Jerry Cowley (Mayo, Independent)
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I am grateful for the opportunity of raising this very important matter on the Adjournment.

If the Chair will indulge me, I support Deputy Kenny and hope there will be a straight answer because there has already been a loss of jobs in Bellacorrick and Allergan, and we could not tolerate another body-blow. Perhaps some straight talk from the Minister will be important for an area that is dying on its feet, the most socio-economically deprived area in Ireland.

I am grateful to appeal on behalf of the area I represent. Mayo General Hospital is recognised as probably the busiest hospital in Europe and has been so described from activity levels. The difficulty is that it is intended to cut its budget by €613,000. This is a hospital that is working very hard around the clock with extremely dedicated staff and this cut is seen as a major body-blow. If a significant amount of money is removed from a budget that is already very tight and providing very essential services, somebody must suffer. The fear is that the people who will suffer are those who are ill and who depend on the hospital. I appeal to the Minister to examine the casemix programme.

An orthopaedic unit has opened, which has put much pressure on the hospital services, but this refers to earlier issues. It is baffling, and nobody can understand, how a cutback can be made because activity is at a high. Occupancy at this hospital is more than 100% because there are two patients to a bed, one in the morning and somebody else immediately after. The bed is still warm when somebody else goes into it. That is how efficiently this hospital is run, but no matter how efficiently it is run, it lacks capacity. It is difficult because there is no high dependency unit in the hospital. There are eight beds in the intensive care unit. There is an orthopaedic unit now, but there is a need for a proper high dependency unit, which would mean an, extra eight beds.

There is a major need also for proper consultant services. People must travel to Galway for urology services, which is almost as far as this building is from Galway, and there is a waiting list there. People wait years to get on the official list and after that they still wait five years. Is it any wonder people get ill while they are on the waiting list? Is it any wonder that accident and emergency departments are congested with people who get acutely ill? If somebody is left on a waiting list for five years or more, he or she is bound to get ill. Then it is not a case of merely doing a simple job, it is a case of dealing with an emergency, which ties up all the resources.

I appeal to the Minister to examine the casemix programme. Perhaps what is happening is that hospitals with more private patients are treated better under the casemix programme than hospitals that abide by the rules and keep private patients to within 20%. We must think of what is happening in this hospital. This is the only hospital serving County Mayo, the third largest county, and it is already under pressure because of the difficulty of trying to deal with services that are not properly resourced and the lack of an ambulance base in west Mayo. People living in Achill are 50 miles from Mayo General Hospital. When the general practitioner calls the ambulance, the person is already ill and he wants that person in hospital. If there is a waiting time of one hour for the arrival of the ambulance and it takes another hour for the ambulance to arrive in Castlebar with the patient, that makes two hours — so much for the golden hour. A case that is not an emergency when the GP calls out the ambulance becomes an emergency two hours later by the time that person arrives at acute hospital emergency services with the result that he or she takes up more time in the hospital services.

Mayo General Hospital is doing a very efficient job. To be treated in this callous manner with a reduction in its budget of €613,000 is unacceptable and the result is that the people of Mayo will suffer and will be left without essential services.

Seán Power (Kildare South, Fianna Fail)
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It is an indication of the respect in which Deputy Cowley is held that the leader of the Opposition remained in the House to hear his contribution. I thank the Deputy Cowley for raising this matter on the Adjournment.

The national casemix programme compares costs and activity between 37 hospitals that participate in the programme. The programme incorporates over €3 billion of expenditure and 1.6 million patient encounters annually. It allows each hospital to take full account of its unique patients and unique issues. The process takes place in consultation with each hospital, placing patient-centred information at the centre of the process. Casemix was introduced in an effort to collect, categorise and interpret hospital patient data related to the types of cases treated in order that hospitals could define their products, measure their productivity and assess quality.

The rationale for the use of casemix as part of the budgetary process is the wish to base funding on measured costs and activity rather than on less objective systems of resource allocation, that is, to fund hospitals for the cases they actually treat and the service they actually deliver. Casemix creates an incentive for better performance by allowing for peer group comparison and is the most internationally accepted performance related activity programme. I am committed to performance related targets to ensure that hospitals operate at maximum efficiency. The budget-neutral policy of casemix rewards efficiency by re-targeting funds from less efficient hospitals to those which are more efficient and have demonstrated that additional funding will result in real benefits.

The negative adjustment of €613,000 was consequently a reflection of Mayo General Hospital's performance vis-À-vis its peers. The hospital gained funding under the programme in ten of the 13 years in which it has been in operation. No objection to the use of casemix was lodged in those years. The programme is operated in an open and transparent fashion and full details of the clinical and financial information on which casemix budget adjustments are based is provided to all participating hospitals. I am committed to the ongoing expansion of the national casemix programme involving my Department and the Health Service Executive to ensure that casemix is used as a central pillar in hospital funding policy.