Vol. 668 No. 3
72 Deputy Jim O’Keeffe asked the Minister for Health and Children when the standards for nursing home care, recently approved by the board of the Health Information and Quality Authority, will be published; when the standards will come into force; if the standards will be compulsory; and if she will make a statement on the matter. [42548/08]
138 Deputy Róisín Shortall asked the Minister for Health and Children when she expects that the nursing home standards being developed by the Health Information and Quality Authority will be in place; and if she will make a statement on the matter. [42454/08]
I propose to take Questions Nos. 72 and 138 together.
The Health Information and Quality Authority submitted its draft national quality standards for residential care settings for older people to the Minister for Health and Children on 29 February 2008. The draft standards have been published and copies are available on the authority's website. In line with best practice, the draft standards, and the regulations required to underpin them, are currently the subject of a regulatory impact assessment. As part of this assessment, a consultation session with key stakeholders was hosted by the Minister and me on 23 October. Further details are available on the Department's website.
I expect the assessment to be finalised by the end of the year and the approved standards and regulations to be in place by the end of the first quarter of 2009. At that stage, and once the relevant part of the Health Act 2007 has been commenced, all residential centres for older people, including public and private nursing homes, will be subject to inspection and registration by HIQA and its chief inspector of social services. The standards involved will be compulsory. In the meantime, discussions are taking place between my Department, HIQA and the HSE about the administrative and other arrangements required to move from the existing system to the new system of inspection.
I thank the Minister of State for her reply. I am very pleased that HIQA will be doing this and there will be some independence in the inspection of public nursing homes. The major deficit to date is that the HSE has been inspecting itself, which is neither tolerable nor sustainable.
Have the necessary staff been appointed and trained up to begin inspections, since we must assume that they must be in a position to start by the first quarter of 2009? Have funds been allocated accordingly?
Some staff have been transferred over, and more staff will follow. There is ongoing negotiation between the HSE and HIQA to finalise the arrangement to sign over the standards and put them in place.
I wish to pursue that specific aspect too. We all welcome the fact that the standards will be in place for both public and private institutions, but they will not be of any use unless the relevant inspectorate is in place to carry out the inspections. The Minister of State referred to the fact that staff will be transferred. Will any new staff be recruited or will it be solely a matter of transferring staff within the system? How often is it intended to visit each nursing home or public long-stay institution?
While there will be some new staff, we anticipate that the vast majority will be transferred over from the HSE. It would not make sense to let people go from the HSE and take on new staff. Therefore, the vast majority of the inspectorate will be transferred directly over, with the possibility of some new staff also being hired.
On the issue of the regularity or frequency of inspections, we do not want to be too prescriptive. As the Deputy is aware, private nursing home inspections take place twice a year, unannounced, which is a good guideline but we have not made a definitive decision on the matter as of yet.
In her introduction to the National Quality Standards for Residential Care Settings for Older People report, the HIQA chief executive, Dr. Tracey Cooper, stated that:
Once the necessary regulations are in place, the Authority's inspectors will carry out inspections across the public, private and voluntary sectors to ensure that the standards detailed in this report are being met and that residents are receiving the highest quality of care.
The Minister of State has indicated that the draft regulations have been published but the critical question is when they will be implemented. I ask the Minister of State to give a more exact indication of when she expects the draft regulations to become regulations which are in situ and being implemented.
The question of additional personnel has already been posed but what additional resources, across all of the needs that HIQA will identify, will be provided in order to carry out what must be a very extensive and comprehensive programme of inspections in all nursing home settings? What additional resources can we expect HIQA to be given to carry out its functions in the most effective and comprehensive manner?
We have engaged in extensive consultations with the key stakeholders on the regulations and agreement has been reached. We hope to finalise the regulations early in the new year, at which stage we will be ready to move forward.
The Deputy also asked about costs and expectations that may emerge.
I asked about additional resources.
A regulatory impact assessment is being undertaken at the moment, which will determine the costs and benefits. When the assessment is finalised we will know what additional costs, if any, will be involved. At present, however, I cannot give the Deputy a definitive answer on the matter.
I am less concerned about costs and more concerned about the quality of the changes that will take place. I seek information on the additional resources that will be given to HIQA to enable it to carry out its function. I must say, with respect, that Deputy Hoctor and the Minister for Health and Children, Deputy Harney, can worry about the costs. I want to know what resources will be provided to HIQA to ensure the best quality of care for older people in the various care settings.
The vast bulk of additional resources will be transferred from the HSE and, as I have stated, some new staff may also be hired.
I am sure Deputy Ó Caoláin is no clearer than I am on the matter. I hope the regulations are not as woolly as the Minister of State's answers, with respect.
I have already asked whether training has taken place and whether staff have been trained up. In order to make the question easier to answer, I will be more specific. Has any additional training of staff taken place? How many staff does the Minister of State envisage will be involved, including transferred and new staff? What grades are involved? What types of staff will be involved; will they include doctors, nurses and occupational therapists, for example?
The staff resources will come from a variety of areas and specialisms, including those mentioned by the Deputy. We envisage that the inspectorate will comprise between 60 and 70 people. Many of the staff involved have already received training and any additional training requirements will be met in due course to ensure the smooth operation of the inspection service.
73 Deputy Ulick Burke asked the Minister for Health and Children the reason there are only three long-term care beds in Dublin north per 1,000 people over 65 years when the national average is 22; her plans to address this anomaly in view of the fact that two hospitals in the catchment area, Beaumont Hospital and the Mater Hospital, have lost in the region of 57,000 bed days in a single year, which is the equivalent of a 150 bed hospital, as a consequence of this; and if she will make a statement on the matter. [42481/08]
Based on the hospitals listed, I understand the Deputy's question to refer to north Dublin, that is, to the area previously covered by the former northern area health board.
The number of long-stay nursing home beds in Dublin North at present is about 2,260. This includes 1,300 beds in private nursing homes, 440 in voluntary nursing homes and 520 in public nursing homes. This equates to 43 long-term care beds per 1,000 people over the age of 65 and compares favourably to the international norm of 45 beds per 1,000 people over the age of 65.
The new 100 bed community nursing unit which was commissioned at St. Mary's Hospital in the Phoenix Park is now fully occupied. Building work has commenced on an additional 100 bed community nursing unit at St. Joseph's Hospital, Raheny, which is scheduled to open in 2009. Planning permission has also been sought for an additional 100 bed community nursing unit at St. Vincent's Hospital, Fairview and for a 50 bed community nursing unit at Oldtown, County Dublin. These developments, when completed, will bring bed numbers in Dublin North into line with, or above, international norms.
Did the Minister of State say that there are 45 beds per 100,000 people aged over 65?
No, I said that there were 43 long-term care beds per 1,000 people over the age of 65, which compares favourably to the international norm of 45 beds per 1,000 people over the age of 65.
That statistic applies across the country. The figures I have indicate there are only 22 beds. However, the real point of this question is to demonstrate that the reason we have such a crisis in accident and emergency departments in large urban areas and particularly in north Dublin, with both Beaumont and the Mater Hospitals suffering enormous delays, is the inability of hospitals to discharge patients back into the community. That inability is caused by the fact that an insufficient number of long-term care beds are available to such hospitals.
Information I have received from Nursing Homes Ireland indicates there are 1,810 nursing home beds lying idle around the country as we speak. I am not sure how many of those beds are in Dublin but I understand that it is in the hundreds. We must bear in mind that 130 patients were lying in beds and effectively blocking day-care beds which were earmarked for day-case surgery. This is what is frustrating the entire system. It is penny wise but pound foolish. There are beds available to which hospital patients should be discharged. Given the fact that we have a shortage of such beds in the public system, will the Minister of State give an undertaking to explore, with the private sector, the provision of such beds under contract until new beds have been built, if that is deemed necessary?
I remind Deputy Reilly that 200 extra beds, most of them in Dublin, were provided from January of this year.
That is simply not enough.
It is very difficult to say when we will have enough beds but that was a new development from 1 January of this year. Funding was provided by transferring fair deal money for both the installation and continued upkeep of those beds. The original fair deal funding figure was €110 million, a portion of which was allocated for the opening and upkeep of those additional beds.
Figures I have for the Dublin North Hospital Group indicate that on 10 November, between Connolly Hospital, Beaumont Hospital and the Mater Hospital, a total of 117 people in acute hospital beds were in a state described as "delayed discharge". This refers to the category of patients or family requesting publicly funded long-term care beds. In the category of patients who required public residential care due to higher care or medical care needs, the equivalent figure was 46. Adding the numbers in these two categories gives a total of 163 people who, on this date, were on delayed discharge in acute hospital beds in north Dublin when they could have been in community beds — whether long-term public beds or private beds. It is crazy that acute hospital beds are being occupied by 163 people who could have been sent either to public beds or private beds. The Minister stated earlier that 110 beds are to be provided in the co-located hospital, if it ever happens, in Beaumont Hospital.
It was 170.
Surely it would be much cheaper for the health budget to provide public long-stay beds for these people, who are currently in highly expensive acute hospital beds blocking other patients, who are on trolleys. According to the Irish Examiner, there has been a 40% increase in the numbers waiting on trolleys since 2006, when we had a national emergency. Surely it is a crazy system to have 163 people in this area who are occupying acute beds but who could be in much cheaper community beds. It is the policy to have people out in the community, and they would prefer to be there. The system we have at the moment is totally illogical. Does it not make much more sense to provide cheaper, long-stay public hospital community beds?
The fair deal will result in a much more equitable situation. As and from the new year, it will be the same cost regardless of whether people are in public or private beds. This will address the Deputy's point.
It will not be in for a while yet if the Minister is allocating €50 million.
The question refers to the north side of our capital city, but that is part of the Dublin/North-East HSE region, if the questioner will excuse me for making the point. When was the last time an audit of all hospital beds across this region was carried out, and what was the result? Does the Minister of State have the information to hand? If not, will she furnish it to the Deputies representing the various parties here this evening?
Does the Minister of State also note that the HSE's plan for this region is clearly a further reduction in the overall number of hospital beds, adding to the calamitous situation that currently pertains across the Dublin/North-East region? Is she conscious of the HSE claims that bed reductions will be compensated for by the introduction of further home-care packages and long-term residential placements for older people, as the previous questioner mentioned, occupying inpatient hospital beds?
Where will the funding come from? We do not have any of the promised packages in place. Where will the funding come from to compensate for this continual erosion of bed opportunities throughout the Dublin/north-east region?
Tomorrow's plans are no substitute for today's action. The reality is that our hospitals are chock-a-block on the north side. We cannot get people in. Waiting times are getting longer and longer. Beds are available in the community today. All that is required is to put out a tender and ask the operators concerned to provide the beds so we can move people who are finished the acute stage of their treatment, and therefore do not want to be in hospital any more, out of the hospital and into long-term care if that is what is required. I am asking the Minister to do this. Another possibility is a specific tender with rehabilitation associated to allow patients to continue their recovery at home.
I am sorry for raising my voice, a Leas-Cheann Comhairle, but when one hears this stuff and there is a ready remedy there in front of us which is not being availed of, it makes one pull one's hair out, such as is left of it.
There is plenty of it anyway. The Deputy is all right.
Deputy Reilly is welcome to try it. See where it brings the Deputy.
Deputy Ó Caoláin asked about an audit. The most recent was the Prospectus audit carried out in January of this year. A total of 68% of beds in the HSE Dublin/north-east region are in private nursing homes, and 32% are public beds. However, that report also notes that there are significant variations across the local health offices regarding the ratio of public to private long-stay beds. For example, in the Dublin north LHO area, 95% of all beds are in private nursing homes, with only 5% in public facilities. Notably, the Dublin north LHO area also has the highest population over 65 in the HSE region. In the Dublin central LHO area, 77% of all beds are in private nursing homes, with 23% in public facilities.
74 Deputy Pádraic McCormack asked the Minister for Health and Children the action she will take to prevent health insurance premiums of older and sicker people from soaring in view of the recent Supreme Court decision to strike down the risk equalisation scheme enacted by herself; and if she will make a statement on the matter. [42530/08]
93 Deputy Phil Hogan asked the Minister for Health and Children her plans on legislating for risk equalisation; and if she will make a statement on the matter. [42524/08]
I propose to take Questions Nos. 74 and 93 together.
A primary objective of Government policy in health insurance is that it should be affordable for the broadest possible cross section of the community, including older people and those who suffer ill-health. This policy objective has been implemented through a substantial body of primary and secondary legislation providing for open enrolment, community rating and lifetime cover. Following the liberalisation of the market in 1994 every political party and successive Governments have supported the maintenance of community rating. It is an inescapable fact, supported by international evidence, that community rating cannot be sustained without some scheme to support the higher claims costs of older or sicker people.
Although the Supreme Court found the particular risk equalisation scheme to be ultra vires, it did not strike down the principle of applying risk equalisation or any of the other important elements of the regulatory framework that supports private health insurance in Ireland. However, after the Supreme Court decision, there was a real risk that older people would effectively face significantly higher premium costs than younger people. Accordingly, the Government has decided to introduce two measures on an interim three-year basis to stabilise the health insurance market.
There will be additional tax relief at source for health insurance, starting for people aged 50 and over and increasing for higher age groups. People aged 50 to 59 will get tax relief at source of €200, those aged 60 to 69 will get tax relief at source of €500, those aged 70 to 79 will get tax relief at source of €950 and those aged 80 and over will get tax relief at source of €1,175. Legislation will also be introduced to provide for the introduction of a community rating levy on health insurance companies in respect of all individuals covered by the health insurance policies issued by them, priced at €160 for each adult and €53 for each child under 18. The level of the relief will be reviewed annually.
The effect of the measures on the premiums charged for particular policies by individual companies is a commercial decision for the companies themselves, as they set both policy benefits and pricing at the same time. However, they should not in themselves lead to an overall increase in the approximately €1.5 billion in private health insurance premiums paid, as the levy will yield approximately the same amount as the cost of the tax relief at source.
The implementation of these measures is subject to approval by the European Commission. They have been formally notified to the European Commission as a potential State aid, as had been done with the risk equalisation scheme. Older people will benefit as the price of their policies will not rise significantly based on their age. While supporting the principle of intergenerational solidarity, younger subscribers will benefit from affordable health insurance as they in turn become older. The Government hopes and expects that the health insurance industry will respond to this initiative by continuing to market community rated products which meet the health needs of all segments of the population.
When are we going to get the replacement legislation for risk equalisation? In addition, I ask the Minister, through the good offices of the Leas-Cheann Comhairle, to give us a series of examples of how this new initiative, which we mentioned earlier and about which many people are concerned, will work. For example, what is the situation now for Mr. and Mrs. Murphy, aged 72 and for Mr. and Mrs. O'Brien, both in their 40s and their two children under the age of 18? It seems to me there will be additional levies on adults and children which in a four-person family with two children would result in €500 extra in levies. There will be a 20% cut in their tax rebate and they are facing the possibility of a rise in premia if what the Minister was intimating earlier and what the newspapers are saying is true, namely that there is to be a rise in premia. It appears the insurance companies will be getting the rebate at source from the Government and they will also be allowed hike up their premia which seems like a double whammy on the customer and a double gain for the insurers. This seems a little bit odd.
There is no price control on insurance. The Government does not have to approve the pricing proposals of any company in the market. Traditionally it was the case that the pricing policies of the VHI had to be approved by the Government but this all changed as a result of the legislation to move the VHI to a commercial situation and it is in order that this should be a matter for the board and the management of the company, not for ministerial or Government approval.
With respect to the pricing policies of the companies, it is a fact that 52% of our population has private health insurance; in fact it is slightly more at 2.2 million out of 4.2 million or 4.3 million. It has moved upwards. Since liberalisation it has grown from approximately 36% or 37% even though many were of the view that we were at saturation point at that level. The numbers have increased due to a growth in the market, particularly the numbers of young people who have been attracted. In light of the Supreme Court decision, no risk equalisation payments would have transferred to the company that has by far the largest number of older people as subscribers. The claims made by an 80 year old are four times greater than those of a 40 year old and those of a 60 year old are twice those of a 30 year old. lf one company has 320 times more people aged 80 or over compared to another company, clearly that company will have a higher claims experience. The basic plan would have increased from €600 per adult. In the case of Mr. and Mrs. Murphy on the basic plan at €1,200 a year, this would have more than doubled if we did not take this initiative.
With regard to the risk equalisation legislation, the case in court was argued on 13 or 14 grounds and the decision of the court was made with regard to one aspect. The legal advice available to me, the official advice from my Department and the actuarial advice all stated that it will take at least two years to draft the legislation in light of all the issues that have arisen. This is the reason we have come forward with a measure for a three year period while we draft the legislation.
I will allow two brief supplementary questions from Deputy O'Sullivan.
The Minister clearly believes in equality for all patients in the case of health insurance and for this I applaud her. I ask her to take the step to do the same for all people in the health service and introduce universal health insurance. Even Boston is now moving closer to Berlin so what about Ireland doing so?
Snap, Deputy O'Sullivan has asked exactly the question I would pose to the Minister. Will she not accept that the same universal provision based on need alone and funded by direct taxation is indeed the best example of true community rating in terms of the provision of health care?
Since the Second World War no country has moved to introduce universal insurance.
The Minister could be the first.
It used to be the policy of my party. We have universal access to hospitals in Ireland——
Except in Monaghan.
——and we would never get to a situation where some people could not top up their entitlements, even with a universal model in place. If we are talking about paying consultants for the public patients they are currently supposed to see on their salaries and if this is the only element which some would advocate——
It is much broader than that.
——then we need to think very carefully. There are also implications for hospitals etc. in a system that is totally funded by insurers. These issues should be examined.
Three years.
That can happen on another occasion.
Written Answers follow Adjournment Debate.
