Year 2000 Health Estimate : allocation to health breaks £4 billion barrier
The Minister for Health and Children, Mr Brian Cowen TD, has welcomed the extra £594 million in gross expenditure provided for the health services in the Abridged Estimates Volume published by the Government today. In the Abridged Estimates Volume for 1998 spending of £3billion was exceeded for the first time In today’s Estimates £4 Billion has been provided to Health. Next year’s spending on Health will be almost £11m per day. The Minister said that the extra resources being provided by the Government to the health services are unprecedented. The figures clearly show the Government’s determination to improve the level and quality of service available to the public. The provision in today’s Estimates will be significantly complemented by the capital infrastructural improvements to be provided for in the National Development Plan and further built upon with anticipated additional funding in the Budget. Increasingly the beneficial impact of the Government’s commitment to the health service over the last two years will be felt by patients and others in receipt of services. There are already significant indications that a transformation across a broad range of services is taking place. The Minister said that there is an unrivalled opportunity for all those interested in improving services to work together to ensure that the full benefit of the resources now available is realised.
The 2000 Estimates for the Health Services as published today show the following:
|1999 Estimates (£m)||Increase (£m)||Increase (%)|
|Total Gross Health Estimate||4,143.867||594||17|
|Gross Non-Capital Estimate||3,913.867||519||15|
This funding will provide for the employment of an additional 3,000 health professionals and other workers in delivering an enhanced level of service.
In interpreting these figures regard should be had for the fact that the figures for 1999 have not yet been finalised. Adjustment will be made through a Supplementary Estimate for increased costs in certain areas such as demand led schemes, superannuation, PRSI, medical indemnity, nurses pay and the General Medical Services. Despite this, provision has been made for these items in the 2000 figures. In order to make a consistent comparison between 2000 and 1999 figures some adjustment to the figures is necessary giving the following estimated increases:
|Increase ( % )|
|Total Gross Health Estimate||14|
|Gross Non-Capital Estimate||13|
These adjusted increases will be of most relevance in framing service plans for 2000. These increases also exclude Hepatitis C Compensation Payments – £96m in 1999 and £30m in 2000 – the reduction in which partially offsets the additional funds for the health services generally.
The Minister will be seeking further funding from the Government, in the context of the forthcoming Budget, for certain key areas such as mental handicap, physical disability, the cardiovascular health strategy, etc.
The Health Capital Programme for 2000 will be £230 million. This is an increase of 48% over the original 1999 figure of £155m.
This is a very significant increase and represents the greatest level ever of capital investment in the health services. It should also be noted that the Government have made a significant commitment to capital investment in the health services for the period 2000- 2006 and this investment will be provided as part of the National Development Plan; more information will be available on the Plan next week when it is launched.
The funding in 2000 will allow continuing investment in the hospital equipment programme which was initiated in 1998. Also, it will provide for replacement of priority equipment, maintenance backlogs and fire precaution works.
A sum of £25 million is contained in today’s Estimates to facilitate a major initiative to reduce the incidence of Group C meningitis. The latest indications are that we can expect a vaccine offering protection against Group C meningococcal disease to be licensed and available for use in Ireland in the early months of next year. The health boards have already commenced planning a programme for the delivery of this vaccine. This will allow for the incorporation of the vaccine in the Primary Childhood Immunisation Programme and for it to be given to older children and young people in a “catch-up” programme. This programme will be a major undertaking, eventually involving the vaccine being administered to about a third of the population. It is estimated that the “catch-up” programme will in total cost approximately £50 million while the continued immunisation of infants will have an on-going cost of £5 million. Ireland has more than four times the European average incidence of meningococcal disease. Vaccination against the Group C strain of the disease, which represents about 40% of the disease in Ireland, will be a major step in the fight against meningitis.
Substantial additional funds will be provided for a range of other areas as a result of both today’s Estimates and the Budget on 1 December. This will allow the considerable progress already underway to be built upon and accelerated.
A total of almost £23 million in additional revenue is being made available for childcare services in today’s Estimates. These resources will allow increased emphasis to be put on the prevention of problems through supporting vulnerable children in the family and community setting while also ensuring that services are promptly available to children at risk. In addition, a further £2 million is being allocated for measures to assist victims of childhood sexual abuse. On foot of the Government initiative earlier this year £2 million was made available bringing the total spend next year to £4 million.
There is no more onerous duty than the protection of children and the promotion of child welfare. The responsibilities imposed upon health boards in this area have expanded greatly. As one indication of this the number of reported cases of child abuse has increased by approximately 290% in twelve years while the number of confirmed cases has increased by approximately 200% over the same period. While legislation is in place this must be backed up by resources. This is the first part of this Government’s strategy – delivering the required resources. For example, funding made available in 1998 and 1999 provided for an additional 750 staff, including social workers, to be employed in the child care area. Ensuring consistent standards apply though-out the service is also a major part of the Government’s child care strategy. To this end a Social Services Inspectorate was established in March of this year. National Guidelines for the Protection and Welfare of Children were published in September. Funding is provided in today’s Estimates for an Ombudsman for Children which will vindicate the rights of individual children. Encompassing all of these developments will be a National Children’s Strategy which is currently being formulated. This Strategy will set out a co-ordinated policy designed to integrate service delivery for children across the range of public services.
Intellectual Disability Services
An additional sum of £10.7 million for intellectual disability services is contained in today’s Estimates. Further additional funding for these services will form a key part of the Budget Package. The Minister is confident that very significant additional funding over and above that announced today will be made available.
Addressing identified needs in intellectual disability services has been one of this Government’s top priorities. The objective is to have significantly reduced the waiting lists, in addition to having enhanced the level of respite care available, over the next two years. As a result of the investment made in these services since 1997 over 900 residential/respite places and over 900 day places have been put in place.
An additional £10.8 million is being made available for services for the disabled in the Estimates. Further funding will also be provided in the Budget for these services.
In the review of An Action Programme for the Millennium the Government made a pledge to accelerate the development of services for mental and physical handicap. Facilities already in place will be improved upon and additional places will be backed up by a range of supports for the disabled, their families and carers.
Amongst the measures to be implemented as a result of today’s funding will be the application of the Domiciliary Care Allowance scheme to eligible children under two years of age from 1st January 2000. This initiative will assist the care requirements of severely disabled infants and will bring the scope of the current scheme into line with common international best practice.
A further £10 million will be made available for dental services next year.
Over £10 million has been made available for dental services so far by this Government between 1998 and 1999. This funding has facilitated the much needed improvement in orthodontic services and the Dental Treatment Services Scheme (DTSS). There has been a phased extension by this Government of routine treatment under the DTSS to all those with medical cards. This process will be completed with the imminent extension of routine treatment to the 35-64 age group.
Services for Older People
In total an additional £35.4 million is being made available for services for older people. This funding will allow for investment in the community services required to support older people living at home. Also provided for is the opening of new community nursing units in Dalkey, Achill, Fermoy and Killybegs and day care centres in Mallow, Skerries and Finglas. Today’s funding will also ensure all home helps are paid at a rate consistent with the national minimum wage. Funding for increased numbers of nursing home subventions and dependency of applicants is also provided.
Over £30 million in extra resources has already been provided by this Government for services for older people. This funding has gone towards community supports, nursing home subventions, extension of medical card eligibility and improvements in the home help services and increases in the rates of home help pay.
In line with its commitment in “An Action Programme for the Millennium”, the Government decided that the income guidelines for entitlement to medical cards for persons aged 70 years or over should be increased significantly. This improvement, which is being introduced over a three year period, began on 1 March this year with an increase of one-third in the guidelines. As result of today’s funding there will be a further increase of one-third next year.
In 2000 the current income guidelines for a single person living alone will be increased from £133 to £177 per week for a person aged between 70 and 79 years of age and from £146 to £187 for a person aged 80 or over. Similarly, for a single person living with family the increases will be from £115 to £153 and £120 to £160 respectively. In the case of married couples the income guidelines will be increased from £199 to £265 per week for the 70 to 79 age group and from £209 to £279 for those in the 80+ age group. The remainder of the increase in the guidelines will be introduced in 2001. The increased amounts stated above are based on the current guidelines and do not include the annual Consumer Price Index adjustment which health board chief executive officers implement each January.
Mental Health Services
A sum of £10.2 million is being provided for improvements in mental health services. This additional funding will be allocated towards the further development of community based mental health services. Resources will be allocated to the improvement of the psychology and social work services which have been identified by the Inspector of Mental Hospitals as major deficits. It is also the intention to continue to improve mental health services for particular groups such as children and adolescents, through the strengthening of specialist child and adolescent psychiatric teams, older people through the provision of more consultants in the psychiatry of old age and support services, and the forensic psychiatric services through the enhancement of services provided at the Central Mental Hospital and the Prison Service in conjunction with the Minister for Justice.
Given the continuing rise in the numbers of suicides, particularly among young males, it is imperative that appropriate measures are taken in an effort to address this significant public health problem. Additional funding will be made available to assist agencies including the National Suicide Research Group established by the health boards in developing intervention programmes and to assist in research into suicide and attempted suicide. The necessary resources are being provided to enable a national research programme on attempted suicide to be commenced by the Suicide Research Foundation in Cork under the aegis of health board National Research Group. This research will have an important bearing on future strategies for preventing suicide.
As indicated recently, a new Mental Health Bill will shortly be published which will provide greater safeguards for patients who require to be admitted on an involuntary basis to mental health facilities. Funding of £2.5 million is being provided in 2000 to provide for this Bill’s enactment.
Hospital Waiting Lists
A total of £23.5 million will be provided under the Waiting list Initiative next year. This is almost three times the level of resources invested by the last Government.
The last Government provided just £8 million for waiting list funding in our hospitals in 1997. The result was more public patients had to wait longer for necessary treatment. It was left to this Government to deal with the consequences. In 1998 £12 million was provided by this Government and this was increased it to £20 million in 1999. The underlying causes of waiting lists are also being addressed. The Report of the Review Group on the Waiting List Initiative was the first comprehensive review of the area and it sets out a comprehensive blueprint for the way forward.
This is a new initiative introduced by the Minister to improve the Renal Care Services. He has allocated revenue funding of £3m and capital funding of £3m for the commencement of a programme for the development of Renal Dialysis services. This programme, which I would hope to see completed over 3 years at an estimated total cost of £20m, will be aimed at achieving a structured enhancement of the capacity of the system to meet existing and anticipated growth in demand for renal services over the coming years. It will ensure the equitable availability of treatment choices for dialysis patients though-out the country. Next year’s investment will be primarily directed at addressing immediate requirements that are apparent from the Department’s review of services in the area. In tandem with this the Department will be engaging in further detailed consultations with all relevant interests and further examining the epidemiology of end-stage renal failure with a view to informing the most effective investment of further resources in subsequent years.
The Commissioning of New Acute Hospital Units
The Minister has also allocated significant additional funding of £11.5m for the commissioning of new acute hospital units. These include the major development at Limerick Regional Hospital which is now near completion and the new facilities which will be provided include an Accident and Emergency department, radiology, renal dialysis, medical day unit, ICU, Out Patients Department, pathology, C.S.S.D., new operating theatres and new paediatric facilities.
Completion of the commissioning of Phase I of the re-development of UCHG to include the new A and E facilities, operating theatres, ward accommodation, radiology facilities and C.S.S.D. In addition, units completed under the first stage of the construction programme at Mayo General Hospital will be ready for commissioning as follow: A and E, C.S.S.D, geriatric assessment and the CT Scanner.
Finally, wide ranging reform of the way our hospital system operates is underway. On Tuesday next, 16 November, a key speech on acute hospitals will be delivered by the Minister for Health and Children.