instead of the requirement for a therapist to spend considerable time in the person's house?
It is just like the area of orthodontics. We have a single training school in Dublin that cannot supply enough people. We need at least one other facility in the south. I would like to see it in Cork, obviously UCC would be an ideal location, but if it were to go to Galway, I would live with that. Is there any funding under subhead K1 for such a facility?
Mr. Peter Bacon produced a significant report on manpower planning for speech and language therapists, physiotherapists and occupational therapists. He identified what would be needed up to 2015. It was the first comprehensive report of its kind done on the therapies. It is ridiculous that there is only one school in the country, but that is the historical legacy we inherited. A new facility is at tender stage. The Higher Education Authority issued invitations to the universities and institutes to submit proposals for the establishment of such schools. That deadline was extended earlier this year. Obviously a separate panel under the auspices of the Higher Education Authority will decide on this and the universities in Cork and Galway worked together on a combined proposal. We are considering regional issues in terms of dissemination, spread and distribution of graduates.
There are too many delays in getting occupational therapists to carry out inspections and we need a more streamlined system. On the other hand we must be careful that the facilities approved are appropriate to the needs of the individual. In the worst case scenario, there would be a general approval and significant money might be spent on a botched job that is of no use to the person. However, more standardised protocols could emerge as to what is necessary for people with specific ailments in terms of bathrooms, en-suites, bedroom facilities, etc. Part of the long waiting list reflects the huge investment being made. People can now apply for something they will get. Up to quite recently there was very little in that subhead for aids and appliances.
Once the Minister gets the trained therapists, I will be happy with the scheme, but I am concerned it could hold up projects.
I hope the number will increase by the time we need them.
They should be on track.
The Minister sought to extend the terms of reference of the Lindsay tribunal on infected blood products, which was resisted by the tribunal. He subsequently appointed a senior counsel to investigate the role of the pharmaceutical companies. Is it his intention that this will now extend to a pursuit of those companies?
We appointed Mr. Paul Gardiner SC to carry out a complete assessment and analysis of the feasibility of establishing an effective tribunal of inquiry to investigate the pharmaceutical companies in the United States. I have received that report. The Irish Haemophilia Society has expressed the wish to discuss the report with me and to obtain a copy prior to it going to Government. I have to, and will, discuss the matter with Government. This is a comprehensive report which contains not only the senior counsel's opinion, but also that of senior American lawyers. There are certain aspects of the report which would impact on a tribunal. If such a tribunal was established, elements of this report could have a particular impact on it. However, the senior counsel's opinion can be published and I intend to do so once the necessary consultations have taken place.
To be fair to the IHS, it was involved in the process more or less up to the end. It pulled back some weeks before the senior counsel completed his work. I will consult the IHS as regards the content of the report.
Can I take it that the Minister is not ruling out the pursuit of the US pharmaceutical companies at this stage?
I am ruling nothing in or out. I am going to Government with the report which I will also discuss with the IHS.
I thank the Minister and his officials. I also thank members for their co-operation.