Vol. 675 No. 3
1 Deputy James Reilly asked the Minister for Health and Children the reason there is a 30% increase in delayed discharges from acute hospitals between 2007 and 2008 which lost the hospital system 216,885 bed days; the further reason the health service is not using beds available in the community; and if she will make a statement on the matter. [6947/09]
I am determined to ensure that all possible measures are taken to facilitate the discharge of patients in a timely manner. At present, there are approximately 750 patients whose discharge is delayed. That represents more than 6% of the total inpatient capacity. There are many reasons for discharges being delayed, including the need for long-stay capacity, community-based supports and, in some instances, a reluctance by families to allow their relative to be discharged until a publicly funded bed becomes available.
The Health Service Executive is addressing the issue of delayed discharges through a combination of increased investment in alternatives to acute hospital stay and improvements in the discharge planning process at hospital level. An additional 273 long-stay beds were made available in 2008, and a further 414 new beds are scheduled in 2009. The HSE has also recently funded 245 additional contract beds to alleviate delayed discharge pressures. Investment in community-based, long-term care supports will be maintained in 2009. This year the HSE will provide 4,700 home care packages, benefiting more than 11,500 people. A total of 6,000 patients were cared for by the community intervention teams that were recently established.
The HSE's funding for long-term residential care services for older people in 2009 is €909 million and it must operate within this resource. This funding currently supports the provision of public and contract beds and the payment of nursing home subventions. It will also be required to support the introduction of the new nursing homes support scheme, a fair deal, later this year. Under the fair deal, long-term care will be more affordable for all who need it.
Hospitals are working to ensure that care is provided in a timely, appropriate and efficient manner. All patients are to be given an expected date of discharge within 24 hours of admission and patients will be discharged at weekends where appropriate. The new consultant contract is key to that. More generally, the HSE's national service plan for 2009 commits to a number of key steps which are designed to improve the efficiency of the hospital system including a reduction in the level of inappropriate admissions, reducing average length of stay, increasing elective surgical admissions on the day of surgery and shifting activity from inpatient to day procedures. The delivery of those measures and targets, combined with the initiatives which I have described, should ensure more efficient use of available capacity.
An average of 293 patients were on trolleys to date in February 2009. That is an Irish Nurses Organisation figure. The average number in February 2008 was 244. In February 2007 it was 297, and it was 332 in February 2006. In March 2006 the Minister declared the situation in accident and emergency services to be a national emergency. Last year the Minister closed 500 beds and this year she intends to close another 600 beds. The Minister has rationalised eleven accident and emergency departments, cut front line and agency staff and critical overtime. In addition, more than 100 long-stay and respite beds are being closed at locations that include the Orchard Nursing Home, Bray, Bethany House, Carlow, St. Patrick's Hospital, Waterford and Heatherside Hospital in Buttevant, County Cork. I was in Waterford last week.
The Deputy should please ask a question.
I want to talk about that for a moment. St. Brigid's ward is perfectly good. People are delighted with it. Families are supportive of it. Patients want to stay in it. Staff are delighted to be working there, yet the Minister wants to close it down. In addition, the HSE is closing a ward in Waterford, which will put more pressure on accident and emergency services there.
Will the Deputy ask a question, please?
When I asked a question of the HSE it provided responses from 36 hospitals giving a total of 216,885 bed days lost. Will the Minister inform the House of the number of bed days lost from all 51 public hospitals?
The Deputy seems to have it every which way. St. Patrick's Hospital, which I have visited, and also Bethany House in Carlow, are very inadequate facilities in modern circumstances. One centre is a former work house and both centres are being closed down for health and safety reasons.
Nonsense.
Bethany House is a relatively new building.
That is not true. I was there.
Deputy Reilly——
A total of €500,000 has been spent on it by friends of the hospital. Staff and patients and their families take a great interest in the hospital.
Deputy Reilly should allow the Minister to answer the question.
I know Deputy Reilly is an expert on many subjects but I do not believe he is a health and safety expert. I know the expertise that was sought. I had a meeting with the HSE this very week on those matters. I have now signed into law standards of care for residential settings, which will be enforced from the summer of this year by HIQA and we must prepare for that environment. In the circumstances that exist in St. Patrick's in Waterford, it is not safe for patients to be on the first floor or for wards to have as many as 28 beds. There is no reduction in capacity in either of those facilities and alternative facilities are being provided. Patients in St. Patrick's will be moved downstairs as beds become available and families will be consulted. I accept there are issues relating to staff but I am concerned in this instance with patients.
Deputy Reilly's accident and emergency figures are wrong. The figures for accident and emergency services have continually improved in the past four years. Deputy Reilly can use averages at 8 a.m. before staff come in. He knows well the difference between the situation then and when the appropriate medical expertise is available. Deputy Reilly cannot have it every which way. We cannot have a situation where every piece of health reform introduced is opposed week in and week out. I refer to the cancer strategy and the reconfiguration of hospital services around patient safety. He cannot continue to do that.
The bed utilisation study will show that if bed utilisation was appropriate in terms of when people went home and who went into hospital in the first place many more bed days would be saved than the late discharges. I accept late discharges are an issue. I believe they are a particular issue as people wait in public hospitals for public beds and that is why the introduction of the fair deal legislation which passed Second Stage yesterday will make an enormous difference in providing affordable long-term care for older people and their families.
I put it to the Minister that the ward in St. Patrick's has had €500,000 spent on it, that the health and safety report, which I have seen with my own eyes, has been addressed, bar one remaining issue, namely, fire screens in the attic that will cost €50,000, which the friends and families of St. Patrick's are prepared to pay.
As to the Minister's contention that the figures are wrong, I put it to her that I have more faith in the emergency medicine group's figures and the INO's figures, which I compared year on year, than I will ever have in the HSE or her.
I know the Deputy does not have much faith in me. He accused me of criminal negligence in the House last week. He should reflect on some of the things he says. Deputy Reilly cannot have it every which way. He has opposed every single reform for political reasons, and he made complaints about the many initiatives that were taken to improve the performance of the hospital system, especially as far as accident and emergency and the utilisation of hospital capacity is concerned.
2 Deputy Jan O’Sullivan asked the Minister for Health and Children if she intends to proceed with the plan for co-located hospitals on the grounds of public hospitals; if she has satisfied herself that the proposals are viable in view of the economic climate; the position in regard to each proposed project, including whether or not contracts have been signed, the planned commencement date of each and the projected completion date; when she expects that the first beds will become available; and if she will make a statement on the matter. [6787/09]
4 Deputy James Reilly asked the Minister for Health and Children the progress of her hospital co-location plan; her views on the viability of the plan in view of the fact that the funding environment has changed in the past six months; when she expects the first bed to come on stream; and if she will make a statement on the matter. [6949/09]
I propose to take Questions Nos. 2 and 4 together.
The co-location initiative is a complex process but it is an efficient means of delivering extra bed capacity. Significant progress has been made in advancing the individual projects involved. The board of the HSE has approved preferred bidder status for the development of co-located hospitals at Beaumont Hospital, Cork University Hospital, the Mid-Western Regional Hospital, Limerick, St. James's Hospital, Waterford Regional Hospital and Sligo General Hospital. Project agreements for the projects in Beaumont, Cork, Limerick and St James's have been signed.
Planning permission was granted by An Bord Pleanála for the Beaumont project late last year. Planning permission for the Cork and Limerick projects has been granted by the local authorities concerned and appealed in each case to An Bord Pleanála. The preparatory work required to make the planning application for the St James's project is under way.
The necessary preparatory work for the project agreements in respect of Waterford Regional Hospital and Sligo General Hospital is proceeding. A tender in respect of Connolly Hospital has been received and is under consideration. Work is being undertaken to finalise the invitation to tender for Tallaght Hospital.
It is a matter for each successful bidder to arrange its finance under the terms of the relevant project agreement. It is the case that the funding environment has changed significantly in recent months, and that has affected both the public and private sectors. The co-location initiative, like other major projects, has to deal with the new situation. The successful bidders are working on the details of contractual terms with banks and other arrangers of finance. The HSE is continuing to work with the successful bidders to provide whatever assistance it can to help them advance the projects.
The Minister announced this proposal in 2004 and she said it would be a quick way to provide beds in acute hospitals. Does she accept she has failed miserably in this regard? Five years later, no block has been laid, no bed has been provided and no patient has been catered for and none will be for probably two years. The Minister did not reply to the question about when the first beds will become available. This is not fast provision of beds. Will she comment on that?
Does she accept the finding of the expert report relating to Beacon Hospital that health insurance will increase by approximately 25% as a result of this scheme? Has she amended the conditions for the funding of co-located hospitals? Various media have reported on pressure on the Department to make it easier for investors to obtain funding from banks and to provide fewer safeguards for the public purse in this regard. Does she plan to make changes? Will the hospital projects proceed?
When the Deputy reads reports, she should read them thoroughly because the first page of the famous Goodbody report states, "The co-location initiative is highly beneficial for the public health system and the Exchequer. It delivers great value for money". Goodbody is working on behalf of the promoter of one of the sites and not the State. We take the advice of the National Development Finance Agency, NDFA, which is the Government's economic adviser. The proposal met the public sector benchmark and the agency said it would provide terrific value for money.
Private health insurance costs have increased since I became Minister because I have steadily increased the cost of private beds in the public health system. I have doubled the cost of such beds, which are subsidised by the State to the tune of €300 million annually.
I do not dispute that.
If the Deputy accepts the policy of charging the market price for these beds, it will have a knock on effect on the cost of insurance. Every year insurers have complained but that is a complaint worth hearing because this cost is not acceptable. The policy behind this is right. If we were establishing a greenfield health system in Ireland from scratch and recruiting consultants, we would never arrive at a position where beds were ring-fenced. In addition, a consultant is paid a private fee for insured patients in public hospitals and that has led to a scenario where public patients are put on waiting lists and private patients have ready access to publicly funded and staffed hospital facilities.
The first objective of co-location is to convert 1,000 such beds, which cost €350,000 each a year, for public use at a cost of less than one third of that amount. That would deliver terrific value for money because the staff are paid anyway. The second objective is to secure private investment in delivery capacity, which I have sought elsewhere in the health system, because we face major pressures. The announcement was made in July 2005 and not five years ago. We have a disparate capital infrastructure because the health services are the most decentralised of all State services given that they must be provided locally and, therefore, there are significant demands on infrastructure, much of which is old. New equipment is always coming on the market to deliver improved care and there are always pressures.
There will no change to the terms of the co-location scheme. The only advice the Government has taken is from our own adviser, the NTDA, which continues to provide us with expert advice.
The Minister did not answer my previous question but, hopefully, she will answer this. The reason I have opposed many of her reforms is she tends to undertake them back to front, as is the case with this scheme. Having removed 500 beds from the system last year and with plans to remove 600 this year, the Minister is still talking about these much vaunted hospitals. She is not shy about opening facilities and turning sods. Has she received an invitation to turn the sod on any of these hospitals yet? When will the first bed be available for a patient? At the end of the day, this is about trust and credibility. The Minister will not deliver on her promises in this regard in the same way she did not deliver on cervical vaccination. When will the beds be available? When does she hope to turn the sod on one of these projects?
I have never turned a sod on a private sector development nor do I intend to do so, and I rarely turn sods on public sector developments. I have been involved in openings but the majority were public sector openings. The Deputy is involved in private health care and I was lobbied by him previously for tax breaks on private health care. I do not understand why he believes private health care in nursing homes and general practice is fine but when it comes to hospitals, it is a mystery.
Answer the question.
We have to go through appropriate procurement and tendering procedures, value for money audits and the planning process because it is a private sector initiative. A former Member, for ideological reasons, appealed most of the planning permissions for these projects to An Bord Pleanála and that delayed them by up to 12 months. Planning for the Beaumont Hospital project was granted only at the end of last year.
I do not want the history to this. When will the beds be available?
I presume the Deputy would like to know the facts.
I know the facts. When will the beds be available?
The Minister without interruption.
There is a connection between 500 beds being removed from the system and her scheme.
Planning permission has not been granted for a number of these projects and clearly I am not in a position to say when the beds will be available. I hope we will see the beginning of this investment as soon as possible.
That is not an answer.
In the current economic climate, can the taxpayer afford to forego approximately €800 million in tax over seven years for these projects? Does the Minister believe there will be private funding for them?
Every day the House discusses the financial difficulties confronting this country and many others relating to public and private projects. I do not want to be dishonest and, therefore, securing money for an investment currently is a challenge in Ireland, as it is elsewhere.
I refer to the study the Deputy mentioned. The tax generated on an annual basis will be more than €200 million and 4,500 jobs created during construction.
What about tax foregone?
It will cost the Exchequer approximately €100 million a year to secure 1,000 beds. If the Deputy can outline a better way to secure 1,000 beds in our public hospital system using modern infrastructure with the facility available to all patients, provide public patients with services at a hugely discounted price and one accident and emergency department, I am open to her suggestion.
What about getting the 700 patients out of acute beds who are ready to be discharged?
The Minister should eliminate delayed discharges by opening facilities in the community to allow those patients to be discharged because the guts of 1,000 beds would be available in the morning.
She did not answer the question. She stated planning permission has been granted and contacts signed for a number of these projects. When will the first beds be available? If she cannot say, she should tell the House she is not in a position to do so because all the talk about delivering value for money and so on is precisely that. It will not happen.
The Deputy is seeking 4,000 additional hospital beds and I have yet to see how they will be funded. Fine Gael also wants cuts amounting to €2 billion. I would love somebody in the party to show me how all that will happen.
Answer the question.
A contract has been signed for one and there are project agreements for many others, which is a different matter. Regarding the hospital where a contract has been signed, clearly I am not in a position to say when the final pieces will be completed. There are legal and financing issues involved. I am not in a position to tell the Deputy when that will happen.
3 Deputy James Reilly asked the Minister for Health and Children, given the findings of the national report on traumatic brain Injury (details supplied), her views on whether the current system is putting patients’ lives at risk; and if she will make a statement on the matter. [6948/09]
I have received the report in question in recent days. The study, which was led by Professor Jack Phillips, consultant neurosurgeon, involved a national audit of more than 2,000 patients with significant traumatic brain injury. Data were collected and analysed over a two-year period from April 2002 from the neurosurgical centres at Beaumont Hospital and Cork University Hospital. I welcome the findings of the study which will help to guide the approach to strengthening neurosurgical services as well as informing the approach to the development of injury prevention and health promotion strategies. The findings of the report show that the level of care provided to some patients was at times less than optimal. I note that the data used in the study were collected between 2002 and 2004.
The development of services in the area of neurosciences, which comprises neurology, neurophysiology and neurosurgery, has been given a particular policy priority in recent years. Since the data were collected and analysed additional revenue funding of €7 million has been allocated to the Health Service Executive in 2006 and 2007 for the development of neurosciences and a further €850,000 is being allocated this year.
On the capital side Beaumont Hospital has received a grant of €4.9 million for neurosurgery equipment. There has been significant investment in the CT scanning service at Cork. The hospital operates a 24-hour CT scanning service, a PET CT is due to be commissioned in the summer and an existing CT scanner is being upgraded at a cost of €1.4 million. In addition, €1.2 million has been spent on equipping and refurbishing the intravascular aneurysm-coiling suite which has now started providing a procedure for treating aneurysms that was previously available only in Beaumont Hospital.
We have only ten neurosurgeons, which is the lowest in Europe. I was in Belfast two days ago and was told that Northern Ireland had 14 with a population one third of ours. That may or may not be accurate.
I have a personal knowledge of this in that a friend and colleague of mine with a brain tumour waited four weeks to get into Beaumont Hospital. I had a patient from Wexford who last year was told to arrive at Beaumont on a specific day because she had a recurrence of her symptoms following brain tumour removal three years earlier and it quite obviously had returned. She got her husband to take three weeks off work to mind their seven children and the night before she was due to go to the hospital she was advised that no bed was available. That is the reality for people. The consultant to whom I spoke at that time said he is faced with having to leave a patient with a brain tumour at home because somebody else who is unconscious must be treated as an absolute emergency.
We are streets behind and the investment has not been made. I was going to confine my comments to neurosurgery, but the Minister mentioned neurology. I have a comparative list of neurologists per head of population that includes Australia, Belgium, Finland, France, Britain and Ireland. We used to have one per 300,000. We now have one per 210,000. The next worst is the UK with one per 164,000. France has one per 39,000. We have not been employing the consultants. Of the 245 consultant posts approved since 2008, of which only 115 are new posts and 154 have been advertised, how many are for consultant neurosurgeons? When will the HSE strategic review of neurology and clinical neurophysiology completed in 2007 be published?
I understand two consultants have been recruited at the moment. I have seen the publicity surrounding the issue of neurology. I have equally seen the correspondence from Professor Drumm. If we want to talk about the number of neurologists we have, we must also consider the number of junior doctors we have. We have an unprecedented number of non-consultant hospital doctors in neurology compared with anywhere else in the world. We also need to consider the performance in the different hospitals. Professor Drumm recently showed me that in some hospitals, consultants in neurology were seeing 80 or 90 new patients a month and in others it was down to 20 to 22. I will send the Deputy a copy of the correspondence which will inform him.
We have more than 7,000 hospital doctors. By any standard that is a large number. The challenge for us is to switch it from non-consultant doctors to consultants. We are awaiting a new contract with very different employment terms, which I am happy to say is virtually finalised and over the coming days we will be able to make final decisions in that regard. It will fundamentally change the way consultants work and make it much easier for us to make it affordable to get new consultants because we will be able to reduce the dependency on non-consultant hospital doctors, of which we currently have 4,900. I believe a subsequent question deals with the matter.
Regarding surgery, my brief informs me that we have 13. I do not know how many there are in Northern Ireland. Since Professor Phillips completed his study, the facility in Cork only commenced in 2003, which has resulted in a major improvement in the service in Cork. I do not take away from the fact that there are still pressure points. I accept that.
If we were being honest we would both accept that there is a major deficit. It might be too kind to call it a pressure point. When will the new neurosurgeons take up their posts? Will it be this year and if so on what date? As we both know, after approving a post, recruiting can take anything up to 18 months.
I am not in a position to tell the Deputy when they will take up their posts. I will see whether I can get that information. The data I have suggest there are ten in Beaumont and three in Cork University Hospital. I will see whether I can confirm that.
Question No. 4 answered with Question No. 3.
5 Deputy Alan Shatter asked the Minister for Health and Children if her attention has been drawn to the fact that bereaved pensioners over 70 years who automatically qualified for the medical card prior to the enactment of the Health Act 2008 and whose spouses died prior to 1 January 2009 will not benefit from the exemption which allows a medical card to be retained for a three-year period following the death of a spouse where their income exceeds €700 per week and is below €1,400 per week and that the three-year concession only applies to those bereaved as and from 1 January 2009 which adversely affects those bereaved in the years 2006, 2007 and 2008; if she will take action to amend this situation; and if she will make a statement on the matter. [6473/09]
The Health Act 2008 allows for a surviving spouse of an over 70 medical card holder to retain his or her card for a period of three years provided that the death occurred on or after 1 January 2009, the surviving spouse or partner was aged 70 or over at the time of the death, and the surviving spouse remains within the €1,400 weekly income limit for a couple. After three years, the surviving spouse will be assessed under the €700 single weekly income limit.
I moved an amendment during the passage of the legislation through the Houses of the Oireachtas to ensure a person aged 70 or over would not lose his or her medical card as an immediate consequence of the death of a spouse. My Department examined the options available to ensure the trauma was minimised for an elderly person whose spouse dies. I am satisfied the provision in the legislation offers the best solution from a non-discrimination point of view.
A surviving spouse aged 70 or over who no longer qualifies for a medical card after 1 January may apply to the HSE for a card under the existing net income thresholds which take account of medical, nursing and other relevant expenses. The HSE may also issue a medical card on a discretionary basis if the person would otherwise be caused undue hardship in providing general medical and surgical services for themselves and any dependants. Such people are encouraged to apply to the HSE for a discretionary card. I am satisfied that within the confines of the legislation it is not possible to change what has recently been legislated for.
Is the Minister aware that if a person over 70 with a medical card died in November 2008 as a consequence of this legislation, his or her spouse will be deprived of it from 2 March? Does she accept that it is a gross discrimination and grossly unfair that such circumstances arise, especially given that if the spouse had lived until 2 January 2009 his or her widow or widower would have retained the medical card for three years? Where is the fairness, equity or humanity in treating those who were bereaved immediately prior to 1 January 2009 differently from those bereaved this year? Is the Minister aware that as matters are now being administered by the HSE, elderly people phoning the HSE whose income exceeds €700 per week but is below €1,400 per week and whose spouses died in 2006, 2007 or 2008 are being told that they will be deprived of the medical card that they believed they would otherwise retain?
When we debated the legislation in the House I said that it would have been desirable to leave the medical card in such circumstances with all such spouses. However, a number of legal and equality issues arose and it was not possible legally to do that. Unfortunately there are always cut-off points in any legislation. Currently a person in his or her 40s, 50s or 60s whose spouse has passed away is in the same circumstances when the card comes up for renewal within the calendar year. I am aware of the anomaly but I am not in a position, unfortunately and for legal and equality reasons, based on the advice I have received from the Attorney General, to do anything more than is in the legislation.
Has the Minister received legal and equality advice from the Attorney General as to the position as it might occur if a person whose spouse died in 2007 or 2008, to whom the three year concession does not apply, took proceedings in the High Court, due to the inequitable application of this legislation? I suggest to the Minister that whatever advice she is getting misses the point that this is a serious unconstitutional discrimination against persons who were bereaved during 2006, 2007 and 2008. Would the Minister acknowledge that when dealing with this issue during the truncated debate that took place on this legislation, she sought to indicate that bereaved spouses, widows and widowers, who suffered a bereavement in the three years preceding 1 January 2009, would be dealt with with some greater care than is currently happening in that she told the House that the practice of the HSE will continue on an administrative basis and it will take all reasonable measures to ensure people in this position are not put at a disadvantage? Could the Minister explain what measures the HSE is currently taking? Is she aware of the fact that only last Friday, the Irish Hospice Foundation called for a change in the legislation in this area, emphasising the detrimental impact it will have on those who were bereaved in the past three years?
As the Deputy is aware, the medical card scheme generally, with the exception of the over 70s, is allocated on an administrative basis. The only legislation is to do with the over 70s which was introduced in 2002. In normal circumstances, when a person passes away, notwithstanding the fact that the income may remain the same and therefore the assessment will be different in a new set of circumstances, the cards are generally left for a period of up to one year, sometimes more. With regard to some of the cases mentioned by the Deputy I would hope it can be done on that basis.
Is there any direction to the HSE to do that?
The Deputy asked me a question. This legislation was drafted by my officials with the help of the Office of the Attorney General and the Attorney General in person. Therefore, we sought to be as reasonable as possible. My desire would have been to have left the card but I was strongly advised that for equality and legal reasons, we were not in a position to do so.
It is grossly unfair to deprive someone of the card who was bereaved three or four months ago but leave it with someone who has only been bereaved a couple of weeks ago. It is grossly unfair.
