Tuesday, 1 June 2004
Dáil Eireann Debate
Mr. Connolly: I am grateful for the opportunity to discuss the impact of under funding in the North Eastern Health Board area. In recent days, a report on deficiencies in services and infrastructure was presented to the Minister for Health and Children by the executive of the North Eastern Health Board. It is as if the executive has suddenly realised that the under funding which has obtained for years is a major matter of concern now that the boards are being dissolved. I have proposed the rejection of service plans for years on the basis that we were not receiving enough money to run an adequate service in the north east. This was having a negative impact on services across the board.
Ours is the most under funded health board in the country and must make do with 79% of the national average. The North Eastern Health Board receives €1,590 per capita whereas the national average is €2,020. The board’s total budget is approximately €550 million per annum. To bring this up to the national average, the North Eastern Health Board would have to receive a further €137 million per year. One can imagine the effect that would have on the delivery of services. The current funding equates to a gross under spending per person in the north east.
The response of the board’s executive to the shortfall in funding has been to cut services at Monaghan General Hospital, Cavan General Hospital and Louth County Hospital and to cut back on medical cards. The executive cut wherever it could think of cutting. Regrettably, every possible cut was made including the closure of maternity units. The executive was supported in this by a Fianna Fáil dominated health board which supported it through thick and thin. I would have preferred to see the executive come knocking on the door of the Minister for Health and Children to demand extra funding. That never happened as the executive knew it was being shielded by the Fianna Fáil dominated board. When one looks at the newspapers, one sees that it is always the north east where troubles arise. That is the result of poor management.
Traditionally, Dublin hospitals treated people from the north east. While they tell us now that we should treat people in our own communities, they have held on to the budget for the treatment they used to provide. The cuts are having an impact right across health services. They are affecting mental health, acute hospital, disability and community services. The north east has an increasing population which has grown by 13% since 1996. There has been a 29% increase in child birth since 1999, our reaction to which was to close two maternity units at Monaghan and Dundalk respectively. We have seen a 32% increase in cardiac admissions, quite of number of which originate in Monaghan. Our reaction to that was to close the accident and emergency unit in Monaghan. Of all road traffic accidents, 25% occur in the North Eastern Health Board area. A large percentage of those occur near Monaghan area which is crossed by four major routes leading to an increased demand for services.
Recent reports identified a need to fill 85 consultant posts to achieve regional self sufficiency, of which 60 remain vacant. The money is not there and we cannot attract the consultants needed to make the north east self sufficient. There are also deficiencies in specialist surgical services including ear, nose and throat, ophthalmology and urology. There are medical deficiencies in cardiology, nephrology and dermatology. A total of 23 major projects are still outstanding in the North Eastern Health Board and I see no possibility that they will be tackled in the near future. The North Eastern Health Board must make do with one member of staff per 100 of population whereas the national average is one per 70. I call on the Minister for Health and Children to take some form of action to address this inequality. With the disbandment of the health boards, we will not know what level of funding is being provided in different areas and it will take a genius to work out the extent to which we are being under funded.
At the moment at least we can identify clearly why and how we are being under funded in the North Eastern Health Board area. There are great needs. There is a 44% shortage of in-patient beds and we need a 90% increase in day places in the North Eastern Health Board area. We also need a 150% increase in day procedure rooms. These are services for which funding is necessary to avoid a scenario in which every time one looks at a newspaper one sees that the north east is the area which appears to be suffering.
Minister of State at the Department of Health and Children (Mr. B. Lenihan): I reply on behalf of the Minister for Health and Children who strongly rejects the suggestion that the North Eastern Health Board has been under funded in the year 2004. The House will recall that overall funding for health and children’s services in 2004 was the largest level of funding provided to any Department. Approximately €926 million was provided representing a 10.7% increase over 2003 in day-to-day spending. The level of funding provided in 2004 for the North Eastern Health Board is €548.784 million which is an increase of €65.7 million or 13.6%.
Mr. B. Lenihan:
This increase was above average. The Deputy refers to cutbacks in the context of a budget which was increased by 13.6%. The chief executive officer’s introduction to the board’s 2004 service plan acknowledges that the increased funding is substantial. He is correct. The increase represents the third highest increase provided in 2004. The Minister recognises the pressures on the board due to demographic shifts, maternity service demands and the increase in the numbers of non-nationals receiving services. Nevertheless, the increase in the board’s funding base since 1997 has been significant by any measurement. The overall increase in funding for all health boards between 1997 and 2004 was €5.2 billion or 196%. The comparative figure for the North Eastern Health Board was €383 million or 231% which has been the largest increase in day-to-day funding of any health board. The next highest increase was
219%. In part, the increase represents an acknowledgement of the Deputy’s point concerning the lower base level of funding in the North Eastern Health Board in 1997.
It is generally recognised that a major reason for the low funding base has been the board’s rate of referral to acute hospitals in the Eastern Regional Health Authority area. This is the highest rate of any board for in-patients, elective in-patients only and day cases. In the case of day patients, the referral rate from the North Eastern Health Board is twice as high as that of the next highest, the South Eastern Health Board. This statistic has an obvious impact on the allocation of funding to the board. The Eastern Regional Health Authority’s hospitals carry a significant financial burden for the treatment of patients from the North Eastern Health Board.
I wish to outline some of the service issues addressed by Ministers since 1997. Acute hospital funding has allowed for a 26% increase in patient discharges, more than 10% of which relate to in-patients. Day cases recorded an increase of 86%. This compares with a national average increase of 23% in discharges overall, with 4% in-patients and 64% day cases. Additional funding of more than €24 million has been provided for services for older people including in particular provision for nursing home subventions and home-help services. Cancer services received increased funding of more than €9 million to support the 130% increase in admissions since 1997. Cardiovascular services have received additional funding of almost €5 million to support a 32% increase in admissions since 1997. The North Eastern Health Board’s employment numbers increased considerably in recent years. Between 2002 and 2003, an additional 1,782 posts were approved giving a staffing complement of almost 7,000 posts at end of 2003. Some 780 additional staff have been approved for the region’s acute hospitals since 1997, of which more than 100 were consultant posts.
These are some of the more significant issues addressed over the past years. It remains the position that the board has been more than fairly treated in the period in which this Government has had responsibility. The Minister and his officials have always and will continue to work with the board to seek solutions to emerging problems. A record of increased services supported by a now significant funding base is testimony to this. The objective for 2004 is to again work with the board to achieve a quality service for its clients while utilising the funding base efficiently and effectively.
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