Caoimhghín Ó Caoláin
Question:6. Deputy Caoimhghín Ó Caoláin asked the Minister for Health when the Health Service Executive service plan for 2014 will be published; and if he will make a statement on the matter. [48067/13]
View answerHSE National Service Plan
Questions (6)
Oral answers (6 contributions)
When will the HSE service plan for 2014 be published? Will it include a breakdown of the so-called saving of €113 million on medical cards under the heading "probity"? Can the Minister tell us exactly what this means, how this very considerable sum will be achieved, how he intends to realise this so-called saving and how it was calculated for budget 2014 purposes? What is the correct figure for the estimated cut in the health budget for 2014? The budget document says it is €666 million but there has been speculation that the real figure is closer to €1 billion.
Under the Health Act 2004, the HSE has a 21-day period from the publication of the Estimates for supply services on budget day to submit its 2014 national service plan for my consideration. This would have required the HSE to finalise and submit its service plan for next year by Tuesday of last week - 5 November. The Act does, however, allow me as Minister for Health to provide the HSE with any such other period that I may wish to allow in this regard. In view of the very challenging nature of this year's budget and the fact that it has come early, I have written to the HSE and advised it that I have allowed it another ten days until 15 November to adopt and submit its 2014 service plan for my consideration. I must wait and see if that is possible given the challenges it faces. It may need a further extension which I will consider if that is the case.
This extended period also recognises the earlier than usual presentation of the 2014 budget. Clearly, there are huge challenges in addressing the budgetary figures we have been given this year. My priority, as I made very clear at all times, is patient safety followed by having patients seen in as timely a fashion as possible. As everybody in this House knows, if somebody's inpatient elective or planned procedure is cancelled and delayed for too long, they end up presenting as an emergency, which is more expensive to the State but much more worryingly, outcomes from emergency surgery are never as good as outcomes from elective surgery when they are considered in statistical fashion. That is not necessarily true for the individual but is true overall.
The Minister spoke about of the delay in the presentation of the national service plan. I ask him to address the other issues I made reference to because they are integral to the entire business of the national service plan. Will the Minister clarify the conflicting situation between the €666 million and the figure of €1 billion cited more frequently at this point in time? Can he also advise if the service plan will show a breakdown of the €113 million designated as so-called savings under the medical card heading over the course of 2014? How will that incredible sum be realised, what steps will be taken to do so and who are the targets who will lose their medical cards as a consequence?
I will conclude with my next point. I encourage the provision in the national service plan of the required funding to allow for the fitting of bilateral cochlear implants to get under way in 2014. I believe all views in this House share a belief in this as a target for the coming year.
In respect of the latter point, I have made it very clear in this House that this is a priority of mine. Obviously, I am not going to discuss the service plan and specifics around it here today before I have had a chance to see what is in the service plan and to present it to my Cabinet colleagues. The Deputy asked a question about the figure of €666 million versus the figure of €1 billion mentioned by Mr. Tony O'Brien, the director general of the HSE at the Oireachtas Committee on Health and Children. The figure of €666 million is the budget target savings we must make and which were given to us by the Department of Public Expenditure and Reform. The figure of €1 billion alluded to by Mr. O'Brien included all sorts of other issues, pressures and developments that might take place. What he was alluding to is the swing of €1 billion so I hope that explains the difference between the two figures.
Not certainly, however, in respect of the €113 million, surely we do not need to wait on the national service plan to get an indication of how that figure was computed. What is the basis of it and what is the Minister's target area in respect of current medical cardholders to realise such a so-called saving over the course of 2014? It is a time of great worry for many medical cardholders and surely they are entitled to some clarity in respect of the Minister's intent in this regard.
In respect of bilateral cochlear implants, we know that an initial allocation of some €12 million might be required but it will be a considerably smaller sum in future years once the bilateral programme is up and running. There is no question that it can be programmatised so let us hope that at least that can be looked forward to.
I spoke to the Minister privately about my final point yesterday. I would like to take the opportunity to say it to him publicly two and a half years after he and the Minister of State at the Department of the Environment, Community and Local Government, Deputy Jan O'Sullivan, as Opposition spokespersons on health gave a commitment as did I regarding the outstanding cases relating to the case of Michael Neary at Our Lady of Lourdes Hospital in Drogheda. We shared a platform together on this matter. I welcome the Minister's statement this week that women over 40 will be included in a form of payment in recognition of the barbarity to which they were subjected and the suffering they have endured. I commend that decision.
I am glad that this is the case. It was only right and proper that this arrangement should be reached. It was a very arbitrary decision to exclude women purely on the basis of their date of birth when they suffered the same harm and damage by the aforementioned Dr. Neary.
In respect of medical cardholders, both the Deputy and I have a responsibility not to cause alarm among people unnecessarily. I made it very clear and the Minister of State has already alluded to the fact that we have put in place a communication strategy to communicate with people to reassure them that their entitlements are not changing in terms of the medical card. If they are legally entitled to a medical card, they will get it and if they have one, they will keep it. There will be no question of people losing their medical cards because of a change in policy. There is no change in policy and it is very important to state that it was never the case that any particular medical condition gave a right to a medical card. What was the case was that medical conditions could lead to particular financial hardship, which was a ground for giving discretionary medical cards and that remains the case. Last year, I asked the HSE to formulate a panel of doctors to ensure that even more latitude and compassion would be in the system to deal with those difficult cases.
Hospital Facilities
Questions (7)
Joe McHugh
Question:7. Deputy Joe McHugh asked the Minister for Health the position regarding refurbishment works at Letterkenny General Hospital. [47943/13]
View answerOral answers (7 contributions)
In the immediate aftermath of our flash flooding at Letterkenny General Hospital this summer, there were questions in the public mind. How did it happen in the first instance?
Why was it allowed to happen and how can it be prevented in the future? Lessons must be learned. What resonates with people in Donegal is the responsibility. We should continue to bear in mind who was responsible and how it can be prevented in the future. There is also fear about services and so forth. However, I commend the Minister on his initiative in bringing the Secretary General and the CEO of the hospital group with him to visit the hospital in the immediate aftermath to set the ball moving. Within a fortnight services resumed and the work that is taking place there at present is phenomenal, to say the least.
I am sorry, Deputy, but you only have 30 seconds.
The people of Donegal would like to know what the plans are for the immediate future.
I thank the Deputy for his question and take this opportunity to laud the people who work in Letterkenny Hospital for the phenomenal work they did under extraordinary conditions. The engine of the hospital, as it were, was under up to three feet of water. Many people might not realise the degree of contamination that causes and the absolute loss of operability suffered as a consequence. The kitchens and laboratory were taken out and the diagnostics were gone, yet the medical staff continued to look after their patient load. The hospital group swung into action with Bill Maher, the CEO of the group, and Noel Daly, the chairman of the board, visiting on a number of occasions. I was there on the Sunday, a couple of days after the event took place, and again on Wednesday, as was my colleague, the Minister of State, Deputy Kathleen Lynch. The Taoiseach also visited.
The reason for the culvert blocking is being investigated and remedial action has been taken to ensure that it cannot happen again. There might be some design issues in the hospital, as much of the water was able to flow across a linked corridor into the other parts of the hospital. That must also be addressed. Again, phenomenal work was done by the staff and there was tremendous co-operation in the hospital group in terms of Sligo hospital's ability to take much of the load and Mayo and Galway helping as well. In particular, the sister hospital, Altnagelvin Hospital, took much of the pressure off in terms of the emergency services. All in all, this was a natural disaster, force majeure in insurance terms, but it was one in which everybody not only in the hospital but also in the community put their shoulder to the wheel to protect, as best they could, their citizens, families and community.
The Minister is right that it was a national disaster. There was some criticism among the people of Donegal that it did not get appropriate coverage nationally but the proactivity of the Minister and his officials ensured that services were resumed within a fortnight. It was not a greenfield site but a building site, and we still had services. The work of all involved at hospital employee level and the voluntary effort at community level were phenomenal. That must be acknowledged. However, while a great deal of work is ongoing at present, we should look at the forward planning for the long term. If there is to be new build, we should look at services that can be done together in synch and consider this smartly. The managers are looking at potential solutions, but in the current environment of such enthusiasm and professionalism in trying to get work done, it is also important that we still have oversight, checks and balances, accountability and transparency regarding the great deal of money that is going into the hospital, which is very much welcomed. I acknowledge the Minister's personal action in getting into his car on the weekend it happened and travelling to Letterkenny. That was very much appreciated by the people there and in Donegal generally.
The Secretary General of the Department of Health accompanied me that day. Work is still ongoing in Letterkenny. One of the biggest challenges for the hospital was to get the diagnostics back up and running. A modular unit was brought in which had very high operational capability, even better than what was there previously. There is a multi-purpose radiology interventional suite there and project teams have been established for services in those areas which were significantly impacted by the flooding, such as the coronary care unit, the cardiac investigations unit, medical records, the laboratories, the mortuary and staff facilities.
Water does an enormous amount of damage by getting in behind panels and under flooring. All of that carries contamination risk, so it is a major job to recommission all these areas but it is one in which the staff in the hospital and the wider community, the county council, the fire brigade and all the voluntary organisations have got involved in a major way to support the hospital getting back to normal so it can continue to deliver the excellence in care which it has traditionally delivered over the years.
I welcome the fact that project teams have been established. While the local teams are doing well in keeping the public informed, we should consider drawing up a medium to long-term plan regarding future services. Certainly, the staff have shown an amazing resilience in adapting. At a time when the political and wider community can be quite critical of civil and public servants, we must mature as a nation and acknowledge the good things as well. The staff working on this project are rising to the challenge. It is important that people in the civil and public service who are doing good work and meeting the professional needs and challenges of their work are acknowledged. We do not do enough of that as politicians or give that feedback. We should be empowering people, and saying "well done" is something they appreciate.
Medicinal Products Expenditure
Questions (8)
Billy Kelleher
Question:8. Deputy Billy Kelleher asked the Minister for Health the net savings he anticipates in 2014 in the State’s expenditure on drugs; and if he will make a statement on the matter. [48050/13]
View answerOral answers (9 contributions)
This question is about the net savings the Minister anticipates in 2014 in the State's expenditure on drugs. The reason I ask the question is that I note there have been agreements with the Irish Pharmaceutical Healthcare Association, IPHA, and the Association of Pharmaceutical Manufacturers in Ireland, APMI. However, in the Estimates last year it was reckoned there would be a saving of €160 million, but a reply to a parliamentary question I submitted last week stated that the anticipated savings would be €120 million. There is a shortfall of €40 million between the Estimates last year and the saving actually achieved this year. This year the Minister has indicated savings in the Estimates for next year. Will he clarify the anticipated savings in 2014?
The State has introduced a series of reforms in recent years to reduce pharmaceutical prices and expenditure. These have resulted in reductions in the prices of thousands of medicines. Price reductions of the order of 30% per item reimbursed have been achieved between 2009 and 2013; the average cost per items reimbursed is now running at 2001-02 levels. Additional savings measures are expected to generate net savings of approximately €152 million in 2014, as follows: new agreements were reached with the Irish Pharmaceutical Healthcare Association, IPHA, and the Association of Pharmaceutical Manufacturers in Ireland, APMI, in October 2012. It is estimated that the combined gross savings from the IPHA and APMI deals will be in excess of €120 million in 2013 with an additional €28 million saved in 2014. The Health (Pricing and Supply of Medical Goods) Act 2013, which came into operation on 24 June, introduces a system of generic substitution and reference pricing. This legislation will promote price competition among suppliers and ensure that lower prices are paid for these medicines resulting in further savings for both taxpayers and patients. It is estimated that this system will yield €50 million in savings in 2014.
As announced in budget 2014, it has become necessary to increase the prescription charge due to the very difficult and challenging economic environment which requires the Government to achieve additional savings in health expenditure, with €666 million of savings targeted in 2014. The increase in prescription charges will account for €43 million of this target. The Government is committed to achieving these savings while protecting front-line services to the most vulnerable to the greatest extent possible.
A review was carried out earlier this year under the Financial Emergency Measures in the Public Interest Act 2009, FEMPI, regarding the operation, effectiveness and impact of the amounts and rates payable to certain health professionals under the relevant regulations. The 20% retail mark-up to community pharmacists in respect of items dispensed under the drug payment scheme, the long-term illness scheme, the European Economic Area scheme and the Health (Amendment) Act 1996 scheme was eliminated.
The 2014 saving arising from this measure will be approximately €17 million. In addition, provision was made in budget 2014 for €10 million in savings arising from the removal of products from the reimbursement list. The HSE will now consider products for review in compliance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013.
I thank the Minister of State for his response.
I believe every word of it.
He does. Hopefully, those measures will come to fruition. Time and again, the difficulty is that anticipated savings are not being realised. This year, we will have a shortfall of €40 million, placing pressure on other services. At the back end of the year, we now have a certain amount of fire brigade action in our hospital budget and the broader budget to try to rein in costs. It is important that when we set about achieving savings, they are realisable in the first place. Issues arose in terms of delays in the legislation.
This matter relates to the question raised by Deputy Ó Caoláin and me in the context of the €666 million in savings. Clearly, there is a great deal of scepticism - on that side of the House, not this side - about the ability to save €113 million in probity. Will the Minister of State make the commitment that every effort will be made to ensure that the savings identified will be implemented at the start of the year as opposed to half way through it?
Most certainly we can give the commitment that everything will be done in order to drive the savings that are required in this context. I welcome the Deputy's support for these changes, as they are important and will yield a benefit for the State, the Exchequer and the health services. We will press on further. We waited many years for this legislation and introduced it this year. Not only have the Houses passed it, but it is also operating and the Irish Medicines Board, IMB, is pressing ahead with its list of interchangeable products.
Change is happening. Given our economic collapse, people are entitled to have low expectations. They view many issues in the economy and the health services generally sceptically. However, we are driving and achieving change and will continue to set and achieve targets.
If possible, I will make an addendum. I acknowledge that savings and progress have been made, but there are significant differentials. In particular, I am aware of the situation of the generic equivalent of Lipitor, a commonly prescribed cholesterol lowering drug that is four and a half times more expensive to me living on this side of the Border as it is to my neighbour a short distance North of the Border under the NHS system. We have a long way to go. The tragedy is that the arguments used by the pharmaceutical companies - a smaller market and greater transport distances - are ballyhoo, as many of the drugs in question are made on our own doorstep in Ireland and the travel distance is even shorter. We need to be much more bullish with the pharmaceutical sector.
My question is like Deputy Ó Caoláin's. The use of generic drugs will amount to a saving of approximately 10%. As the Deputy pointed out, Lipitor's equivalent is approximately €48 in the Republic and €10.60 in Newry. Is the Minister of State able to explain why this is so? I do not understand it.
I will not be able to dress any particular drug, but I share people's interest in and concern about this matter and am keen to follow up on it. There are differentials. A report prepared by the ESRI this year provided a good analysis of this situation. Sometimes, one does not always compare like with like, although I am not making an excuse for the differentials. There are many factors, for example, pharmaceutical manufacturing, pharmacies' mark-ups and so on, that we need to address.
I assure the House that there is the same level of concern on this side about the issue as there is on that side. We will press onwards. We have made great strides, but there is more to do.
Health Services Provision
Questions (9)
Seán Kyne
Question:9. Deputy Seán Kyne asked the Minister for Health the position regarding the urgent upgrade of the health centre on Inishbofin for which planning permission has been obtained but expires next month; and if he will make a statement on the matter. [44246/13]
View answerOral answers (5 contributions)
I am seeking information on the provision of a new health facility for the island of Inishbofin. As the Minister of State is aware, island communities face unique challenges. When I visited the island recently, the building was in a poor state. I spoke with a retired public health nurse who stated that the facility, to use her words, was awful, cold and unsuitable for serving the public.
The construction of a new health centre on Inishbofin was identified as a priority for the provision of health services under the CLÁR programme to the island population in 2003. The Department of Community, Rural and Gaeltacht Affairs, which had responsibility for the islands at that time, indicated that there was support for the Inishbofin project under the 2004-05 programme.
The then Western Health Board, now HSE West, undertook to advance the project as the main stakeholder by procuring and appointing a design team. The project was developed and planning permission was granted in November 2008. However, co-funding remained an issue and, to date, the Department of Arts, Heritage and the Gaeltacht, which now has responsibility for the islands, has not agreed to co-fund the project.
Nevertheless, the HSE has continued to try to progress matters by endeavouring to secure the proposed site by purchasing required additional land adjoining the current site. The estates department in HSE West is actively pursuing the acquisition of the adjoining site. Once this process has been concluded, a request for co-funding for the project will be sent to the Department of Arts, Heritage and the Gaeltacht. Meanwhile, an extension to the current planning permission for a further five years is being sought.
I thank the Minister of State for his response. I am pleased that an extension to the planning permission has been sought. According to the Minister of State, this centre was identified as a priority in 2003. There has been a major delay. It is difficult to believe that the upgrade so badly needed by the island community would be delayed by ten years. The centre is in a poor state. I am happy that progress has been made but the process should be rushed. In the event that co-funding is not found within the Department of Arts, Heritage and the Gaeltacht, the HSE should consider using its own budget, as this is a necessary facility. Some deal should be made. It is unfortunate that the island community might fall between two stools in terms of funding, with neither body taking full control and possibly blaming the other for the project not going ahead.
I welcome the Minister of State's response and ask him to continue pursuing this project with the HSE.
Deputy Kyne made some reasonable points, particularly regarding the delay since 2003 in resolving this matter. I take his comments on board and thank him for raising this matter with his usual assiduousness. We will pursue the matter as he has requested us to do.
As the Deputy who tabled the next question is not present, we will move on to No. 11.
Question No. 10 replied to with Written Answers.
Mental Health Services Provision
Questions (11)
Denis Naughten
Question:11. Deputy Denis Naughten asked the Minister for Health if he will seek an independent audit of mental health services in the Roscommon-Galway primary community continuing care, PCCC, area; and if he will make a statement on the matter. [47947/13]
View answerOral answers (6 contributions)
I have tabled this question because €8 million is being spent on mental health facilities that are planned to be decommissioned. In recent months, there have been a number of serious incidents at acute psychiatric units within the region because of poor patient management. Decisions are being made on the reconfiguration of mental health services even though we still do not know what patients' catchment areas will be. We are also closing a modern facility in Ballinasloe valued at €2.8 million while spending €24 million on other facilities within its catchment area.
I thank the Deputy for raising this issue. Mental health services in HSE west, including Galway and Roscommon, which operate as one administrative unit, have been resourced to implement A Vision for Change. This involves modernising the service in the area to provide better outcomes for patients and staff. However, existing resources in Galway-Roscommon need to be reshaped and the priority for some time has been to achieve this in line with similar reconfigurations undertaken or planned elsewhere nationally.
In this light, a detailed assessment was carried out by HSE west, including taking account of the recommendations of an expert group to reconfigure mental health services in Galway-Roscommon. An open and transparent scoring system was used to assess the merits of all relevant criteria and locations, including the most appropriate skill mix for service delivery in the future. I accept the recommendations of the executive to bring about a much needed and long called for reconfiguration of mental health services in the region.
I wish to stress that community mental health services in this case can only be enhanced on a transitional or phased basis, particularly bearing in mind that at least some staff from St. Brigid's in Ballinasloe must transfer to new community-based provision. There is flexibility within existing overall HSE west mental health resources to deliver this objective.
I and HSE senior officials recently met with a delegation consisting of local public, care professional and union representatives about the re-configuration of services across Galway-Roscommon to outline the position. Bearing in mind all the circumstances, I am satisfied that the approach being taken by the HSE to enhance future mental health services for this area is the best option, taking account of overall service needs and all relevant resource issues.
With regard to the type of audit suggested by the Deputy, I would point out that the decision of the expert group was reached as objectively as possible and the approach used was similar to that adopted for similar initiatives elsewhere. Any such audit would significantly delay the pressing need to continue modernising local services and would not be justified. The Deputy will also be aware that HSE west has recently established an implementation team, including both patient and staff representation, to engage in appropriate consultation to progress this initiative and to address any outstanding local concerns. The team has already held a number of briefings and meetings with, among others, the Mental Health Commission, Ballinasloe Town Council and HSE staff.
I wish to reiterate my own commitment, and that of the Government, to using the significant funding provided for mental health in recent times to continue implementing A Vision for Change, including delivery of measures that are in the best interest of clients of mental health services in the HSE west area.
I thank the Minister of State for her response but I wish to pose a few supplementary questions. She said that similar audits have been carried out elsewhere. Has a similar audit been carried out in Mullingar where €5 million is currently being spent on a facility in St. Loman's Hospital? It would be of a similar standard or grade to Ballinasloe. I am referring here to an audit of all mental health services in Roscommon-Galway and not just the acute services. Can the Minister of State explain how we are examining the reconfiguration of a system when we do not know the catchment area? It has not been finalised where the integrated service area will be, whether Mayo will be included, or whether it will go across some of the other catchment areas. Is it sensible to make decisions when we do not know what the final reconfiguration will be?
The Minister for Health has put the case well that money should follow the patient, and we would all agree with that principle. Why does it not also apply to mental health services?
If we were to carry out the audit now, as the Deputy has suggested, one would find that Galway-Roscomon - which has always been considered as one administrative unit for mental health - would be well above what is recommended in A Vision for Change. We are not doing that now. We know what is there and what we need to deliver the service. Phase 1 provides for the closure of five beds in Ballinasloe and the opening of five beds in Galway University Hospital to be implemented by January 2014, phase 2 involves the closure of a further five beds in Ballinasloe and the opening of five beds in Galway University Hospital, to be completed by April 2014 and phase 3 will see the opening of a further five beds in Galway University Hospital, bringing the total number of beds there to 50, and the closure of Ballinasloe.
I was asked why I was doing this. It is because I believe the people in that area deserve an exceptional service, which exists in other areas of the country. I still do not understand how Deputies can stand up here and tell me that I am implementing A Vision for Change too slowly, yet when it comes to their particular area they do not want it done at all.
There is an issue concerning numbers in Galway-Roscommon. As the Minister of State knows, there is a historic issue there regarding people with an intellectual disability and that needs to be acknowledged. We are opening a high observation unit as an interim measure, which did not exist three months ago when we had a crisis in Roscommon. It is planned to demolish that €3 million facility in two years' time.
As regards the issue of money following the patient, why is it that a woman can have her baby in Portiuncula Hospital but if she has acute post-natal depression she cannot be treated in Ballinasloe because it is not within her catchment area?
Even though there is a connection between maternity and post-natal depression, we have to separate maternity services from mental health services. In the new mental health services in Galway, for instance, we will be putting in place facilities for women and their babies to be dealt with in the one unit. That is already happening in Cork with the new unit we are building there and it will have to happen elsewhere also.
As regards crisis management within acute units, we are dealing with vulnerable people. I am always surprised that people are surprised that we have episodes that need to be managed more directly. We are dealing with very ill and vulnerable people. Those who work in the service and manage these situations every day know that it is not peculiar to Ballinasloe. This happens in every acute unit around the country. We must start recognising that people in the Galway-Roscommon area deserve the same excellent service that exists in other areas of the country.
Medical Card Data
Questions (12)
Seamus Healy
Question:12. Deputy Seamus Healy asked the Minister for Health the actions he will take to end the practice by general practitioners of charging medical card holders for blood tests; and if he will make a statement on the matter. [48061/13]
View answerOral answers (4 contributions)
The Minister of State, Deputy White, said earlier that there is a lot happening in primary care, and indeed there is. Most GPs and their staff are working above and beyond the call of duty. However, that does not entitle GPs to put further pressure on ill, low-income patients with medical cards. Unfortunately, that is happening nowadays because GPs are charging for services that in the past were covered under the medical card service. I ask the Minister of State to ensure that the practice will be stopped.
Under paragraph 11 of the general medical services or GMS contract, a general practitioner or GP shall provide for eligible persons, on behalf of the HSE, all proper and necessary treatment of a kind usually undertaken by a GP and not requiring special skill or experience of a degree or kind which GPs cannot reasonably be expected to possess. Under paragraph 27 of the GMS contract, a medical practitioner shall not demand or accept any payment or consideration whatsoever in reward for services provided by him or her, or for travelling or for other expenses incurred by him or her, or for the use of any premises, equipment or instruments in making the services available.
In circumstances where the taking of blood is necessary, either to assist in the process of diagnosing a patient or to monitor a diagnosed condition, the GP may not charge that patient if he or she is eligible for free GMS services under the Health Act 1970, as amended. The HSE has written to GP contract holders and clarified the position on this matter and has also communicated its position to the Irish Medical Organisation. Any alleged instances of eligible patients being requested to pay for a routine service of this nature from their own limited resources is viewed as a serious matter by the HSE and by the Department.
I have been advised by the HSE that its local health offices will fully investigate any reported incidents of eligible patients being charged for phlebotomy services which form part of the investigation and necessary treatment of patients' symptoms or conditions. In such cases, where a medical card holder or a GP-visit card holder has been inappropriately charged for the taking of blood, the HSE will make deductions from the routine GMS payments of those GPs.
Officials in my Department are in consultation with the HSE with a view to drawing up a new GP contract. The appropriate arrangements for phlebotomy services will be considered as part of the new contract.
I appreciate the Minister of State's reply but because of the relationship between patients and GPs, it is difficult for individual patients to make complaints. The HSE and the Department of Health should initiate a procedure whereby GPs would not charge medical card holders for blood tests.
A number of other issues have also arisen in GPs' surgeries. The Irish Medical Organisation has indicated that general practitioners should charge for letters, which is now happening, and also for minor surgery. There is a significant issue concerning blood tests, but other matters are also coming down the tracks. The Department of Health should monitor the situation and initiate contacts with GPs and the IMO on this matter.
As I said in my reply, we have communicated with the IMO and GP contract holders generally. I have heard of this issue coming up before as parliamentary questions have been tabled about it. The position is very clear in that a person cannot be charged for blood tests in circumstances where it is necessary to assist the process of diagnosis or to monitor a condition that has already been diagnosed.
I accept as Deputy Healy said that people may feel that it is hard for them as patients to make a complaint. We have made our position clear publicly, to the IMO and again here today by me. To the extent that it is necessary for it to be tightened up further contractually, we will address that when dealing with new contracts. All I can do is assure the Deputy that the position is that charges should never apply in the circumstances I have outlined. I have not addressed the secondary issue raised by the Deputy of letters and so on but I will have a look at it.
Written Answers follow Adjournment.