Minister Martin marks Millennium Budget with additional £1,000m expenditure for Health Services
The Minister for Health and Children, Mr Micheál Martin, TD, announced (7 December, 2000) that health sector expenditure will exceed the £5 billion mark in 2001. There will also be significant positive effect on the full year cost implications for 2002.
Gross spending on health will increase from just under £4.3 billion in 2000 to approx. £5.3 billion (revenue and capital services) next year. This results in daily spending on health services amounting to almost £14m. Approx. 86,500 staff are now directly employed in delivering these services. The Budget Day package alone, standing at £194m is the biggest ever for the health services. It amounts to three times the figure approved for the year 2000.
“Since taking up my appointment as Minister for Health and Children, I have set about developing a focused approach to targeting funds in areas of prioritised need. The Budget Day Package together with the planned Estimate for 2001 reflects that approach.
I have said earlier that a planned coherent and strategic evaluation of needs of the health sector is a must. Nevertheless, we cannot afford to wait until all the analysis is fully carried out and reported. The focus of the expenditure profile for 2001 and 2002 does take into account previously identified areas requiring support, other areas where obvious intervention is required now and the initial phases of programmes which will require monitoring and subsequent adaptation during their implementation”, the Minister said.
Day-to-day health spending will, in broad terms, be distributed as follows across the major programmes in 2001:
- £1,750m on public hospitals
- £800m on services dedicated to the needs of older people
- £500m on the GMS (Medical Card) Scheme, and a further £200m on Community Drugs Schemes
- £450m on intellectual disability and autism services
- £350m on psychiatric services
- £200m on physical disability services
- £200m on child support services
- £200m on community protection measures such as vaccinations, food safety and health promotion
- £100m on dental and ophthalmic services.
Details of Significant Areas
Intellectual Disability and Autism Services
A total additional amount of £ 83m (including capital) will be made available in year 2001, amounting to an additional total of £100m (including capital) over the next two years.
The planned services for 2001 include:
- 450 new residential places;
- 110 new respite places;
- 40 specialist places;
- 600 new day places; and
- increased health related support services for children with an intellectual disability, including Autism.
Physical and Sensory Disability Services
A total additional amount of £39m (including capital) will be made available in year 2001, amounting to an additional total of £66m (including capital) over the next two years.
The planned services for 2001 will include:
- development of the National Database;
- enhanced therapy services;
- priority interventions identified by the health boards in consulting with disabled parties;
- significant increases in house support services and personal assistants.
- just under £1m is being provided to increase the Respite Care Grant, in respect of certain Domiciliary Care Allowance beneficiaries from £300 to £400. Also the grant is extended to cover a second eligible child.
- additional revenue funding of £3.35m is provided in 2001 towards services for persons with a disability at work in sheltered workshops.
- training of £5m in 2001 for Disability sector.
- £2.5m in 2001, rising to a full year cost of £6m in 2002, for Personal Assistant Services, enabling the recruitment of 312 additional assistants.
- Doubling of the Mobility Allowance, which currently benefits approx. 2,600 persons, from £45.60 to £90 per month. This will cost a total of £1m in 2001.
- Revisions for eligibility criteria for receipt of the Domiciliary Care Allowance – abolition of the six month rule and pro-rata payments for children, normally resident in special care institutions, for periods spent at home.
Services for Older People
An amount totalling just under £71.6m (including £18m capital) will be devoted to services for the older person.
This expenditure for 2001 will include:
- £7m to extend benefit of medical cards to all persons of 70 years or older.
- £2m for enhancing the scope of the home help service.
- £5.49m for the improvement of ‘home based’ community support structures.
- £2m for carers support.
- £0.6m is being provided to the Alzheimer’s Society of Ireland for care services.
- £0.23m is being made available to a range of voluntary groups.
- £3.65m to the improvement in staff/client ratios in extended care facilities.
- £14.267m for the Nursing Home Subvention Scheme.
This will involve an increase of 25% from 1st April, 2001 in the nursing home subvention rate.
The remainder of this funding will be used for the improvement and enhancement of existing services e.g. additional funding provided to community nursing units, day care centres, community services, as well as a contribution towards improvements in home help pay, and for innovative approaches to the delivery of services for older people at a local level.
An amount totalling £5.4m will be made available in 2001 for Palliative Care Services. The total additional amount spent over the next two years amounts to £7.8m.
This funding will support a minimum of one consultant-led, multi-disciplinary team in palliative medicine in each Health Board. Other improvements include home care and day services at a cost of £0.83m. The remaining £3m will be used in support of national policy in the area of palliative care which will be further developed on foot of the, soon to be published report of the National Advisory Committee on Palliative Care.
Mental Health Services
An amount totalling £32.6m (incl. capital of £14m) will be provided for improvements in mental health services in Year 2001.
Priority areas in 2001 include:
- £8.255m for further development of community based mental health services;
- Approx. £5m for expansion of child and adolescent psychiatry and psychiatry of old age;
- £0.83m towards suicide prevention programmes;
- £0.10m towards implementation of the recommendations of the Task Force on Suicide.
During 2001, the Mental Health Bill will be enacted. It is planned to provide £2m for the establishment of a Mental Health Commission which will implement proposals in the Act.
Additional funding of £3.390 million for Renal Services, building upon the first tranche of £3 million provided in 2000. Investment is aimed at achieving a structured enhancement of the capacity of the system to meet existing and anticipated growth in demand for renal services and to ensure the equitable availability of treatment choices for dialysis patients throughout the country.
Additional funding of £1.7m to support the development of the hospital accreditation programme in eight major acute hospitals and for accreditation of laboratories.
South Infirmary/Victoria (Sexual Assault Unit)
Funding for the piloting of a sexual assault treatment unit to be located at the South Infirmary/Victoria Hospital site in Cork.
Acute Hospital Service Developments
£26 million additional funding across the country for acute hospital service developments. This investment demonstrates the Ministers commitment to regional self sufficiency which is manifested by the allocations given for further commissioning in Limerick Regional Hospital, Mayo General Hospital Castlebar and in his support for the integrated hospital initiative among Cork city hospitals. Among the hospitals where new units will be commissioned in the Eastern Regional Health Authority are: St Lukes’, Beaumont, Temple Street, Tallaght, Cappagh Hospital, and St James’.
Funding of £7.6 for the further development of cardiac surgery services at the Mater Hospital, St James’ Hospital, Crumlin Hospital and Cork.
Waiting List Initiative
Building on the consistent reductions in waiting lists and the considerable progress achieved in the target specialities in the current year. This amount of £11m will allow me to continue the investment of approximatley £34.5m again in 2001.
£18.849 million for the continuing development of cancer services, including supporting cancer specialists who have been appointed since the launch of the National Cancer Strategy and funding for new oncology drug treatments, the development of specialist units for symptomatic breast disease, the further development of consultant haematology services in the North Western and Southern Health Board’s and the funding of specialist radiotherapy services.
Acute Hospital Bed Capacity
£7 million for the implementation of initiatives identified in Phase 1 of National Bed Capacity Review. Moneys to be targeted at the develoment of A & E, Day-Case and In-Patient services nationally. This is in addition to £10m provided for the appointment of an additional 27 Accident and Emergency Consultants and 15 Consultant Anaesthetists.
£1.5 million for the treatment at St Vincents’ Hospital and the Mater Hospital, Dublin, of women screened under the National Breast Screening Programme who require follow up treatment.
A total additional amount of £14.4m will be made available in Year 2001 bringing the total funding for implementation of the “Cardiovascular Strategy – Building Healthier Hearts” to £27m.
The medium term objective to bring our levels of premature deaths from cardiovascular disease in line with the EU average, is at a minimum.
This is in a 5 year programme with a total cost of £150m involving implementation of some 211 recommendations.
During 2001, the initiatives are:
- Provision of structures and resources for the next phases of the national campaigns (including Ireland Needs a Change of Heart);
- Health promotion initiatives to reduce the incidence of smoking and encourage healthy eating and physical activity;
- A major national pilot primary programme of structured care and secondary prevention for patients with chronic cardiovascular disease;
- Necessary infrastructure for primary care including community dieticians and training for community based health professionals;
- The implementation of an information system and clinical audit programme in pre-hospital services;
- Recruitment of resuscitation training officers and other hospital staff.
Alternative Care Services
A total of £9 million is being allocated to further develop the foster care services. These developments will be based on the recommendations of the forthcoming Report of the Working Group on Foster Care. The Working Group has completed its deliberations and it is anticipated that its Report will be published very soon.
“£5m is being made available to address the problem of Youth Homelessness particularly in the Dublin area where a comprehensive range of new services is being put in place. These include:
- three emergency accommodation centres with 30 places, two of which are ready to open this month;
- outreach teams;
- downstream residential places;
- appointment of some 30 additional staff in child care services in the ERHA area.
Substantial capital funding is also being provided for facilities for homeless young people.
£1.2m has been provided for the introduction by the health boards of a voluntary notification and support system aimed at childminders looking after three or fewer children. These childminders are exempt from the notification and inspection requirements of the Child Care (Pre-School Services) Regulations, 1996.
Specific funding is being provided in the area of intercountry adoption. This additional funding will boost staffing to meet the continuing increases in demand for assessment services.
Earlier this year the Government approved the preparation of a Bill to allow for the establishment of a Children’s Ombudsman and the recently launched National Children’s Strategy recognised that such an office will provide children with a significant new voice at local level. A sum of £250,000 has been allocated to allow for the establishment of a Children’s Ombudsman in the coming year.
Cardiac Surgery Waiting List Initiative
- An additional £5m is provided for 2001 to continue and progress the reduction of cardiac surgery waiting lists. The objective is to guarantee public hospital patients access to cardiac surgery within an average waiting period of six months from diagnosis.
- £4.5m will be allocated to the Eastern Regional Health Authority for adult and paediatric surgery.
- £0.5m will be allocated to the Southern Health Board for additional cardiac activity at Cork University Hospital.
- An additional £2.58m to address cardiovascular disease and to enhance the provision of services,
- £2.08m will be allocated to the Eastern Regional Health Authority and the South Victoria Hospital, Cork, will receive £0.5m to develop its cardiology service.
Symptomatic Breast Cancer Treatment
- £1.5m is provided to the ERHA specifically to meet an increased demand on the symptomatic breast cancer treatment service in the Mater and St Vincent’s Hospitals in Dublin.
- This increased activity has arisen directly from the screening undertaken by “Breastcheck”, the National Breast Screening Programme on women in the 50 – 64 age group in the Eastern, North Eastern and Midland health board areas.
- The early detection and consequent earlier treatment of cancers will lead to decreased mortality rates for this group of at-risk women and is an important element of our overall cancer strategy.
An additional £10m is provided to enhance dental services in 2001. This includes a £5m initiative specifically targetted to tackle the orthodontic waiting lists.