Vol. 693 No. 2
83 Deputy James Reilly asked the Minister for Health and Children the impact the revised programme for Government commitment to proceed with the current programme of co-location limited to already committed projects under the existing project contractual agreements will have on her co-location project; and if she will make a statement on the matter. [39346/09]
87 Deputy Arthur Morgan asked the Minister for Health and Children the cost to date in 2009 of the co-location programme; the number of public hospital beds that have been freed up as a result of the programme; and if she will make a statement on the matter. [39274/09]
99 Deputy Lucinda Creighton asked the Minister for Health and Children her views, in view of the commitment in the programme for Government that co-location will be limited to already committed projects, on whether co-location is viable; and if she will make a statement on the matter. [39310/09]
122 Deputy Lucinda Creighton asked the Minister for Health and Children the number of beds which will be provided by committed co-location projects under existing project contractual agreements; and if she will make a statement on the matter. [39311/09]
I propose to take Questions Nos. 83, 87, 99 and 122 together.
The renewed programme for Government reaffirms the Government's commitment to the current co-location programme. The procurement process which is under way will continue. Projects will be developed within the terms of those project agreements which have been signed or which may be signed.
It is an essential requirement that each co-location project demonstrates clear value for money to the taxpayer. There is a requirement on each of the preferred bidders to pay a non-refundable deposit to the HSE on the signing of the project agreement. The intention of this requirement is to allow the HSE to recoup the expenses that it has incurred in this context.
The Finance Act 2009 provides that the schemes of capital allowances for all private hospitals and certain other health facilities will be terminated, subject to transitional arrangements for projects already in development. Provided that a co-located private hospital project conforms to the requirements of these transitional arrangements, and otherwise satisfies the general requirements of the scheme of capital allowances, the tax relief will apply. The value of the tax relief in each case will depend on the level of qualifying capital expenditure. I would add that additional revenues will accrue to the Exchequer from the extra activity generated by the construction of the hospitals, the employment arising and the related services provided on which taxes will be paid.
Preferred bidders have been selected for the Beaumont, Cork University, Limerick Regional, St. James's, Sligo and Waterford Regional projects. The total number of beds proposed in these six facilities, exclusive of critical care capacity, is in excess of 1,200. Project agreements have been signed in respect of the first four of these developments and the proposed capacity associated with these projects comes to 917 beds altogether.
I call Deputy Ó Caoláin.
A Leas-Cheann Comhairle——
The order of the questions on my list is different. I should have called Deputy Reilly first.
I thought the Chair was being ultra generous.
The questions are listed in reverse order on my list.
Back to front — how does one spell NAMA back to front?
Deputy O'Sullivan put the issue succinctly at the outset of the debate on this issue. Four years and four months have passed and not a single bed has been provided. Some 21,000 people gave up their health insurance during this year. The VHI estimates that by the end of next year the number will have increased to 200,000.
Co-location projects with signed agreements and planning permissions are entirely dependent on the Beacon Medical Group. When does the Minister expect the first sod to be turned and the first bed to be available? How many non-refundable deposits have been paid and received by the HSE? I ask the Minister to consider that this not only a flawed but a failed policy. It has not delivered, by the remotest stretch of the imagination, the fast-track provision of beds. We know that there are modular units that can be built and put on site in six months. Approximately three years and ten months ago we could have additional beds if we had not gone down this nonsensical route.
The Deputy is wrong on one point. The HIA has informed me that 12,000 people have dropped out of health insurance this year. Out of a total of 2.2 billion, that figure of 12,000 represents a very small number by any standard. People have switched from one provider to another. People have left the VHI to take out insurance with some of its competitors. The VHI may have lost 4%, 5% or up to 6% of its market share, but that business has gone to its competitors.
Approximately half of our population has private health insurance and I envisage in that region will continue to have it.
The VHI does not believe that.
It may have issues around its membership, about which it is concerned, but we are talking about the overall market. As the Deputy has told me on many occasions previously, he is not interested in which insurance company people belong to and neither am I. Competition in the market has been a very good thing. During the last recession in the 1980s very few people dropped out of private health insurance and some 37% of the population had such insurance at that time.
This policy was enunciated as a way of providing capacity because our public hospital system needs investment. We need more single rooms to ensure the control of infection in particular. We do not have resources available to make that investment. That is a fact. It does not matter who is in this seat, such resources are not available.
Because of the fragmentation of our health service, the massive investment that has taken place during the past decade, in particular, has been targeted at priority areas. One of the key priorities currently is long-term care where many of our current public stock does not and cannot meet the standards laid down by HIQA. That must be a priority for public investment.
People have opposed this policy from the start. It is opposed because the funding will come from the private sector. It was supposed to be the great bonanza for investors. If it was such a great bonanza , it would have been easy for people to get the money much sooner than now. There are big risks associated for the investors and that is why the banking situation has not been easy, particularly with the current difficulties.
A number of Members wish to speak on these questions.
I accept that. I cannot look into my heart and tell the Deputy when the first sod will be turned, but I can tell him, as I said in reply to Deputy O'Sullivan's earlier question, the Beacon Medical Group has spoken about this recently and mentioned that it envisages the first facility will be in place in 2012.
I understand two or three projects have paid over the non-refundable deposit. I understand in one case the deposit was €350,000. When project agreements are signed, the deposit must be paid over at that point. That is my understanding.
Since the Minister came up with what I can only describe as her disgraceful co-location programme, every time we have raised the shortage of acute hospital beds, she has continually referred to this co-location programme proposition as the means to free up additional public beds in our public hospitals currently occupied by private patients. Does she recall that when we first engaged on this issue she indicated that 1,000 additional beds would be so created across the public health system? Does she further recall that when I challenged her in this Chamber in 2007 to indicate the number of beds that would be involved at each co-located hospital, she said she was not in a position to give an answer. That was her reply. Is it the case that two years on from that exchange between us in the Dáil that day, not a single square metre of concrete has been poured and as a consequence, not a single further public bed has been created by this project that the Minister holds so dear?
Will the Minister agree to call an end to what I can only describe as a very expensive farce on her part? Will she admit that this never had anything to do with the creation of further public beds but was all about creating further opportunity for those who see health care as a means for creating profit? How can the Minister justify continuing with this collocation programme when we see a disgraceful situation where children are being denied access to the beds and resources they need to protect their interests, while patients are in Crumlin's hospital for children which only recently highlighted once again——
I must call the Minister.
How can the Minister justify this approach when €231 million——
Please, Deputy.
——would have provided those 1,000 beds in the public health system?
A number of Deputies have indicated their wish to get in on this question. It is supposed to be one minute for a question. Each of the speakers so far has taken three minutes.
I will try to obey the Leas-Cheann Comhairle. First, there was never any doubt about how many beds were involved. If I did not have the information to hand, it was available. I can give it to Deputy Ó Caoláin rather than waste time. In Beaumont, it is 157 inpatients, 54 day beds, and so on. I can give him the information.
The Minister had not got it two years ago.
I am sorry. I may not have had them before project agreements were signed when we had gone to tender but there was never any doubt about each project agreement.
How many are in place?
Deputy Ó Caoláin knows none of them have happened yet. If it was the great bonanza for profit makers that he seems to think, they all would have happened overnight.
Much has changed.
For the information of the Deputy, UMPC has taken over 40% of Beacon. It is a not for profit organisation with a considerable international reputation. I presume most here will be aware of its reputation in the United States and beyond. Therefore, not all of these projects are being developed by what Deputy Ó Caoláin would call "the profit motive".
On capacity generally, we have a fragmented public health system. If we were to start from a greenfield site we would not put in place what has been in place. We all know that. The delivery of quality safe care to patients to best international practice is not possible if one has a fragmented system.
Deputy Ó Caoláin opposes everything as being a disaster, but there are many international experts looking at our cancer plan, admiring and supporting it, and seeking to have it replicated elsewhere.
The Minister is the one who is straying now. It is hard enough to confine ourselves to the question.
On the infrastructure that this will provide, keeping all of the consultant manpower on the one site and allowing the public and private facilities to work hand-in-hand as they do in other facilities in the country that are collocated——
More like hand in our pocket.
The reality is that under contracts of employment negotiated long before I or Deputy Ó Caoláin ever came into this House, consultants have certain rights in relation to private patients. The idea here is to free up these facilities for the public patients.
That means, to change.
Thank you, Minister. You only took twice the allocated time.
Do any plans still exist for collocation at University College Hospital, Galway? Some time ago Galway City Council gave permission for a four-storey research facility there which has subsequently been appealed to An Bord Pleanála. Is that considered any part of collocation?
Considering that collocation could not even be fitted on the grounds of University College Hospital, Galway, how will this proposed research facility be facilitated there if permission is eventually granted?
I am afraid that is a separate question.
It is to do with collocation. I want to know the collocation part of it.
A research facility is not a hospital collocation. Perhaps the Minister would revert to the Deputy. I do not expect her to have that.
I do not mean to be smart-ass with Deputy McCormack, and I am not trying to be, but he, among others, lobbied me from Galway to have that cancer research facility included as part of collocation.
Galway city has many private facilities. It has the new Galway Clinic in place in recent years. Besides the logistical issues of the university hospital site he mentioned, capacity from the private sector does not exist.
To get final clarity on this, can I take it as read, assuming the private finances are supplied, that Beaumont, Mid-west Limerick, CUH and St. James's hospitals will go ahead with tax breaks? Can the Minister clarify whether Waterford and Sligo hospitals, where project agreements are being prepared, will go ahead with tax breaks? Can she clarify whether Connolly and Tallaght hospitals, which are at earlier stages, will go ahead with tax breaks? Was the deputy leader of the Green Party, Deputy Mary Alexandra White, right in stating that most of the planned collocation hospitals would wither on the vine because there seems to be a difference of opinion in Government on all of this?
The Greens are always right.
I want to make clear that I am not certain all of the hospitals will avail of tax breaks.
Would they be entitled to them?
There are transition arrangements which the Minister for Finance announced. My understanding is, if memory serves me right and subject to correction, that anyone who has applied for planning permission by the end of this calendar year will be facilitated. My understanding is that at least one of the projects where a project agreement has been signed will not be availing of tax breaks.
Applied for, or granted, permission?
Applied for.
In light of the fact that none of these has gone ahead and there is obviously a major scarcity of bed space at present, which has clearly shown up in what has happen in Our Lady of Lourdes Hospital in Drogheda where the crisis is desperate, would the Minister reconsider her action where she has closed off so many beds in other hospitals?
I am afraid that is well beyond the scope of the question. I call Deputy Reilly for a final supplementary question.
The Minister has the right to answer that.
I will not stop the Minister if she wishes to comment.
Far be it from me to stand in the way.
I will answer it. On what has happened in Drogheda, Drogheda is following best international practice. When there is an outbreak of something like C. diff, one closes off a hospital to visitors if that is what is required to make the hospital safe. That is normal practice. It does not only happen in Ireland. If the Deputies read any international press, which I am sure they do from time to time——
It did not happen by accident.
——they will see it is common practice in many other countries.
It is normal practice to ensure that it does not happen.
Notwithstanding the bed pressure, activity this year is ahead of last year.
I call Deputy Reilly for a final supplementary question on this.
It is all very well to speak of following best standards and practice in terms of how one deals with it when it happens, but if the Minister applied best standards in terms of not having the place overcrowded having closed down half of the facilities in the north east——
Hear, hear.
——she would not have this situation in the Drogheda hospital, which is a hospital that has suffered from many disquieting scandals over the years.
After four years and four months — if the Government remains in office the Minister may be in office until 2012 — the Minister has become well known for plans for the future as a substitute for action today. I have no faith that 2012 will deliver either a sod, a bed or anything else for us in private. The Minister must acknowledge that this is a poor return for her tenure and in terms of adding additional beds, when there are 700 closed to date due to cutbacks.
What real action she the Minister take in terms of the quite considerable health budget available to her to bring about real change in the hospitals to increase our capacity. We are spending nearly €5,000 per man, woman and child in this country.
The Deputy is giving information rather than seeking it.
What will the Minister do about this? She has told the House that we do not have money. However, we are spending €5,000 per man, woman and child in this country. They spend only €3,500 in Holland where they do not have this problem. They do not even have the hand-washing dispensers in the hospitals, and I asked why. The response was that they do not have a problem. They do not have the problem because when the patient is admitted he or she goes into a room and until his or her status, as far as MRSA, C. diff or anything else is concerned, is known, he or she does not circulate in the hospital.
Every reform we try to introduce is opposed by Deputy Reilly.
I supported the Minister on cervical checks. I supported her cervical vaccine.
When we tried to reduce the cost of delivering drugs to patients, he even opposed that.
No, I did not.
He did. I saw his "chaos, disaster, the wrong policy".
I did not oppose it.
Deputy Reilly cannot look for more for everyone who works in the service.
Do not rephrase it.
He cannot look for more, as he is good at doing. Every vested interested is represented in this House by Deputy Reilly. If he is to be the spokesman for the main Opposition party——
The people I represent, including the patients——
Please, allow the Minister.
——and he aspires to be Minister for Health and Children, I expect a bit better from him.
On many of the reforms, whether it is HIQA, the fair deal, the hygiene standards, the cancer control programme or changing how we remunerate pharmacists, everything has been opposed by Deputy Reilly. That is a fact.
We have learned not to have such expectations.
84 Deputy Brian Hayes asked the Minister for Health and Children the way she proposes to overcome difficulties that Irish Duchenne muscular dystrophy sufferers incur when travelling to Britain for care and clinical trials; her views on the Irish British Duchenne muscular dystrophy registry; and if she will make a statement on the matter. [39360/09]
Following the Dáil debate regarding muscular dystrophy earlier this year, I met with Duchenne Ireland and discussed a range of issues, including research, clinical trials, the registry and standards of care for the treatment of boys with Duchenne muscular dystrophy. The issues raised by Duchenne Ireland are under active deliberation and receiving detailed consideration at the highest levels in the Department. However, I must point out that while the Department is working through the various issues raised by Duchenne Ireland, it may not be possible to come to a full resolution of all the issues that are of concern to it.
The Duchenne muscular dystrophy registry is a database for patients diagnosed with Duchenne or Becker's muscular dystrophy. It is hosted by Action Duchenne in the UK and is promoted by Muscular Dystrophy Ireland and Duchenne Ireland. It is very positive that access for Irish children to the registry has been secured so that they can be considered for inclusion in trials. While the use of registries as a tool to identify patients for clinical trials is gathering momentum, the Duchenne muscular dystrophy registry is a voluntary database and, as such, it is a matter for each individual to include themselves on the registry.
I am not aware of any requests made to the Health Service Executive for assistance to fund Irish Duchenne muscular dystrophy patients travelling abroad for care and treatment in the UK.
The point is that the children going to the UK for trials encounter many challenges and this is not acceptable on an ongoing basis. There are three key areas: research, a proper register and standards of care. Duchenne Ireland contends that only a fraction of boys with the condition are on the register. What is a needed is a dedicated neurologist to drive the updating of the register and to establish the standards. The Lancet journal will next January or February list a register of standards for all countries with regard to the research and trials that have been carried out. This register is what will form opinion. GlaxoSmithKline has already signed a deal to put a product on the market.
If we do not have a proper register for the children of this country, they will miss out. It is estimated there is a core of 150 to 200 boys with the condition. I ask the Minister in the first instance to dedicate a neurologist from within the current core staff of the HSE to drive this forward.
I have met the group and intend to meet it again in the next few weeks. I have taken the request on board. At this point, I cannot say I can deliver the Deputy's request but I accept that because the register is voluntary, people are disinclined to use it, which sends us a message. If we are to give the register some value, I would hope to be able accede to the request in the near future. However, I want to meet the group before I give that commitment.
We addressed muscular dystrophy in the House in May of this year, including an address of Duchenne muscular dystrophy. A number of specific areas were identified as being in need of address. What steps have been taken to progress the needs of people suffering from Duchenne muscular dystrophy and muscular dystrophy generally? The shortage of neurologists has been highlighted in part, as well as the need for enhanced support for neurology in the national centre, which is Beaumont Hospital, the need for enhanced Government support for Duchenne muscular dystrophy research and, lastly, the need for greater support for muscular dystrophy sufferers, particularly given the outlay they must expend annually in regard to the hire of ventilators to assist their breathing, which is expensive and is not covered by medical cards. Is consideration being given to extend medical card entitlement to all those suffering from muscular dystrophy, including Duchenne muscular dystrophy?
First, the extension of medical card cover is not a consideration. To reaffirm the point raised by Deputy Doyle, I reiterate the importance of a register that would give value. The issue of a neurologist specifically designated for that purpose is one I am considering. I would hope to meet Deputies Doyle, Ó Caoláin and their colleagues again in the coming weeks.
The point concerning clinical trials arose at the meeting with the representatives. I pointed out that we have no identifiable lead clinician or investigator willing or able to co-ordinate the protocols of a trial. Without trying to hide behind that response, the reality is that until such time as we can identify somebody who would take up that role, we are stuck in regard to dealing with the clinical side in Ireland. As Members will be aware, at the last meeting I gave certain commitments by way of dealing with the need to upgrade and add importance to the register.
We all want to see progress on this issue and I welcome the fact the Minister of State has engaged with it. The condition affects a relatively small number of people but it would make a huge difference to their lives if we can have a proper register, a dedicated clinician and get them directly linked to the trials. To achieve this, we need a commitment to be shown on behalf of the Government that we are fully engaged in the process. We must come back to the Minister of State on this issue. Perhaps it is up to us to table questions to him as it is important we would have follow-up in this regard.
I accept the Minister of State's bona fides in this regard. However, the question is when action will be taken on behalf of those who suffer this life-threatening illness. Time is not on their side. Many of the people I met at the beginning of last year have lost their sons. How many more will lose sons before we take action? I know we are in a financial crisis but we need to deal with this issue.
I want to mention Deputy Joe McHugh, who is involved in this issue and would be present today if he were not on paternity leave. On a lighter note, perhaps the Minister of State would join me in congratulating Joe and Olwyn on the arrival of young Darragh Thomas McHugh.
To come back to the main question, this is a heart-rending issue. I would like to support the Minister of State and the Minister in trying to find the funds to make this possible for these children.
I meant to mention Deputy McHugh earlier as he was part of the meeting with the Minister, Deputy Doyle and myself some time ago. I gave the commitment that I would hold another meeting before the end of this term. I hope that meeting will not be just for the sake of checking where we were at the last meeting. It is to deal with the issue of the register and, more importantly, to find whether we can secure a lead investigator.
I understand 155 boys travel to the UK. I offer my sympathy to them, but more than just doing that, I will try to deal with the matter.
I add my congratulations to Deputies McHugh and Enright. Indeed, I sent a card to my constituency colleague, Deputy Enright, on the good news.
The EU competent authority in this area is TREAT-NMD, which is based in Newcastle. It is willing to assist in this regard but it has not yet been engaged with. Will the Minister of State make contact with TREAT-NMD to request its assistance?
I will.
85 Deputy Jack Wall asked the Minister for Health and Children if she will intervene to ensure that charges in regard to the implementation of regulations in respect of the monitoring of nursing homes imposed by the Health Information and Quality Authority on nursing homes are not passed on to residents; and if she will make a statement on the matter. [39308/09]
112 Deputy Seán Barrett asked the Minister for Health and Children the action, legislative or other, she will take to prevent the €190 per bed annual Health Information and Quality Authority licensing and registration fee from being passed on to nursing home residents; and if she will make a statement on the matter. [39319/09]
I propose to take Questions Nos. 85 and 112 together.
I understand the Deputies' questions relate to the fees associated with the system of registering and inspecting nursing homes which commenced on 1 July 2009. Under the Health Act 2007, statutory responsibility is given to the chief inspector of social services, part of the Health Information and Quality Authority, for inspecting and registering categories of designated centres, including nursing homes for older people. The authority's inspection process comprises three parts: pre-assessment, the inspection visit and report completion, including a process of fact-checking and verification. Since July 1, the authority has begun 106 inspections. Of these, 59 were announced and 47 were unannounced visits. The average duration of inspection visits to date has been two days. Of the inspection processes begun, nine have reached conclusion with the publication of reports, along with the publication of one additional inspection report. The remaining reports will be published shortly.
It is important that this new inspection regime is effective, robust, independent and properly resourced. It was decided that the new registration and inspection regime would mainly be self-financing. The 2007 Act provides for the following fees: applications for registration or renewal of registration under section 48, where this section states that the applicant shall include with the application the prescribed application fee; an annual fee payable by the registered provider under section 99; and a fee for variation or removal of any conditions of the registration under section 52. A registered provider making an application under this section must include the fee with his or her application.
Following analysis of the types of centres, numbers of places and so on, it was decided to set a registration fee of €500, payable every three years by each nursing home together with an annual fee of €190 per place in each registered centre. It is estimated that the fee represents an average weekly cost of €3.73 per registered place. The fees are payable by the registered provider, or in the case of applications for registration, by the applicant who for existing designated centres would normally be the registered provider. These fees are not due or payable by the resident or their family.
It is a matter for each individual nursing home to determine the price charged for services. However, article 28 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009 states that:
(1) The registered provider shall agree a contract with the resident within one month of the admission of that resident to the designated centre.
(2) Such contract shall deal with the care and welfare of the resident in the designated centre and shall include details of the services to be provided for that resident and the fees to be charged.
Therefore, only those fees set out in the contract, including any agreed increases, should be charged by the registered provider to the resident.
While the Minister of State may say that it is the nursing homes that must pay the fees, the fact is that many nursing homes are passing on that fee to the residents. One hundred and ninety euro per place is quite a lot of money to an elderly person who has very little left in his or her pension to pay for other extras like chiropody, physiotherapy and other things that may not be covered under the fair deal. What will the Government do to make those nursing homes not charge that money to their patients? The Minister of State has just said that under the 2007 Act, only what is contracted for is meant to be charged. I presume this would not have been in the contract when the nursing home residents came in. Can the Minister of State clarify that she will tell the nursing home owners not to charge the residents?
We have already done that. It is understood that Nursing Home Ireland advised their members that the fee should be passed on to residents. This disregarded the obvious intention that the fees should be considered in the context of the National Treatment Purchase Fund negotiations. The Department wrote to Nursing Homes Ireland in August and October 2009 to advise that as private enterprises, it is a matter for each individual private nursing home to determine the rate charged for services, and that the price set by each nursing home is not determined by the Minister, the Department or by HIQA.
When these new fees were introduced, the Minister anticipated that they would naturally be subject to periodic renegotiations to take account of inflation, deflation and other developments. The Department stressed that this should in no way be taken as an imprimatur for individual nursing homes to invoice their residents with an additional charge on the introduction of the new fees.
How is the Minister of State going to protect old people from this?
I would like to raise a point of order before I comment on the Minister of State's response. A few moments ago, the Minister corrected me when I said that 21,000 people had given up their health insurance, by stating that the figure was 12,000. I would like her to correct the record. I have in front of me Question No. 248 on 20 October 2009, which was addressed to the Minister for Health and Children by Deputy Richard Bruton, and the response given by the Minister. The figure for those on health insurance for December 2008 is 2,299,000, while the figure for June 2009 is 2,278,000. The difference is 21,000 people and I found it in an answer from the Minister's Department.
That is not a point of order.
I apologise. Whatever technicality it should come under, the Minister should correct the record and I presume she will do that.
My brief contains the HIA statistics. If there is any need to correct the record, I will certainly do that.
Very good. I will allow Deputy Reilly a brief supplementary on the question.
The Minister of State has raised a very interesting point. It is incumbent on any business to make sure that it can meet its costs. This is an additional cost to business. I do not think it will surprise anybody in the Chamber that this will have to be factored into what is charged for the service. When the NTPF was negotiating its fees with nursing homes, was this fee factored in by both sides?
It is very difficult to accept what the Minister of State is saying about the Department's attitude to the passing on of this nursing home inspection fee of €190 when the Minister for Health and Children stated last March at a press conference that "€3.73 per week, it is an appropriate fee that is necessary to ensure that standards are enforced... clearly it will be passed on, I accept that". Those were the Minister's own words only six months ago at a press conference here. How does that sit with HIQA's statement that the practice contravenes official regulations? Where is the truth in all of this?
The misinterpretation of what the Minister said was taken out of context by the private sector. Nursing Home Ireland was advised that these fees could not be passed onto the residents, and that they were to be taken into consideration by the NTPF when negotiating their fees.
If the Minister was misinterpreted, will she——
I call the House to order.
Written Answers follow Adjournment Debate
