Speeches

Address by the Minister for Health and Children to the Select Committee on Health and Children, Estimate for 2004

Chairman, I am pleased to address the Select Committee on the Revised Estimates for 2004 for Health and Children Estimate.

The Revised Estimate for 2004 shows a total gross estimate of almost €10.08 billion for the health services. This is a significant milestone in funding for the health services and it demonstrates the considerable investment over the past number of years.

This consists of €9,570 million current funding and€510 million capital funding.

In relation to day-to-day spending, this represents a €926m (10.7%) increase over the Revised Estimate for 2003 and a €782 million (9%) increase over the Outturn for 2003.

Given the overall increase in spending on public services and the Government’s strategy to contain public spending levels in 2004, this level of additional funding underlines once again the Government´s commitment to our health services.

Health Spending

Much has been said of Ireland´s position in regard to its level of health spending within Europe. Despite the negative comments made by some, this Government´s investment record in health continues to be impressive with percentage increases in double digits in each of the last seven years.

In 2001(the latest year for which comparable data is available) Ireland´s publicly funded health expenditure per capita was 1,560 in US$ PPP (Purchasing Power Parities). This is 98% of the average spending of 14 EU countries, ranking Ireland 9th among 14 EU countries in terms of per capita public spending on health. These figures show Ireland in an improved position relative to the EU average in 2001 compared to 2000. I am certain that this position will be further improved when comparable figures become available for 2002, given the substantial increase in funding of 19.5% in that year.

Increased Investment, 1997-2004

The total spending figure (current and capital) for this year will be €6.58 billion higher (or 188%) than provided in 1997.

The Government has provided some €6.2 billion in increased revenue funding over the past seven years. This represents a 185% increase on the 1997 figure of just under €3.4 billion and brings us to a Non-Capital Vote of in excess of €9.6 billion.

This extra investment over recent years has brought about significant results, including record levels of activity in the acute hospital system and a whole range of additional services provided across all care programmes, such as:

  • For the first time ever there has been over one million discharges and day cases treated in our hospitals. This represents an increase of 46,000 discharges or almost 5% over 2002.
  • Indeed, in the area of day cases there has been a massive increase of over 190,000 cases or 76% since 1997, giving a total of almost 441,000 at the end of 2003.
  • The total staffing figures for the public health service has increased from about 68,000 in 1997 to an end 2003 position of approximately 96,000 whole time equivalents, a 40% increase.
  • This figure excludes home helps who provides services direct to older people
  • According to the Brennan Commission 10 out of every 11 additional employees recruited since 1997 are engaged in duties of direct service to patients and the public.
  • Since 1997, an additional 482 consultants have been appointed which represents an increase of 37%
  • Since the end of 1997 there has been a 130% increase in the number of occupational therapists, a 71% increase in speech and language therapists and a 37% increase in the number of Medical/Dental personnel working in the health services.
  • In 1997, there were 25,233 whole-time equivalent nurses employed in the public health system. By the end of September 2003 this figure reached 33,442. This is an increase of over 8,000 during the period, or almost 30%.
  • An additional 245 clinical nurse specialists have also been appointed in the cancer services area.
  • Substantial progress has been made in recent years in ensuring that those in need of mental health services receive care and treatment in the most appropriate setting.
  • There are approximately 411 community psychiatric residences in the country providing over 3,146 places. This compares to 391 residences providing 2,878 places in 1997.

Health Funding 2004

Whilst positive signs are emerging in relation to the economic climate generally, the Government needs to continue to employ a cautious and prudent approach to the use of resources in the short term. The increases in funding available to my Department in 2004 must therefore be seen in that context. Notwithstanding this, I have secured a 9% increase over the 2003 outturn, which amounts to 27% of the overall increase in Exchequer spending in 2004 compared with the outturn for 2003.

The complexity of services now delivered within the acute hospital sector has increased enormously. Significant investment has been made in additional specialists and diagnostic and investigative processes. These have allowed for more emphasis on day care work, shorter lengths of stay and overall a greater turnaround of patients leading to better utilisation of beds. In addition, acute hospital discharges in 2003 exceeded one million for the first time and represents an increase in activity of over 4% between 2002 and 2003. The early indications for 2004 suggest a continuation of this trend with day case work again showing significant increases.

This demonstrates the continued efficiency within the health system and the ability of the people in the health services to generate real value for money in relation to the way that services are delivered.

VFM strategies

New Technology Assessment has an increasingly central role to play in the use of VFM strategies and health boards were asked in their letters of determination to ensure that every effort continues to be made to seek out assessments of new technologies to guide their introduction so that tighter targeting of the use of technologies, combined with appropriate protocols, will ensure that new technology is employed only for those cases where clear demonstrable benefits exist and resultant costs are justified. In this regard, it is proposed that the health boards and agencies, pending the establishment of the Health Information and Quality Authority, should continue the development of a common approach to the assessment of new technology under the auspices of HeBE.

VFM Targets

The attainment of better value-for-money through effective and efficient use of resources continues to be a critical objective for all health agencies. Health boards and agencies must continue to pursue VFM during 2004 and their determinations reflect an appropriate amount of VFM targets which apply across the boards to both pay and non-pay areas. In developing their approaches to achieving that target, they were asked also to take into account possibilities that will emerge from the Procurement Strategy for health services, which is being completed under the aegis of HeBE.

It is critical that all health agencies use the skills and structures now in place to maximise co-operation and actively pursue value-for-money in materials management, particularly in the development of national protocols and contracts. The level of co-operation between boards to achieve greater VFM will be closely monitored by the Department throughout 2004.

The Casemix Programme, which was introduced in Ireland in 1991, is used all around the world and is unique in that it is developed, at international level, by administrators / clinicians / statisticians & finance personnel all working together. Casemix has now proven itself and is tried and tested here in Ireland.

Casemix has been developed to assess comparative efficiency and create incentives for good performance in health care systems and has been endorsed in the Health Strategy.

Following a recent review of the Casemix system, the national programme will be significantly enhanced and expanded, allowing it to be applied to all acute hospital encounters and all acute and sub-acute hospitals by the end of the decade. At least 50% of acute hospital funding will be based on Peer Group related Casemix performance by 2009. This is a significant development in the system and will greatly enhance resource allocation in the health sector.

Chairman, I would now like to outline some of the features of this year´s Estimate, beginning with Acute Hospitals.

Acute Hospitals Programme

Bed Capacity Initiative,/h3>

Under the Bed Capacity Initiative a total of €12.6m is being made available from overall funding in 2004 to the ERHA (€8.8m) and the SHB (€3.8m) to facilitate the discharge of patients from the acute system to a more appropriate setting thereby freeing up acute beds. The funding will provide for the subvention of additional beds in the private nursing home sector and ongoing support in the community.

Pre-Hospital Ambulance Services

The Strategic Review of the Ambulance Services report recommended the elimination of “on-call” duties from emergency rosters, and the introduction of other identified measures to improve response times. €3.2 million is being made available to meet the costs associated with this recommendation.

Cancer Services

Since 1997, there has been a cumulative investment of approximately €550 revenue million in the development of cancer services, including an additional €15m being made available in 2004. This allows us to continue to address increasing demands in such areas as oncology/haematology services, oncology drugs and symptomatic breast disease services. The overall funding has enabled the approval of an additional 91 consultant posts in key areas of cancer services, including among others, oncology, histopathology and palliative care.

Since 1997, approximately €95 million in capital funding has been allocated to cancer initiatives, including Radiation Oncology, the Bone Marrow Unit at St. James´s Hospital and some €11.9 million for BreastCheck.

The key goal of the National Cancer Strategy of 1996 was to achieve a 15% decrease in mortality from cancer in the under 65 year age group in the 10 years from 1994. I am pleased to report that the Deloitte Evaluation of the 1996 National Cancer Strategy, published in December of last year, shows that this reduction has been achieved, 3 years ahead of target.

Radiotherapy

€3.5 million of the €15 million revenue funding mentioned above is being used to implement the recommendations contained in the Report on the Development of Radiation Oncology Services in Ireland launched last year. Its recommendations have been accepted by Government and provide a framework for the future development of radiation oncology services nationally.

I have approved the purchase of two additional linear accelerators for the Supra-Regional Centre at Cork University Hospital and the necessary capital investment amounting to over€4 million to commission this service as rapidly as possible. In 2004, €1 million on-going revenue funding is being made available for the development of this service.

In relation to the Supra-Regional Centre at University College Hospital Galway, the new Radiation Oncology Unit is constructed and the equipment is currently being commissioned. In 2004, €2.5 million revenue funding is being made available for the development of this service.

Report of the National Task Force on Medical Staffing (Hanly)

The Hanly Report, published in 2003, set out the measures need to comply with the European Working Time Directive, introduce a consultant-provided service, reform medical education and training and the consequent need to reorganise the acute hospital system.

As you are aware, I have already announced the composition and terms of reference of implementation groups in each of two Phase 1 regions (East Coast Area and Mid-Western Health Boards). A Phase II Group has also been announced and, under the Chairmanship of David Hanly, will prepare a national hospitals plan for the Interim Health Services Executive.

I have already taken a number of steps to develop further the services being provided in smaller hospitals. For example in Ennis General Hospital I have given approval to the appointment of a design team to plan for infrastructural improvements there. In the region of €15.5 million is being invested in a new Community Hospital in Thurles. This state of the art facility which will have 72 beds and a day hospital service for a further 15. A new Health Centre in Nenagh.

As mentioned earlier, I have provided €12.6 million to facilitate the discharge of patients from the acute system to more appropriate settings, thereby freeing up acute beds. I have also taken steps to reduce the extent to which Emergency Medicine Departments have to deal with injuries and conditions which are more appropriate to the primary care setting.

I have announced policy approval to the development of the Emergency Medical Technician – Advanced (EMT-A) programme. Considerable work has been done by the Pre-Hospital Emergency Care Council in conjunction with my Department in preparing the legislation necessary to give effect to the introduction of this programme in the current year.

Waiting Lists

Funding available under the Waiting List Initiative has been re-distributed with an additional €12.2 million being allocated to the NTPF bringing their allocation for 2004 to€44 million. The balance of the WLI funding – €31.6 million – has been allocated to the Health Boards and the ERHA as base funding to support core posts and services that have been put in place over the years with Waiting List funding. Having a single funding stream through the NTPF to reduce waiting times for patients is now seen as a more effective use of resources.

The number of adults waiting more than 12 months for in-patient treatment in the target specialties has decreased by 42% between September 2002 to September 2003. The number of children waiting longer than 6 months for in-patient treatment in the target specialties has fallen by 39% between September 2002 and September 2003.

National Treatment Purchase Fund

In light of the commitment given in the Health Strategy to reform the organisation and management of waiting lists, I have given a significant role to the National Treatment Purchase Fund in 2004. Significant progress has been achieved by the NTPF in targeting those patients who have been waiting longest for treatment. To date some 13,000 patients have already had treatment arranged by the Fund. It is now the case that, in most instances, adults waiting for a procedure for six months, or three months in the case of children, are now being facilitated by the Fund. If patients are prepared to travel outside of their local area, their treatment can be arranged more quickly.

Renal Services

Additional revenue funding of over €20 million has been provided since 2000 to develop renal services in response to increased demand. This includes a further €5 million being made available in the current year.

This investment has supported the development of renal services on a regional basis. More patients than ever before are now accessing renal dialysis units. The number of patients receiving services at June 2003 was 966 – up 50% from the 1998 figure of 641. This is a major improvement in services. Based on current trends, it is estimated that an additional 120 patients will require dialysis in 2004. In terms of clinical expertise, this funding has also facilitated the approval of six additional Consultant Nephrologist posts since 2000, bringing the total number to eighteen.

Proposed developments to further enhance renal services include the commissioning of a new dialysis unit at Letterkenny General Hospital and a new unit is due to open this year at the Midland Regional Hospital, Tullamore. Services have been expanded at Tralee General Hospital. Work is also due to commence shortly on a new dialysis unit at Sligo General Hospital, whilst a Design Team has been appointed for the development of the country’s largest renal unit at Beaumont Hospital.

Blood Policy

The Government has agreed to accept in full the recommendations contained in the Lindsay Tribunal. Work on the establishment of the National Haemophilia Council to oversee the implementation of the recommendations of the Lindsay Report is at an advanced stage. An additional €1 million is provided for this purpose.

€2.2 million has been provided to allow for work to begin on the implementation of the EU Directive setting standards of quality and safety in the collection, testing, processing, storage and distribution of human blood.

Child Care Services

A total of €6 million in additional funding was provided to Child Care Services for 2004, which provided for Legal Costs and the cost of providing and maintaining services, including the counselling of victims of abuse. The base funding available to my Department continues to support the work of the Youth Advocacy programmes, the Social Services Inspectorate and the Special Residential Services Board. A further €5 million is provided in 2004 for foster care allowances, formerly funded by the Department of Social and Family Affairs, bringing the total available to €20 million. This is a more efficient arrangement, whereby health boards will include provision for these allowances eliminating the need to seek recoupment from the Department of Social and Family Affairs.

Services for People with Disabilities

Intellectual Disability and those with Autism

Additional funding amounting to €28m was made available in 2004. This consisted of €10m to meet the full year cost of the additional services approved in July 2003 and €18m in the Budget 2004 to meet the costs in 2004 associated with a similar range of services i.e. emergency residential placements, day places and the enhancement of health related support services for children with intellectual disability and those with autism.

Physical and Sensory Disabilities:

€3m was made available in the Budget 2004 for services for people with physical or sensory disabilities to meet priority service pressures as identified by the Eastern Regional Health Authority and the health boards in consultation with other relevant agencies.

A further €3m was made available in the Budget to the Voluntary Sector Service Providers who are responsible for the provision of a wide range of services to people with physical and sensory disabilities.

 

Traveller Health

An additional €1 million was made available to the health boards to fund developments under Traveller Health – A National Strategy 2002 – 2005, aimed at improving the health status of Travellers. This brings to the total cumulative allocation from 1997 to 2004 inclusive to €8.1 million.

Mental Health Services

Additional revenue funding of €4 million is being made available in 2004 for improvements in mental health services. Areas of special note in 2004 include Forensic Psychiatry at the Central Mental Hospital and the Mental Health Commission.

Forensic Psychiatry

Additional funding of €1m was made available in the Budget 2004 to employ additional staff at the Central Mental Hospital to deal with service pressures at the Hospital resulting in delays in the transfer of mentally ill prisoners to the hospital.

In 2004, additional capital funding of €1m was also provided to the Central Mental Hospital to allow necessary refurbishment works to be carried out to treat prisoners.

Mental Health Commission

Additional funding of €3 million is being made available to the Mental Health Commission in 2004 to facilitate the Commission to put in place the various mechanisms required to support the Mental Health Tribunal process. The total funding available for the Commission is €5.3m in 2004.

Services for Older People

Nursing Home Subventions

€3.749 million is being made available in 2004 to ensure that health boards can continue to provide Nursing Home Subventions and enhanced subventions to those currently in long-term care. This funding will also meet the demands for subventions from new clients. This brings the total available for this area in 2004 to some €144 million, an increase of €89 million, or 162% over the 1998 figure of €55 million.

Home Help Services

Home Help Services have received an additional €3.748 million this year. This service has been greatly enhanced in recent years following significant increases in funding. It is seen as a vital part of the range of community supports required to maintain people at home and allows for respite for carers who are often in difficult circumstances. The numbers of home help hours available in 2004 is approximately 8.96 million, an increase of 134,000 over the hours available in 2003, an increase of 1.5%.

Community Care Support Services

€1.25 million is being made available to develop community care support services for Older People so that older people can be supported in the community for as long as possible and that recourse to long-term care will only happen when all other care options have been explored.

Palliative Care

Following the Report of the National Advisory Committee on Palliative Care a further €1.2 million is being allocated to this area in 2004 to continue the implementation of the Report of the Advisory Committee on Palliative Care. This brings the total base funding since the publication of the report in 2001 to approximately €17.8 million.

Elder Abuse

€0.750 million is being provided in the area of Elder Abuse to continue the implementation, on a phased basis, of the recommendations outlined in the Report of the Working Group on Elder Abuse.

Tobacco / Smoke Free Workplace Initiative

A prohibition on smoking in the workplace was introduced on 29 March 2004. The smoke-free at work initiative is a Government approved health priority. The primary purpose of the prohibition is to protect the health and safety of workers and the public from exposure to toxic environmental tobacco smoke. There is an international scientific consensus that second hand smoke kills and causes disease.

€1.3 million is being made available to health boards and the Office of Tobacco Control to enable this new measure is to be promoted, monitored and implemented effectively. This year I intend to develop a new campaign, based on the successful Nico advertisement, targeted specifically at children to reduce the numbers of those who start smoking young.

Since the introduction of the smoke-free workplace measure on 29 March 2004 the reported compliance levels are very high.

I would like to pay tribute to the responsible and co-operative attitude shown by representative bodies in all the sectors and the public themselves in ensuring a high level of compliance.

Figures published as part of the SLÁN National Health and Lifestyle Surveys show a significant drop in smoking prevalence in the population from 31% in 1998 to 27% in 2002. This represents about 100,000 less smokers.

We are now at a stage where most people don´t smoke, most people who do smoke regret starting and want to quit. Many are trying and the primary reasons for quitting are health concerns. The health message is getting though. We must continue to give encouragement and support to smokers who want to quit and break their addiction to tobacco based nicotine. The National Quitline which was established in October 2003 is being widely availed of by many people determined to break their addiction to tobacco-based nicotine. Almost 18,000 calls have been made to the line.

Reduction in tobacco use will increase life expectancy in Ireland and result in happier, healthier and better quality lives for many Irish people.

Cardiovascular

“Building Healthier Hearts”, the report of the Cardiovascular Strategy Group, was launched by the Taoiseach in July 1999. It set out the blue print for tackling heart disease in Ireland in the long term.

The Cardiovascular Health Strategy has developed and is working to deliver a multi-faceted approach right across society and right across the health services. Already €54.5m has been spent in the first years of the strategy. We have funded the appointment of almost 800 new staff across the broad range of health services, including 18 consultant cardiologists and their supportive infrastructure. We have funded cardiac rehabilitation, chest pain clinics and community initiatives such as the first responder scheme.

The implementation of the Strategy has reaped many benefits, including;

  • decline in death rates from heart disease,
  • people living healthier lives for longer,
  • people at risk of heart disease receiving quicker and better treatments closer to where they live,
  • people with established heart disease living a better of quality of life.

Primary care

The first ten projects of the Primary Care Implementation Projects continue to be supported in 2004 with base funding of€6.242 million being allocated to support their wider implementation. These projects will allow more than 80,000 clients to benefit from having direct access to an improved range of services provided by their primary care team.

General Medical Services

General Practice Co-ops

An additional €3million is being made available in 2004 to boards in respect of the GP Co-ops as well as €0.962 million being re-allocated for this project. This brings the total base funding available to boards for GP Co-ops to €28 million. Every board now has a GP Co-op, most of which provide round-the-clock cover. Almost every county is covered by this initiative and I hope to have full coverage in place in 2 years. The success of the co-ops has led to demands from boards for even further funds for expansion, as more doctors express growing interest in the co-ops.

GPs Non EU Nationals

A targeted grant scheme is currently under development to invest€1 million to aid GPs who are experiencing heavy workloads due to the treatment of non-EU Nationals.

GMS (Payments) Board

An additional €127 million, over and above the 2003 outturn, was been provided to meet the expenses of the GMS (Payments) Board to provide for the application of pay increases, increases in drug costs and prescribing fees which are all part of costs associated with higher demand for medical card holders.

Dental

Additional revenue funding of €4.348 million was allocated for increases in the Dental Treatment Services Scheme. The Waiting list for Orthodontic assessment has been reduced by 11,357 from December 2001 to 9,021 at the end of March 2004 and the waiting list for treatment has been reduced to 10,578 at the end of March 2004 from a figure of 11,890 at the end of 2001.

Food Safety

In accordance with a Government decision in December 2002, funding for the Local Authority Veterinary Service (LAVS) will be channeled through my Department to the Food Safety Authority of Ireland. This funding had previously been channeled through the Department of Agriculture and Food. In 2004 a total of €7.630 million will be directed to the LAVS.

HIV/AIDS/Drugs

In 2004, €2.5m is being made available for Drugs/HIV/AIDS/STI Services to deal with the following issues:

HIV/AIDS

Funding is being provided to the ERHA in 2004 to progress short-term priorities identified by the Care and Management Sub-Committee of the National AIDS Strategy Committee. In particular this funding will address issues at Our Lady´s Hospital for Sick Children, Crumlin.

Drug Services

Funding has been provided to health boards in 2004 for the costs associated with the introduction of a contract for GPs involved in the methadone protocol.

Under 18s Report

A report on guidelines for the treatment of under 18 year olds presenting with serious drug problems has been finalised and will be discussed by the Inter-Departmental Group on Drugs at its next meeting. Funding is being made available in 2004 to the ERHA in order to commence implementation of the recommendations contained in the Report.

Personnel Management and Development

Clinical Indemnity

The Clinical Indemnity Scheme (CIS) was introduced to allow the State to better manage its exposure to medical malpractice risks. The CIS was introduced for hospitals and other health agencies and all staff with the exception of hospital consultants on 1 July 2002. Claims against consultants were brought within the scope of the Scheme on 1 February 2004.

To date, any savings under this heading have been retained by the Health Boards, pending discussions with the Department.

Intensive efforts were made over a period of 18 months to have consultants brought within the scope of the CIS by agreement. Ultimately, I could not justify the continuing expenditure on reimbursing consultants´ indemnity costs where a secure State-backed indemnity was already in place.

The Government has taken measures to ensure that the cost of professional indemnity cover for consultants working in private practice remains affordable by limiting the amount of cover which they need to purchase. The limit is €1m for all specialties other than Obstetrics where it is set at €500,000.

€12 million is available to meet claims under the Scheme in 2004.

Nursing

As you know, I introduced the Fees Initiative for Nurses in May 2000. €2.5 million is being made available in 2004 to meet the growth in demand for this worthwhile initiative and to cover the increases in fees charged by the teaching bodies.

An additional €0.480 million has been provided in 2004 for Specialist Nursing Courses, under which nurses and midwives are entitled to full pay and the payment of their fees while studying in specialised areas of clinical practice, such as A&E, intensive care and oncology.

An additional €0.943 million in 2004 has been provided for various other nursing issues in 2004.

Additional funding has also been provided in 2004 to implement agreements involving:

  • new rates for Travel and Subsistence in the public service (€3.9 million)
  • the agreement following the recent Public Health Doctors dispute (€3.8 million)

Private Bed Charges

There will also be an increase in the income for public hospitals from the charges raised by these hospitals from private beds; that increase will be 15% to give additional income of some€20 million. This income goes towards supporting services in public hospitals and is part, therefore, of their budgets. Even with this increase, the cost of providing services to private patients in those hospitals is far greater than the income from the private insurance companies.

Health Research Board

In 2004 funding of €20.552 million is being allocated to the Health Research Board. This 2004 revenue figure represents a total increase of 209% over the corresponding 1999 allocation. Furthermore, €9.058 million in capital funding has been allocated in the four years since 1999.

Capital – National Development Plan

Total capital expenditure for the years 2000 – 2003 was approximately €1.7 billion while total capital funding for this year for the health sector is €509.5m. NDP funding in 2004 will allow for the planning and construction of several major projects in the acute and non-acute sectors. These include, for example:-

Acute Hospitals

  • Mater / Temple St. Hospitals
  • Cork University Hospital – Cardiac Services and Renal Dialysis Unit
  • Beaumont Hospital – Renal Dialysis Unit
  • Coombe Women´s Hospital – Extension to ICU, new theatre, scanning room etc.
  • Naas General Hospital – Phase 3B and 3C
  • Incorporated Orthopaedic, Clontarf – Phase 2
  • Wexford General Hospital
  • Merlin Park Hospital – Rehabilitation Unit
  • Ennis General Hospital, Outline Development Control Plan
  • Letterkenny General Hospital – A&E Department
  • Our Lady´s Hospital for Sick Children – Outline Development Control Plan; and interim projects (MRI and Haemotology/Oncology)
  • Midland Regional Hospital at Tullamore
  • Cork University Hospital – Maternity Unit
  • Cork University Hospital – A&E Unit / Day Procedures Unit
  • Our Lady´s Hospital for Sick Children – Theatres
  • St. Vincent´s Hospital, Elm Park – Phase I
  • University College Hospital Galway – Phase II
  • Our Lady´s Hospital, Cashel – Development
  • Roscommon County Hospital – A&E Department
  • Beaumount – re-equipping and refurbishment
  • St. James´s Hospital – Expansion to existing A&E Department

Non-Acute Sector

  • St. Ita´s Portrane – Intellectual Disability Services
  • Beaumont Hospital – Acute Psychiatric Unit
  • Nenagh Hospital – Acute Psychiatric Unit
  • Hospital of the Assumption, Thurles (Older People)
  • Sligo General Hospital – Acute Psychiatric Unit
  • St. John´s Hospital, Enniscorthy (Elderly)
  • Merlin Park – Rehabilitation Unit (Older People)
  • Nenagh Health Centre
  • St Ita´s Dementia Unit, Newcastle West.
  • Dingle Hospital (Older People)
  • Tralee CNU
  • Fermoy Hospital (Older People)
  • C.C.H.Q. at Tralee

The Nursing Degree Programme, which commenced in 2001, has an overall capital requirement of approx. €250m, with expected expenditure of over €65m in 2004. This capital spending will facilitate the integration of nursing students in the higher education sector.

As announced in Budget 2004, the Department of Finance has put in place a rolling five-year health Capital Investment Framework. The total proposed health capital envelope for the period 2004 to 2008 is in the region of €2.7 billion, to include Public Private Partnership initiatives in the non-acute sector. The new Framework, as a rolling multi-annual programme will allow greater certainty in the level of investment to be provided that, as such, will enable my Department to plan and manage more effectively the health capital programme.

Health Services Information Systems

€60 million capital funding has been provided for the NDP Information Communication Technology project in 2004 which is an increase of 100% on its original allocation for 2003. The bulk of this is expected to be spent on Enterprise Wide Systems such as PPARS, Financial Information Systems Project and Infrastructure.

Work is also commencing on the planning of Primary Care systems and a new project to coordinate developments on Telemedicine.

The Information Society will also receive funding of €5m in 2004, an increase of 25% on its allocation for 2003. This allocation will aid developments in Health Portal, the Client Eligibility Index and the European Health Insurance Card.

Reform Programme

€3 million is being made available to support the implementation of the Health Service Reform Programme. €2 million has been provided for the establishment and maintenance of the Interim HSE in 2004 and a further €1 million is available to support the Health Service Reform Programme. In addition,€1 million is available for initiatives to support implementation of the Health Strategy.

The implementation of the Health Reform Programme, which includes both the Prospectus and Brennan Reports, is well underway. The current phase of implementation consists of four distinct but interrelated strands which will take place this year. These strands are – the work of the Interim HSE, aspects of the Reform Programme for which the Department has lead responsibility, the work of the Acute Hospital’s Review Group, and the on-going management of the health system and internal preparations for the new organisation and governance arrangements. The new arrangements, combined with the introduction of system-wide best practice governance and accountability systems, will ensure a stronger more effective health system and an improved health service for patients and clients.

Conclusion

Chairman, the system has commenced the reform process which is vital to the future delivery of our health and children´s services. Our experience tells us that the task is both challenging and complex and will not be achieved overnight. Nevertheless, I believe that the current delivery system is now providing a high quality service, backed by a dedicated and skilled workforce and supported by a very significant funding base. This Government, through its consistent approach to prioritising health and health issues has provided this essential financial base. The task for all of us going forward is to apply it as efficiently and effectively as possible