Dáil Éireann - Volume 372 - 30 April, 1987

Ceisteanna—Questions. Oral Answers. - Health Boards.

1. Mr. Allen asked the Minister for Health the plans, if any, he has to reform the health boards; and if he will make a statement on the matter.

Minister for Health (Dr. O'Hanlon): I am considering the question of the appropriate future organisation of health services. Part of this consideration is the necessary structures within which that organisation can best be provided including the structuring of the health boards. While my consideration of this matter has [718] not yet been completed, I would like to make it clear that I do not see any good reason to propose a reduction in the number of health boards.

Mr. Allen: In the context of the financial cutbacks the Minister has presided over in recent times, can he outline to the House how he proposes to reduce the administrative costs within the health system and if he can inform the House of what he plans in that regard and what he plans in relation to the quality of management within the health system?

Dr. O'Hanlon: As I said, I am studying the structures within the health boards and I do not see any particular reason why we should reduce the number of health boards. Having regard to the fact that it is part of our policy, as it has been of previous Governments, to transfer resources from the hospital side to community care, we will in considering the restructuring of the health boards, be laying a lot of emphasis on that part of our policy.

Mr. Allen: Let me ask the Minister a question on his views on the question of the hospital services. Has he any plans to remove some of our major hospitals from the control of the health boards as the hospital services are now taking up over 50 per cent of the total health bill?

Dr. O'Hanlon: As the Deputy is aware, the majority of the acute mental hospitals are voluntary hospitals and I have no intention of interfering with them. The health board hospitals will still remain under the health boards.

Proinsias De Rossa: Does the Minister not feel that it would make for a more efficient management of the health services in any given board area if the voluntary hospitals were to be directly under the auspices of the health boards? Would the Minister also indicate whether he feels the health boards as they stand at present can survive, given the very severe cutbacks in their allocations this year for current spending?

[719] An Ceann Comhairle: Specific questions in this matter are worthy of special questions.

Dr. O'Hanlon: I do not expect that the voluntary hospitals would be better if they were under the control of the health boards. Certainly, I would be in favour of closer co-operation between the voluntary hospitals and the health boards. As regards the latter part of Deputy De Rossa's question, I am satisfied that the health boards will be able to provide an adequate and proper level of service out of their allocations which are an increase on what they received last year.

Mr. Keating: In his reply the Minister said that he saw no good reason for reducing the number of health boards. Does the review he referred to deal with the question of whether the health boards are per se the right structure and is he closed to the possibility, for example, of abolishing the health boards as an outdated vehicle for delivering services or changing their membership which is loaded with vested interests as he well knows? Therefore, are we going to see nothing more than a very cosmetic change arising from whatever review the Minister refers to at some unspecified date in the future or are we going to see some fundamental reform?

Dr. O'Hanlon: As I said in my reply, I do not see any good reason to reduce the number of health boards. A number of proposals have been made to me as Minister and to my predecessor and I am studying those proposals with a view to reorganising the structure within the health boards.

Mr. Keating: That is what the Minister said a few moments ago.

An Ceann Comhairle: Order, please. Deputy Mitchell.

Mr. J. Mitchell: The House will be very disappointed to hear that the study of the health system has already been pre-empted by a commitment to maintain [720] the present number of health boards. Would the Minister not agree that one of the problems in health expenditure is the escalation of administration costs over the past then years? If there were cutbacks in administration costs perhaps some of the pernicious things the Minister is now doing in the hospitals could be avoided.

Dr. O'Hanlon: I am monitoring very carefully the cost of administration in the health services and certainly we will be looking for efficiency in administration but, as I said in my reply, I am not convinced that reducing the number of health boards would improve the delivery of services to the people. What is important is to ensure that we do deliver an adequate and proper service.

Miss Quill: In view of the fact that to date all health board cutbacks seem to have been made at the point where the patient meets the service and very few, if any cutbacks appear to have been made in the area of administration or in the travelling expenses of officials or members of health boards, would the Minister consider issuing a directive to the CEOs of the health boards asking them to make corresponding cutbacks in the expenses which are now paid to officials and members of the health boards, especially in the outrageously high fees which are coming in for travelling expenses?

Dr. O'Hanlon: Officials of my Department have already written to the health boards asking them to take account of such items as travelling expenses and also asking them to ensure that front line staff would not be the first to be affected by any savings that have to be made.

An Ceann Comhairle: I want to bring this question to finality. A final supplementary from the Deputy who tabled the question, Deputy Allen.

Mr. Allen: Can the Minister explain why the health boards seem to have made cutbacks on the lower paid and unskilled workers within the health system? Has [721] the Minister examined the reasons why there appear to have been no cutbacks made in the senior management or administrative sides of the health services and why there have been no efforts to cutback on the abuses at the higher level in the medical profession, in private practice? The Minister made a token effort in asking for £1.5 million back from the consultants when they are getting ten times that out of the system?

An Ceann Comhairle: Brevity, please.

Mr. Allen: Why has the Minister not taken steps along those lines?

Dr. O'Hanlon: I have requested the health boards to send me a profile of how they intend to implement savings this year. As soon as all the meetings of the health boards have been held to discuss their budgets for this year, I will be receiving a report from each of the health boards and I will look at what they intend to do before making a decision.

Mr. Allen: I must say that——

[722] An Ceann Comhairle: Sorry, Question No. 2.

Mr. Allen: ——I am shocked that the Minister has pre-empted the whole debate by closing his mind to reducing the number of health boards.

An Ceann Comhairle: Order, I have called Question No. 2.

2. Mr. Desmond asked the Minister for Health the final departmental cash allocation for 1986 in respect of each health board and each public and voluntary hospital; the notified allocation for 1987; the actual percentage reduction in each case; and the amount withheld from each such agency to date in respect of the 1987 allocation.

Dr. O'Hanlon: I will circulate in the Official Report a tabular statement giving these details.

Table I

Health Board

Latest Approved* Allocation

1987 Original Allocation

Percentage Change

£m

£m

%

Eastern

177.600

183.210

+3.16%

Midland

53.600

54.300

+1.31%

Mid-Western

72.600

72.760

+0.22%

North Eastern

52.900

53.300

+0.76%

North Western

68.700

68.750

+0.07%

South Eastern

91.200

91.260

+0.07%

Southern

133.900

134.000

+0.07%

Western

107.400

107.620

+0.20%

Total

757.900

765.200

+0.96%

* These allocations fall to be adjusted marginally to take account of certain non-recurring items.

Table II

1986 Revised Allocation

1987 Allocation Notified

Per Cent Change

£m

£m

%

Adelaide

5.315

4.885

–8.1

Jervis Street

13.447

12.818

–4.7

Mater

26.173

23.795

–9.1

Meath

8.585

7.643

–11.0

Baggot Street

5.306

4.344

–18.1

St. Laurences

16.331

15.831

–3.1

[723][724]St. Vincents

22.503

20.510

–8.9

Dr. Steevens

6.711

5.475

–18.4

Monkstown

0.477

0.370

–22.4

St Michaels

3.591

3.298

–8.2

Mercy

4.798

4.651

–3.1

North Infirmary

3.499

2.806

–19.8

South Infirmary

3.609

3.277

–9.2

Victoria

1.643

1.510

–8.1

Barringtons

2.184

1.897

–13.1

St. Johns

2.037

1.588

–22.0

Portiuncula

5.803

5.227

–9.9

Waterford Infirmary

1.404

1.065

–24.1

Drogheda Cottage

0.840

0.649

–22.7

Lourdes Drogheda

9.368

8.793

–6.1

Coombe

7.147

7.070

–1.1

Holles Street

7.347

7.018

–4.5

Rotunda

7.976

7.581

–5.0

Waterford Maternity

0.954

0.812

–14.9

Temple Street

8.419

7.673

–8.9

Harcourt Street

3.233

3.326

2.9

Crumlin

13.381

12.245

–8.5

St. Annes

1.118

1.007

–9.9

Hume Steet

1.037

0.796

–23.2

St. Lukes

4.751

4.281

–9.9

Royal Victoria

4.634

4.179

–9.8

Cork E.E.& T.

1.158

1.107

–4.4

Incorporated Orth

0.994

1.001

.7

Cappagh

4.263

3.864

–9.4

Baldoyle

0.870

0.766

–12.0

Lourdes Dún Laoghaire

4.281

3.784

–11.6

Dublin Dental

0.773

0.812

5.0

Hospice

2.943

2.814

–4.4

F.D.V.H.

1.730

1.538

–11.1

C.R.C.

1.163

1.182

1.6

C.V.H.B.

0.297

0.298

.3

St. James

31.227

30.505

–2.3

James Connolly

10.893

9.330

–14.3

Linden

0.350

0.262

–25.1

Donnybrook

2.550

3.038

19.1

N.R.B.

3.243

3.413

5.2

Leopardstown Park

1.368

1.285

–6.1

Cork Dental

0.485

0.255

–47.4

St. Vincents Fairview

2.509

2.341

–6.7

Drogheda Memorial

0.111

0.095

–14.4

Total

274.829

254.110

–7.5