The report of the Eastern Regional Health Authority (ERHA) on how to spend its £1.8 billion budget for this year makes impressive reading. Its review of the services provided, and of the services needed, is comprehensive and rational. The setting out of its aims and its philosophy in the provision and development of the services provided is admirable and it does not try to avoid the challenges which it must meet and overcome if it is to deliver its programmes satisfactorily. Some of those challenges are formidable and not all of them are fully within the control of the Authority to meet.
The remit of the Authority is vast. It must arrange and oversee the provision of health and many social services for almost half of the population of the State. It must accept that 20 per cent of the patients in the hospital beds in its region come from outside the area (because of the number of national specialist units situated in Dublin) and that, on current estimates, its shortfall in the number of hospital beds required to meet the demand is of the order of 700 or more. And, among its many other functions, is the need to provide secure accommodation for the troubled, and often homeless, children whose therapeutic requirements have not been properly met for decades, and the need to abolish the wholly unacceptable waiting lists which delay the admission to hospital of public patients in urgent need of treatment.
These last two issues have had a high public profile in recent times because of the neglect of successive governments in providing the financial resources required by all health authorities. It is encouraging to note the confidence of the ERHA in its assertion that "during 2001 it will be possible to provide a range of accommodation options which will mean that no young person need be out of home at night". It is to be hoped that, in addition, the highly expert specialist staff required to counsel and treat these young persons can also be recruited and retained. The provision of additional family support services, which may help to prevent the homelessness in the first place, is also to be welcomed.
There are also proposals to improve the flow of patients through the region's busy Accident and Emergency departments in the hospitals although it seems unlikely that the over-crowding in these departments will subside significantly until a mechanism is devised whereby general practitioners can refer patients directly to hospital without their having to wait to be seen by a junior doctor in casualty. The recruitment of 10 additional Accident and Emergency consultants for hospitals in the region makes sound sense if such consultants can be recruited.
The 22 per cent under-use of existing operating theatres in the region is attributed to shortages of staff and poor management of existing theatre facilities. There are promises to improve the management, but staff shortages are acknowledged as one of the main challenges facing the health services in the eastern region. Despite the unprecedented size of its budget for 2001, the ERHA may need some further assistance to recruit, and to retain, further professional staff.