Vol. 613 No. 3
127 Dr. Twomey asked the Tánaiste and Minister for Health and Children if suitably trained home help staff and adequate home help hours will be provided at community care level in 2006; and if she will make a statement on the matter. [3278/06]
An investment package of €150 million has been put in place for 2006 and 2007. This is the largest ever increase in funding for services for older people and the package has a strong focus on community based supports. Of that investment package, an additional €33 million full year cost was allocated to the home help programme. This represents a significant increase over the Estimates provision of €112 million for 2005.
This development funding will enable the HSE to provide an additional 1.75 million hours nationally in 2006. The additional resource will further enhance the service and facilitate the expressed wish of many more older people to continue to live in their own homes for as long as possible. It should be noted that €55 million was also allocated towards the provision of home care packages, 1,100 of which are provided at present and an extra 2,000 of which will be provided during this year. These comprehensive packages, which include co-ordinated and integrated care provided by nurses, home care attendants and therapy services such as physiotherapy and occupational therapy, may also include an element of home help services.
The funding outlined was provided to the HSE on a national basis. The HSE is responsible for the delivery of the home help service across the country and also for the training of home help staff. The HSE has informed the Department that training programmes have been developed to ensure home helps receive appropriate training and these training programmes have been rolled out in the HSE over the last number of years. These programmes will continue in 2006 to improve skill levels of home helps. In addition, home helps also receive regular, on the job training in conjunction with other health professionals.
With regard to training of home helps, has the Minister reviewed any of the curricula? Can he list Piaget's four stages of cognitive development or Erikson's eight stages of development? These are included in one of the courses for people who are studying to be home helps. I do not know what they are and I am sure the Ceann Comhairle, who is also a medical doctor, does not know what they are. I wonder about the content of some of these courses which are supposed to teach people to be home helps. Who devises and monitors them? This was a FETAC course. The Minister should investigate the content of these courses. They might not be appropriate to what people are doing.
The lack of transparency regarding the number of home help hours is causing a huge problem for Opposition Members. Even the person in charge of this area in the HSE could not tell me how many home help hours were provided last year. If medical services are to be provided using the home care packages, is VAT at 13.5% being applied to those packages? If there is an element of a social service involved in the home care packages, will VAT be applied at 21%?
As the Minister of State knows, the HSE does not have to pay VAT. There is also tax relief at source for people who put their relative in a residential nursing home. Will VAT be an issue for people accessing these services or in providing value for money for the people getting the services? Will this service be a value for money issue for taxpayers rather than being a service provided by the HSE?
Over past years, especially with regard to the health strategy, Quality and Fairness — A Health Strategy for You, the Department has failed to implement many of the recommendations it promised at community care level with regard to home help services and looking after carers in the community. There are so many contradictions in what has come out and what was announced in the most recent budget that value for money and delivery of the service could continue to be a problem.
The Deputy has raised a number of issues, but it is a bit of a joke to talk about contradictions in the recent budget. We announced a package of €150 million in the budget for services for older people, including a number of community supports vital to maintaining people in their own homes and communities, which is the expressed wish of the majority of older people. The Deputy may be as critical as he likes of the past, but we have made a major effort to improve and build on the community support structure in place.
With regard to the content of the various courses undertaken by the HSE, I will have the issue examined and come back to the Deputy on it. The HSE attaches great importance to providing adequate training to people who intend to become involved in the provision of home help. The private sector has become increasingly involved in the provision of home help throughout the country and it too attaches great importance to the training of people before taking up employment. I will check on the content of courses to ensure there is adequate provision. I am happy with the response we have received from the HSE in that regard, but I will seek further information and come back to the Deputy on the matter.
The issue of VAT has been raised by a number of providers. The matter is being investigated and we have taken it up with the Minister for Finance. We realise the difficulties VAT creates and will clarify the matter. This is not something on which I can make a decision, but I will come back to the Deputy on the issue as soon as I have definitive news.
When does the Minister of State think he can get back to us on that issue? The implementation of the home care packages will be difficult for some providers if there is no change.
I know the providers require us to bring some clarity to the issue in order that they can make plans for the future. We will renew our representations to the Minister for Finance. I cannot say how soon he will get back to us. I appreciate the urgency of the situation and know it would be helpful to have an early decision. We will try to get that decision as quickly as we can.
128 Ms McManus asked the Tánaiste and Minister for Health and Children if a submission has been received on the extent of the current risk to patients in view of the fact that for animals there is full protection from malpractice in the pharmaceutical sector while for humans there is not, and that there is no statutory fitness to practise or fitness to operate legislation on pharmacy; the steps she intends to take to protect patients and within what timeframe; if she can be held liable in any claims arising from malpractice in this area; and if she will make a statement on the matter. [3280/06]
The practice of pharmacy is governed by the Pharmacy Acts 1875 to 1962. I am aware that the current fitness to practise provisions in these Acts are inadequate for the modern practice of pharmacy. On foot of the recommendations of the pharmacy review group I obtained Government approval in June 2005 to commence the process of drafting, as a priority, new pharmacy legislation to allow, among other things, the making of fitness to practise regulations for pharmacists. The purpose of these new provisions is to ensure the highest standards from pharmacists and to safeguard the safe and effective delivery of pharmaceutical services.
My Department is at an advanced stage in drawing up the heads and general scheme of a pharmacy fitness to practise Bill and I intend to take a memorandum to Government in the very near future, seeking approval for the draft heads and general scheme and requesting that the legislation be referred to the parliamentary counsel's office for formal drafting of the Bill.
Will the Minister accept that there is an urgency to this matter? Does she not find it extraordinary that animals here have better protection against pharmacy malpractice than humans? Does she not have a serious concern that the registry body has no power to strike pharmacists off the register? It has power only to put people on the register. In its estimate, two to three pharmacists should be struck off the register each year. That is the approximate level of malpractice. Does the Minister accept that she has responsibility to ensure not just fitness to practise legislation is speeded through the House, but also fitness to operate a pharmacy? Fitness to operate a pharmacy has not been mentioned and I ask her to include it and comment on it.
We are all conscious of scandals, for example, where terrible things were done by Dr. Shipman. The role of the pharmacy in that scandal is relevant and germane to this issue where we do not have proper regulation. If such a scandal arises here, which seems more likely than unlikely, will the Department be exposed to litigation because of its failure to deal with what is clearly a matter of protection and public safety?
I accept that the legislation governing the regulation of pharmacy is unsatisfactory. It dates back to 1962 and much has changed in the intervening period. At a recent event I was told by the incoming president of the pharmaceutical society that when his father was its president many years ago, he expected the new law during that year. That was 30 years ago. I do not know why we have not been able to frame legislation in the intervening period, but the matter is urgent. There are many urgent matters on my desk, including the Medical Practitioners Bill, the regulation of the nursing profession, illegal charges in nursing homes etc.
There are two issues here. The Pharmaceutical Society of Ireland only has a role with regard to recommending removal from the register where there is a breach of criminal law. It has no right to strike off others. The tool used traditionally by the State to penalise malpractice is the GMS contract. While it was the case in the past that there was hardly a pharmacy that did not have a GMS contract, there are a growing number that do not. Therefore, that route is not available to the State. The matter is a priority.
Recently, I had a good meeting with the pharmaceutical union and it raised with me the issue of the operation of the premises as well as the individual. I have asked my officials to examine that in the context of the first Bill. A second Bill will deal with the service aspect, the physical conditions and such matters which, while important, are less urgent. To deal with the legislation quickly, we want to deal with the regulatory aspects, particularly with regard to fitness to practise. I hope to bring the scheme to the Government within a matter of weeks.
129 Ms C. Murphy asked the Tánaiste and Minister for Health and Children the number of court actions regarding the provision of resources such as speech and language therapy, occupational therapy, psychological services and multi-disciplinary teams for children with special needs in which she or her predecessors have acted as respondents that are pending and which took place each year since 2002; the number of these actions which progressed to the hearing stage; the number of cases that resulted in the provision, by her Department, of the resources sought by the plaintiffs; the costs which were incurred by her Department in responding to these court actions; and if she will make a statement on the matter. [3224/06]
Since the late 1990s, a number of parents of children with autism began to take High Court cases to obtain specific educational services for their children. Since 2002, my Department has been involved in 74 cases in which applicants are seeking access to such appropriate education services. In cases involving children with disabilities this also includes, on occasion, access to appropriate health related supports.
These cases are broken down as follows. In 2002, there were 35 cases, 15 of which were judicial review cases and 20 plenary cases. In 2003, there were 18 cases, seven of which were judicial review cases and 11 plenary cases. In 2004, there were 12 cases, five of which were judicial review cases and seven plenary cases, and in 2005, there were nine cases, five judicial review cases and four plenary cases. In that time, three cases have proceeded to full hearing, the first in 2003 and the second during 2005. The court ruled in favour of the State on both occasions. The third case has yet to be determined. A number of other cases which commenced prior to 2002 are also being dealt with by my Department.
The cost to my Department, excluding the costs of the State defence which is borne by the Office of the Chief State Solicitor, in each of the years since 2002 was as follows. In 2002, there were no legal costs and settlements amounted to €438,450, totalling €438,450.
In 2003, legal costs amounted to €2,492,579 and settlements amounted to €297,106, totalling €2,789,685. In 2004, legal costs amounted to €1,339,660 and settlements amounted to €297,181, totalling €1,636,841. In 2005, legal costs amounted to €2,741,436 and settlements amounted to €290,987, totalling €3,032,423. It should be noted that these figures do not include the costs of staff involved in responding to these cases.
These cases are, in the main, taken against the Department of Education and Science and allege a failure on behalf of the State to provide for an appropriate education as provided for in the Constitution. While these cases are mainly taken by parents of children with autism, there are also a number of cases relating to ADHD and intellectual, physical and sensory disabilities.
The Deputy should note that the Department of Health and Children is not specifically named as a defendant in all these cases but is involved due to its role in the formulation and development of policy in respect of the provision of health care and support services. The Health Act 2004 provided for the creation of the Health Service Executive, which was established on 1 January 2005.
As the Deputy is aware, significant progress has been made in recent years regarding enhancing and developing services for people with disabilities. I am satisfied that the level of investment in disability services demonstrates that the Government is committed to the provision of appropriate services to enhance capacity within the health services to deliver on the various legislative provisions contained in the national disability strategy. This includes continued enhancements to services to allow children with disabilities participate in the education system.
Some of the court cases probably follow on from the cases where people sought education and, having been granted it, felt the support services were insufficient. Does the Minister of State agree that planning for the provision of the support services involves a far more efficient way of spending funds than meeting the costs of litigation to deny those services? Given the figures the Minister of State has just mentioned, one can only conclude that the latter is the approach.
I received a similar reply from the Department of Education and Science to the effect that, for two years, there was in the region of €10 million in respect of one side of the court action — there may well be an overlap in the figures, which essentially implies the State was denying services to children.
Children who received primary education on foot of legal action are now presenting for second level education but the support services are not in place. Bearing in mind that there is a relationship between the Department and the Health Service Executive in terms of the provision of the required support services, it seems nobody is counting the children in question. This is a denial of their entitlement to an appropriate education.
Is the Minister satisfied that the second level children are being captured properly? It seems they are only captured properly when there is a court action. This morning I communicated with a parent whose child requires speech therapy. The family lives in Kildare where the HSE does not have services specific to children with the child's diagnosis. If the family moved to west Dublin the child would receive the required services but it does not receive them because the family is living in Kildare.
The time allocated for the question has been exhausted.
On the Deputy's point that people who cannot avail of services would be able to avail of them if they moved to another area, this should not prevail under the Health Service Executive — it should be possible to avail of them. I will take up the specific matter if the Deputy gives me the details.
On the Deputy's point on the lack of planning, much planning is being done but the State cannot prevent anybody from taking a legal case if he is not happy with the services he is given. There is much planning associated with the provision of these services.
The Deputy is correct regarding the lack of provision of services in occupational therapy and speech and language therapy. However, we have provided increased capacity in the universities to educate people in these disciplines. Unfortunately, these people will not graduate for a few years. We are doing everything we can to try to recruit people from abroad to fill the positions in this area for which staff are unavailable in Ireland. Although everything is being done to hire more therapists, I agree there is a lack of them in the country at present.
Question No. 130.
May I ask a brief supplementary question?
We have exceeded the time enormously on this question.
It is just a very quick supplementary.
We are way over the time allowed.
I am being told the public service embargo is——
Has the Deputy a question?
Yes. The public service embargo will preclude the employment of the therapists in question unless administrators are lost.
The Deputy may have been told that but it is not correct. It does not apply regarding people with disabilities. The problem is that we cannot get the therapists. However, we are doing everything possible to recruit them from abroad.
130 Dr. Twomey asked the Tánaiste and Minister for Health and Children her plans to prevent the cancellation of elective operations and procedures; and if she will make a statement on the matter. [3279/06]
It is regrettable that some patients have their operations postponed and I recognise that this can cause inconvenience and stress for them and their families. Every effort continues to be made by the HSE and hospitals to keep cancellations to a minimum. However, due to fluctuating demands on the acute hospital system, in some instances it is necessary to reschedule planned treatment, particularly when priority has to be given to emergency cases.
The Government has pursued a number of policy initiatives to increase throughput of the acute hospital system by way of improved infrastructure, providing additional acute beds, increasing the amount of day surgery, increasing the number of consultants and providing more step-down accommodation and home-care packages. For example, the number of patients treated on a day-case basis has doubled between 1997 and 2004. The number of approved consultant posts increased by 56%. The National Treatment Purchase Fund has also been successful in facilitating treatments for patients in private hospitals, here and abroad. To date more than 38,000 patients have had treatment arranged for them by the National Treatment Purchase Fund and waiting times for elective surgery have fallen significantly. It is now the case that, in general, anyone waiting more than three months for surgery will be facilitated by the National Treatment Purchase Fund.
As Deputy Twomey is aware, the Health Service Executive, through the National Hospitals Office, has lead responsibility to manage and deliver the services provided in acute hospitals. The Department of Health and Children will continue to work closely with the HSE in monitoring the delivery of acute hospital services to ensure that the postponement of elective operations and procedures is kept to a minimum.
Even today a great number of patients are having neurosurgical, cardiothoracic, orthopaedic and other major operations cancelled. Basic diagnostic procedures, such as colonoscopies for bowel cancer, are being cancelled on an all too regular basis. A report was published in the Sunday Independent on 22 January 2005 which highlighted seven faulty work practices within our hospitals. I am sure the Minister has seen the report. Why did none of these deficiencies in work practices turn up before the benchmarking process was implemented? Why were benchmarking payments awarded to all the professionals in the health service when the seven work-related issues we read about in the report, and which are obviously widely publicised, were not addressed? The Minister will have seen references to them. They have been known to every Member for at least ten years and many of them have been commented on in this House for a number of years.
When commenting on the work practices referred to in the report, the Minister used some very strong language. She was very critical and used phrases including "indefensible" and "highly inefficient". In light of this, why was nothing done about the work practices during the course of the past several years, during which period they were well known? Why did they not turn up when the benchmarking process was being considered? We expect the Minister to give us the answers because, apparently, all the background details on benchmarking have been destroyed and we will therefore not be able to find answers in the records.
It is always unacceptable when somebody has elective surgery cancelled. To put the matter in perspective, the percentage of cancellations is between 2% and 3% per annum, although that is still too many. I was reading that in the United Kingdom 15% of elective work is done by the private sector for these kinds of reasons.
The HSE recently commissioned process mapping exercises of ten of our acute hospitals to examine their practices throughout the hospital. Those exercises are now to hand, I have had an opportunity to read them and they will be published shortly. They form the basis for the HSE's allocation of funds to those hospitals during this year.
The recommendations will require major internal reform of how hospitals operate. For example, in the Cork area the time a patient spends in hospital is on average one day shorter for every procedure than for the Dublin area — I do not know why this should be the case. Much of the difficulty clearly has to do with pressure, although I do not want to take from the fact that there are many pressure areas, such as issues concerning older patients and the speed at which they can be accommodated in more suitable accommodation when doctors medically discharge them. Issues also arise with regard to work practices, discharge policies, length of stay and so on. These matters form the main basis of the reform now underway, which, in particular, will this year take the route of the funding allocations.
I do not have information on the benchmarking exercise. I do not think it went into the kind of detail to which the Deputy refers, which was one of the flaws of the exercise.
Some €1 billion of taxpayers' money was invested in professionals working in the health services and benchmarking. Now it seems the Tánaiste is seeking to scapegoat many of those working in the health services with this sort of fast-tracking and some of the information coming out of it, some of which is ancient news. I am surprised the Tánaiste never tried to do anything about this in the past.
These difficulties do not arise in the private system which, to be fair, does not deal with trauma and accident and emergency cases, which cause many of the difficulties in the public system. I acknowledge that the health care system is experiencing a major shortage of consultants, which is why it is extremely important to get a new contract of employment that suits the public health care system in particular. That would greatly add to the system. For example, currently only a consultant can discharge a patient. We are too heavily dependent on junior hospital doctors, of which there are 4,000 whereas there are 2,000 consultants. We need to reverse that balance, which would greatly help, particularly in the discharge area. Instead of services being led by consultants, they would be delivered by them. That process proves highly successful in other countries and I have no doubt it will do so here also.
131 Ms McManus asked the Tánaiste and Minister for Health and Children, further to a promise made on 26 January 2005 to deliver real and measurable improvements to the accident and emergency crisis within months, her views on the fact that one year later, with reports of over 400 patients on trolleys across the country, the accident and emergency crisis has worsened and that the ten-point plan has failed; the steps she intends to take to address this crisis; and if she will make a statement on the matter. [3281/06]
I do not accept that the accident and emergency action plan has failed. On the contrary, a wide-ranging approach has been adopted by the Health Service Executive to improve access to accident and emergency services, improve patient flows through accident and emergency departments, reduce waiting times, free up acute beds and provide appropriate longer-term care for patients outside the acute hospital setting. A particular focus of the action plan has been placed on those patients in acute hospitals who have completed the acute phase of their treatment and are ready for discharge to a more appropriate setting.
The HSE has made considerable progress and is continuing to make sustained efforts in this regard. A range of measures, including the provision of high dependency beds, intermediate care beds in private nursing homes, additional beds in public nursing homes, home care packages and enhanced subventions, have facilitated approximately 1,500 patients to leave acute hospitals. In addition, €6.6 million is targeted at increasing the level of home support available in the community, which should assist in keeping people well in their homes and thus avoid the necessity for presentation at accident and emergency in many cases.
Within the context of the action plan, the HSE undertook an audit of efficiencies and process. The study was conducted in ten hospitals, and its conclusions point to a number of areas for further improvement. These include strengthened discharge planning processes, improved clinical decision making at every stage and better co-ordination of and access to diagnostic services. A key action for 2006 for all hospitals with accident and emergency departments will be the full implementation of the efficiency audit recommendations. In tandem with this, a programme of financial incentivisation will be introduced, aimed at rewarding those hospitals that are meeting agreed performance targets and facilitating overall improved performance.
The HSE will continue to maintain a focus on the implementation of system-wide measures to further improve the delivery of accident and emergency services.
The Taoiseach recently stated publicly:
People say so what, what about Joe and Mary down in A&E. They shouldn't be on a waiting list. I think it's a pity that people are so unintelligent, actually.
Does the Tánaiste agree with him?
I was abroad when the Taoiseach gave the interview. To be fair to the Deputy, I do not know whether she is quoting him out of context. However, the Taoiseach is more than aware of the difficulties and pressure in accident and emergency units. He may have been suggesting we should put matters in context, although that is not to justify what happens from time to time — on too many occasions.
Each day, approximately 4,000 people present at accident and emergency units. Even on the worst days — there was a very bad day two weeks ago — fewer than 10% of those who presented were on a trolley overnight, although that figure is still far too high. All our efforts are focused on finding alternatives, particularly for those who have been medically discharged from the acute phase to better settings — they are better for a host of reasons — and improving access to diagnostic facilities. Work is underway in that regard, although the facilities have not been put in place. We have gone to tender with regard to improved primary care, particularly on the north side of Dublin, as this is an issue which is placing huge pressure on some of the hospitals on the north side of the city.
I assure the Deputy that the Taoiseach is very sensitive to the difficulties being experienced by too many patients at accident and emergency level in some of our hospitals.
I would hate to see the Taoiseach not being sensitive if that is the kind of statement he can make about distressed relatives.
Let us deal with the real and measurable improvements the Tánaiste promised would occur within months of her statement last January. How many minor injury units and chest pain and respiratory clinics have been provided and where are they located? Is the MRI scanner for Beaumont Hospital in place and, if so, for how long has it been in place? How many of the acute medical units promised by the Tánaiste are in place? Is the Tánaiste aware that the one hospital that has managed to provide this kind of unit, St. Luke's in Kilkenny, was penalised and fined by the Tánaiste during the past year?
What is the delay with regard to the out-of-hours service in north Dublin, which was promised over one year ago? While there was an urgency about it at that time, there does not now seem to be any urgency from the Tánaiste. Why has the service not been put in place? There is clearly a desire among general practitioners in north Dublin to provide it. What is happening that the Tánaiste cannot even provide that simple measure? At what locations is GP access to diagnostics available and how many GPs can access diagnostics in this new and desirable way? What improvements have been made with regard to palliative care and where have they been made? All of these matters were contained in the Tánaiste's ten-point plan.
Absolutely. With regard to acute medical units, AMUs, to which the Deputy referred, a number of hospitals, including St. James's Hospital in Dublin, have them. A number of other hospitals sought to completely over-spec what the HSE and the Department felt was required. If people in the health care system think a pot of money is available, they sometimes feel they have to go for the largest possible slice of that money as a cure for all their ills. The HSE made a decision, with my support, that until we knew the outcome of the mapping exercise, which was examining all the internal functions of the hospital, we would not allocate additional funding to be spent in the same way. That exercise, which will be published shortly, hospital by hospital, details a significant number of interesting facts. For example, in some hospitals 100 staff work in accident and emergency units and deal with 100 patients a day, a ratio of one staff member to one patient. A patient must often go through a number of layers before he or she can get near a staff member to treat him or her.
The doctors on the north side of Dublin submitted a tender which the HSE felt was not adequate to provide the service. I understand the HSE is in discussions with the doctors on the north side of Dublin. Professor Drumm recruited Dr. Sean Maguire, who set up the first out-of-hours facilities in the UK and, subsequently, in Ireland. He is a doctor with huge experience in this area and is currently spearheading the discussions on the out-of-hours facilities with the doctors on the north side of Dublin, which I understand will be completed soon.
The MRI scanner for Beaumont is a second scanner. I understand a mobile facility was to be acquired. The hospital is in a position to make that happen very quickly.
As the Deputy is aware, public procurement means that although a decision may be made today, unfortunately it takes many months before some of these developments can happen, for good public procurement reasons.
The focus on accident and emergency services is thorough and robust. I had a meeting with the Health Service Executive yesterday which dealt with many of these issues, particularly care of the elderly. A package worth €150 million has been made available for this purpose. If this money is used to support people at home, it will have a major impact on the flow of patients through hospitals.
