Black hole? No, the money's right here

There's no mystery about where additional health funding has gone

There's no mystery about where additional health funding has gone. It's being spent on better services for more people, argues Michael Lyons, chief executive of the ERHA.

Increased funding provided to the Irish health services in recent years has not gone into some mysterious black hole, as some critics glibly allege. Instead, it is being spent on a much higher volume of better, high-tech and more expensive services for an increasing population, with significantly improved outcomes.

Open-heart surgery, heart, liver and bone transplants and cochlear implants are now becoming routine. People are leading high-quality lives and returning to work following recovery from accidents and other conditions that would previously have proved fatal. Death rates from the common cancers have dropped significantly. Older people are living longer lives with considerable help and support from the State.

These new high-tech treatments and equipments are costly, however. In some cases, the Eastern Regional Health Authority, or ERHA, has spent more than €1 million on one patient, and new machinery for the earlier diagnosis of cancer costs €2,200 a scan.

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In line with every other worker in Ireland, salaries for all those providing health services have increased under partnership deals, and the vast majority of these are front-line staff providing direct services to patients and clients. For example, excluding our department of public health, the entire staff of the ERHA, which manages a budget of €2.9 billion, is 136 people.

Expenditure on the health services has increased in recent years because of a clear decision by the Government to invest in healthcare. Those who speak about the large amounts of money poured into the health services should remember the initial low base, however - and that Ireland's spending on health is still not high by international standards. The Economist records our spending on health as 6.8 per cent of GDP. This compares with 12.9 per cent in the US and 9.3 per cent for the European area.

Since the ERHA was established, hospitals in its area have become more efficient and are treating many more people more effectively, and there has been a major expansion in the services provided by the three area health boards.

And despite individual difficulties, it would appear that people generally are pleased with the services they receive and that they are delivered in a professional and dedicated fashion. A recent survey by an independent company showed that 95 per cent of those who had used the services in the east were satisfied with general practice, 90 per cent with hospital in-patient services, 93 per cent with hospital out-patient services and 74 per cent with A&E services.

The population of our region has gone up by 106,000 in the past six years. In addition to those who live in the east, we are providing services for people from the rest of the country. At any one time, 20 per cent of our hospital beds are occupied by people from outside the region. A proportion of these are for national and tertiary services, but a number are for procedures routinely available in their areas. If these patients could be persuaded to accept treatment locally, it would take considerable pressure off the east.

Because of the downturn in the economic climate this year, our focus is on providing the same level of services as was planned last year. I would like to emphasise that we have sufficient funds to buy the same level of acute hospital services this year as planned in 2002, that acute hospitals have assured us that patients will be prioritised on the basis of clinical need and that there will be no diminution in the level of care that patients receive in hospital. We have additional money for cancer, heart and renal services. We are also working with all our agencies to minimise the effects on patients of efficiency initiatives.

This year there will be more than two million attendances at acute hospitals in the east. There are now 6,446 drug-treatment places in the area. More than 7,000 clients with intellectual disability are receiving day services, and more than 2,600 are receiving both day and residential services.

A €100 million hospital has been opened in Naas, another is almost complete in Blanchardstown, a €340 million development at Eccles Street will see new beds and facilities for the Mater Misericordiae and a new children's hospital to replace the existing children's hospital at Temple Street.

Meanwhile, a state-of-the art hospital is being developed at St Vincent's, the A&E department is being developed at St James's, St Colmcille's is being upgraded and a €34 million development has been approved at Our Lady's Hospital for Sick Children in Crumlin.

The debate about the health services would be far more constructive if commentators were to acknowledge that although reform is desirable, significant improvements have taken place. I would hope that balance could be introduced to the debate.

Michael Lyons is also chairman of the health board chief executives' group