Vol. 702 No. 1
1 Deputy James Reilly asked the Minister for Health and Children the action she will take to tackle the number of patients waiting on trolleys in accident and emergency, which was recorded by a union (details supplied) at a high of 500 during January 2010; and if she will make a statement on the matter. [7227/10]
A number of emergency departments have been recording high numbers of patients waiting to be admitted to hospital in recent weeks. However, detailed sampling from 24 hospitals, which began in February last year, to the end of December indicate that 87% of all patients attending an emergency department were either discharged or admitted within the maximum target of six hours, and 94% of all patients who did not require an admission were discharged within this time.
I do not believe that the "trolley count" figures for patients awaiting admission are an adequate indicator of performance in emergency departments as they only record the waiting time from when a decision has been taken to admit. From the end of March, the HSE will record waiting time from when a patient arrives in the emergency department. This will be a far more meaningful record of patients' experience in emergency departments.
I have been monitoring the situation in emergency departments very closely. I met with the chairperson, CEO and members of the HSE management team recently to review progress and to ensure that all possible steps are being taken to minimise the waiting time for patients awaiting admission. I asked the HSE to streamline the administrative processes for dealing with applications under the fair deal so that the discharge of patients to a suitable long-stay facility is not delayed unnecessarily.
The HSE has put several actions in train including escalation plans to enable patients to be moved to wards, additional ward rounds to take place daily to help earlier discharges from hospitals and ensuring access to additional diagnostic facilities such as imaging to allow earlier decisions about admission or discharge. At my request, the HSE is also putting in place a system of early warning measures so that corrective action is taken as soon as problems in a particular hospital are identified. Hospitals have also been instructed to ensure that all escalation measures are implemented and reviewed as necessary and that appropriate liaison arrangements with primary and community services are in place.
I thank the Minister for her response. I welcome the fact that, not before time, the waiting time will be counted from the time the patient attends the accident and emergency department. To be frank, it is nonsensical to have any other system.
The reality is that during January the figure reached 500 people on trolleys. It is a number of years since the Minister declared that this would be treated as a national emergency. It is not a blip. Last week, the Minister said on "The Pat Kenny Show" that it was a blip and that there will always be people on trolleys in every health care system and every hospital in the world. I have to disagree. I stood in a busy hospital in Holland where there were no patients in the corridors and no patients on trolleys in accident and emergency. Patients were seen within ten minutes of coming into the hospital, and admitted and discharged within a couple of hours. That is what we should have and there is no reason that we should not have it.
This is reality for people. I have an e-mail from a constituent——
A question, please.
I will ask a question. I want to ask about this constituent, whose father is aged 85 and lay on a trolley from Sunday night until last night. He has now been moved to a bed but he is still in an annex to accident and emergency in Beaumont Hospital.
The recent contention of Professor Brendan Drumm that 30% of patients, because they are only in hospital for 48 hours, do not really need to be there is utter rubbish. I have spoken to my colleagues about this. There is not a single patient admitted into Beaumont, the Mater, the James Connolly or any of the other hospitals who does not need to be admitted.
Does the Minister accept she has failed to solve the accident and emergency crisis, that the plans she has put in place have been a dismal failure and that a new approach is required?
First, I do not accept that everybody who is admitted to a hospital should be there. We know from the bed utilisation study that a large percentage of patients should not have been in hospital in the first place. As Professor Drumm said at the committee the other day, many people are admitted in order to get access to diagnostics. Not only is that an issue for the public health system, it is also an issue for insurers. I am engaging with private insurers to make sure we do not support bad practice, which is that we financially support inpatient activity when it is not necessary.
We know a large percentage of patients who enter from accident and emergency are admitted when senior decision makers may not be available to deal with their issue. I spoke to a consultant friend recently who told me that when he was working in accident and emergency one weekend, he was able to discharge a large number of patients who were down for admission and refer them to his clinic the following week. That is an issue. The new consultant contract, with clinical directors and the huge new powers we have given, including nurse prescribing, will lead to a more immediate response.
Second, I am not aware of any hospital in the world, and I have visited some of the best, where there are not trolleys in accident and emergency.
The Minister should visit Holland.
I had an experience in an accident and emergency department in County Waterford a number of years ago, where I was on a trolley while tests were done. I am not aware of a hospital anywhere in the world where trolleys are not used if the staff are doing blood tests or other tests.
The issue is how long people are waiting before they are either discharged or admitted. A number of years ago, we did not measure that. The issue is not whether it is 200, 300 or 500 patients; it is how long any individual patient is waiting. Last year, only 40% of patients who were being admitted were admitted within the six hours. This has now increased to 52%. I accept there are still 48% who are not admitted in that six-hour period, which is unsatisfactory. However, we never measured against a six-hour target until recently and, from the end of March of this year, hospitals will have to measure from the time patients arrive.
If somebody was waiting six days, I would like to get the details of the individual case. That is totally unsatisfactory. If the Deputy would give me the details, I would like to pursue the matter.
I did not refer to six days today but I will get the Minister the information, which relates to another person.
I thought the Deputy referred to six days. Perhaps it was three days.
We all get disorientated in here. It happens to the best of us. With regard to the Minister's semantics about somebody lying on a trolley, we all know what we mean by trolleys in accident and emergency and the length of time people have to wait. There is no question about that. What the Minister describes is something that will happen into the future. The reality is that people are lying on trolleys now, and they were there yesterday, the day before, last week and last year because they do not have access to the diagnostics to which the Minister referred because they are not being provided. There is no point talking about utopia and how things will change until those measures are put in place.
Professor Drumm and the Minister gave a great performance at the committee earlier in the week about all the things that will be done. Until they are done and until we see the primary care rolled out, we have a real problem. The bottom line remains that the Minister must accept responsibility. For the past three years, despite announcing her plan, despite the money that was spent on it and despite saying this would be treated as a national emergency, it has not happened. After three years, the public do not believe it will happen under the Minster's jurisdiction.
I have a lovely graph which I will send across to the Deputy. I do not want to hold it up in the Chamber and be accused of using a banner. The graph shows performance in 2005 as against now. By any yardstick, there have been considerable improvements. While I am by no means saying the situation is ideal, there have been steady improvements.
I genuinely believe the clinical directorate model which is now in place is making a huge difference. I also strongly support the escalation policies. I have been reading material from other countries, even since the committee meeting earlier in the week, which confirms what the chief medical officer said. The fact is that when there is an issue in an emergency department, it is not just an issue for the emergency department but for the entire hospital. The entire hospital must deal with it seriously, as happens in many hospitals throughout the country — Waterford hospital has a very good track record in this regard, as does Kilkenny hospital and many other hospitals.
There are hospitals, particularly in the greater Dublin area, that currently have issues around late discharges, and the introduction of the new scheme has caused initial delays because it is very new and must be signed off on legally and in some cases by the courts. However, when those 7,000 applications are processed, this will have a huge impact on late discharges.
2 Deputy Jan O’Sullivan asked the Minister for Health and Children her plans to ensure that the cut in the operational budget of the Health Service Executive for 2010 does not result in overcrowded accident and emergency departments, longer waiting times for operations, diagnostic procedures, reduction in essential community supports and other negative outcomes for patients; and if she will make a statement on the matter. [7126/10]
4 Deputy James Reilly asked the Minister for Health and Children her views on whether reducing in-patient procedures by between 46,000 and 54,000 in 2010 means that patients will have to wait longer for essential diagnostics and treatment and will result in increased pressure on accident and emergency departments; and if she will make a statement on the matter. [6905/10]
I propose to take Questions Nos. 2 and 4 together.
The HSE National Service Plan 2010, which I approved on 5 February, commits the HSE to delivering activity levels for 2010 which are broadly in line with 2009 levels. The plan was laid before both Houses of the Oireachtas on 8 February and has been published on the HSE's website. During 2010, the HSE will provide me with monthly performance reports on all aspects of progression of the plan.
As part of the Estimates process, the Government made a series of decisions that will reduce HSE costs by approximately €1 billion in 2010, comprising savings of €630 million on pay and almost €400 million in non-pay. However, it also made available additional resources to assist the HSE in responding to priority demographic and other needs and to support ongoing reform of the public health services.
Planned activity levels for primary community and continuing care services in 2010 are in line with 2009, with some growth in activity proposed in areas such as fair deal, home care packages and medical cards schemes.
In respect of acute hospital services, the plan targets a reduction of 54,000 in-patient cases through a combination of reducing emergency admissions by more than 33,000 and providing access to diagnostics on a non-inpatient basis to at least 10,000 patients who would otherwise be admitted only for that purpose. It also targets a further increase in day case activity to 689,000 which is in line with the trend during the last decade whereby the number of day cases carried out in the public hospital system increased from 273,000 in 2000 to an estimated 679,000 in 2009.
The national service plan commits the HSE to specific and demanding targets for improvement in average length of stay, the proportion of a specified basket of procedures to be undertaken on a day surgery basis and day of surgery admission. These targets have been informed by international evidence and data indicating that within the Irish health service there is an appreciable variation in performance as between different hospitals for similar procedures. The Executive will therefore focus on reducing this variance in performance as well as on protecting in-patient beds for elective surgery in order to reduce waiting times.
I recognise that meeting these targets will require co-ordinated and sustained effort, involving clinicians, management and other professional and support staff. However, the changes required are driven not only by efficiency considerations but by evidence that they deliver other benefits in terms of patient safety, a more user-friendly service delivery and better patient outcomes. Achievement of the performance targets in relation to emergency admissions will require increased access to the specialist skills and senior clinical decision-making available in medical assessment units, to diagnostics and to other ambulatory care services. Accordingly, under the national service plan the acute sector will continue to manage emergency admissions while at the same time achieving elective activity targets.
By reforming the manner in which services are provided, I am confident the HSE will deliver the volumes of service provided for in the plan, while at the same time continuing to improve service quality and patient outcomes.
It is a scandal that almost half the number of patients admitted to hospital through the accident and emergency department are not admitted within six hours. What changes or improvements in this regard will take place in the coming year? Will the Minister confirm that 1,100 acute hospital beds are to be closed this year owing to the cuts proposed in the service plan? If that is the case, how is the Health Service Executive to reach its targets in terms of reducing the number of people on trolleys in accident and emergency departments and in regard to reducing the waiting times for people to be admitted to hospital? How can the Minister square that circle? It seems to me to be impossible.
The cuts are right across the board. How are more people to be treated in the community if the community is also suffering cuts and the effects of the moratorium? The Minister stated she will address the fact that the fair deal scheme is causing people to remain in hospital unnecessarily. That people cannot leave hospital owing to the situation in regard to medical assessments is a serious problem. The Minister spoke about this issue in a general way. What specifically does she intend to do in regard to the conditions of the fair deal scheme, in particular the financial assessments which are the core of the problem? For example, will people be permitted to leave hospital before their assessment has been completed? What specific measures does the Minister have in mind?
A later reply to a question dealing with the industrial relations environment may deal with some of the issues raised by the Deputy. As regards the Deputy's request to brief her party on the fair deal scheme, I am happy to do so. I would be happy to provide same for the Fine Gael party.
On fair deal, a completely new legal system has been introduced. In many cases we are dealing with people of diminished ability and issues in respect of family residence require court approval and so on. There is a time lag in respect of the backlog. The majority of the 7,000 applications to which I referred are in respect of people already in care or in the acute hospital system. A backlog was inevitable given the new scheme came into operation only in November. We all anticipated such a backlog. I am satisfied that when those decisions are made, many of which will not require court approval and some of which have been already approved, people will be able to move rapidly to appropriate care. Many of the people who have made applications are people already in care and who are opting for this system as opposed to the subvention system. Others may not have received any support.
On the closure of beds, the plan contains no proposal to close X or Y number of beds. The plan is to move from in-patient to day care. Best practise is that 80% of surgery should be done on a day case basis. We have quite a bit to go to reach that target. We must also reach the target in respect of same day admission, even where overnight is required. Among the initiatives currently underway with the appointment of Dr. Barry White as clinical director is the ringfencing of beds for surgical or elective activity, having new care pathways led by specialist clinicians around the country so that there is less emphasis on people having to go into hospital, in particular for those with chronic illnesses such as diabetes, respiratory and other conditions, and a greater emphasis on providing that service on a non-hospital basis.
The plan is seeking a reduction of 33,313 emergency admissions and a reduction of 54,000 in-patient procedures, all of which is to be compensated by a small increase of 10,569. The arithmetic does not work out.
When one compares the figures for planned in-patient surgery for January 2010 in respect of people waiting in pain to have gallstones removed, to have hernias repaired or for knee or hip replacements with the figures for 2007, 2008 or 2009, the reduction has been huge. I spoke today with a Dublin surgeon who told me all surgeons are experiencing a reduction from eight to one cases per day owing to the unavailability of beds. This plan will further reduce the number of beds available.
While the Minister did not mention a figure, the one being bandied about in terms of bed closures this year is 1,100. There is no question but that this will impact negatively on patients. The Minister must know how many beds are to be closed. I am sure she can confirm whether the correct number is 1,100, which is the figure being bandied about. When will the Minister focus on sorting out hospital inefficiencies rather than on cutting services and closing beds?
The Deputy will be aware that the manner in which hospitals and clinicians are now assessed is across performance indicators. The key performance indicators are available on a monthly basis and make for very interesting reading. There is a huge variation, even in emergency departments, between the number of patients seen per medic or nurse in one part of the country as compared with another and between hospitals. There is also a variation in costs, which I accept is in some instances related to the acuity of what is being dealt with. One must compare like with like. If one compares ratios of patients to doctors or nurses, there is a huge variation across the country. Now that we have performance indicators we are able to access this information. What one does not measure one cannot manage. We did not have these indicators before nor did we have appropriate waiting times in emergency departments.
Three years ago we were only measuring people waiting 24 hours for treatment. We recently commenced measuring those waiting 12 hours for treatment and more recently six hours. From the end of March all hospitals will be required to measure not alone patients waiting six hours for treatment but the length of time of treatment from when they arrive at the door which, rather than the time the decision is made by the clinician to admit the person, is the issue. All of these steps are being taken with a view to improving and driving efficiency.
On beds, we often become obsessed with numbers.
The Minister would too if she were left waiting on a trolley for hours.
Yes. What is important is that the patient is treated. If it is appropriate for treatment to be provided on a non-hospital basis in a primary care setting, day case basis, same day surgery and so on, that is where it should be given. The issue for surgeons, which is being addressed by Dr. White, is the ringfencing of beds. Many surgeons say that they do bring in their patients in advance to ensure they have a bed. That has been part of the problem, but it is being addressed at the moment. Those clinical leads will be in place on a interim basis in March and will be appointed on a permanent basis later.
In the context of the 48% who are not admitted within six hours, it may well be, as the Minister said, that there are people on trolleys in accident and emergency departments around the world. However there is a big difference between being on a trolley in a cubicle in an accident and emergency unit, and being on a trolley out in a public space in the way of nurses who are trying to do their work. There is, for example, no privacy if an elderly man or woman has to use a bed-pan. Let us look at the situation honestly. If one is in a crowded accident and emergency unit with nowhere to go for six hours or more, surely that is very different from the rosy picture the Minister paints of people waiting on trolleys in accident and emergency units around the world. They may do so and it is fine if they are in a cubicle. There are a certain number of cubicles in our accident and emergency departments, but we are concerned about those who are out in public spaces literally blocking corridors. I wish the Minister would realise the seriousness of this problem for people who have to endure it.
I do not want to get into semantics with the Minister but I hope we are measuring the number of people in accident and emergency, rather than measuring people. The bottom line is that there have been serious delays in surgeries and people are being left in pain needlessly. Another issue is now arising. Given the Department's focus on breast cancer, people who are being screened for suspected cancer are being brought in a bumped up the list ahead of men and women who have proven bowel, bone or lung cancer. This is having a deleterious effect on people with cancer. They require operations, yet they are being bumped down the list to ensure the figures stack up, so I am told, for the breast cancer scheme. There is a lot of shifting around here, so I would like the Minister to address that issue.
There is no doubt that hospitals are unable to cope, and this is particularly so in those serving north Dublin, including Beaumont, the Mater, James Connolly and Drogheda. Some 61 people were on trolleys the other day in Beaumont Hospital. People are waiting 72 hours for treatment and this is not anecdotal, it is happening daily. People are contacting me by e-mail and telephone to ask what the Minister is going to do about this.
The Minister could simply put out to tender services for physiotherapy, speech, language and occupational therapy, which are associated with existing nursing beds in the community, thus moving people out of hospitals. If they are not moved soon after their acute phase of treatment, they do not get rehab and are left there for four or five months, the opportunity is missed and thus they will end up in long-term care and will never get home. Will the Minister consider that?
Yes. We are providing additional beds. I am in dispute with some of the Deputies from Kerry because we are providing more rehab beds as opposed to long-stay facilities, such as those in Tralee. That is because that is the requirement and that is what is advised.
I am concerned with Dublin where the problem is acute.
I am concerned with patients everywhere. As regards the issue of treating patients in hospital, many people end up in accident and emergency departments who do not require such treatment. When the Deputy and I were growing up in this city, an emergency department was for a genuine emergency. Unfortunately, because of some of the issues he has raised, people have ended up in accident and emergency departments as a route to access acute hospital services or because they need diagnostics.
Very few.
In some cases it was the only way of accessing those diagnostics. I accept what Deputy Jan O'Sullivan says about having people in unsuitable facilities, particularly in some of the older accident and emergency units that have poor facilities. That is why we strongly support the escalation policies, as the accident and emergency consultants do. I have been reading about great hospitals all over the world, including Stony Brook Hospital in New York which is regarded as one of the best hospitals there. It has a full capacity protocol policy and that is exactly what they do when they have an issue in their accident and emergency department. I saw it for myself in Vancouver when I was there. That is the policy we want to implement here, although there is resistance to it, particularly in the Deputy's own area. That is the kind of approach that has delivered success elsewhere, rather than having large numbers of people in accident and emergency.
Does the Minister mean to move people into crowded wards instead of a crowded accident and emergency?
I want to give the Deputy the evidence, which she should examine. I know she is a person who genuinely looks at the facts.
I have been in Vancouver General Hospital and it is a hell of a lot more spacious than Limerick Regional.
The accident and emergency consultants themselves support it and I know this is on the agenda of the accident and emergency forum. We thought we were close to agreement there, but there are still outstanding issues. The Deputy's own accident and emergency consultant, Dr. O'Donnell in Limerick, who is regarded as one of the best — he is a terrific doctor with great leadership skills — has been a strong advocate of this policy for quite some time. He said this is better and safer care, and I accept that.
It is not safe care though. That is the point.
Yes, it is better and safer.
There is not enough space in the wards.
3 Deputy James Reilly asked the Minister for Health and Children if the work to rule by staff and the refusal by unions to cooperate in certain work practices and to cooperate in the transfer of staff has resulted in an impairment of patient care or services; if she will give assurances that no diminution of services to patients will occur as a result of the work to rule; the measures she has taken to avoid an impairment of patient services; and if she will make a statement on the matter. [7228/10]
The industrial action which is under way across the public service has the potential to cause serious disruption in the health sector depending on its scope and scale. My main concern is to ensure that the effect of the dispute on patient care is minimised as much as possible and, so far, this has been achieved.
The HSE and my Department are monitoring the evolving situation daily in close co-operation with the Department of Finance, which has responsibility for the public service. Where issues that could impact on patient care have arisen, it has so far been possible to resolve the situation at local level. I want to acknowledge the responsible approach which has been taken to date in this regard by the relevant health service unions.
There is no doubt that, following a period of rapid increase in funding, the health services are now facing the challenge of managing with much tighter financial resources. There is scope within the health system, by reforming the way services are delivered, to achieve more through greater efficiency and concentrating on services that contribute most to people's health and well-being. There is an onus on all concerned — Government, management, trade unions and employees — to find a way of engaging on the reforms which are needed to deliver better services to patients.
I know the HSE has expressed serious concern about the impact of this industrial action. According to reports, staff are not checking patients' daily treatment appointments. In addition they are not answering phones or agreeing to the redeployment of staff and the change in working hours currently in place, and are not providing weekend on-call arrangements. This is having an extremely negative effect on patients. It is particularly difficult and stressful for those who are terminally ill. They may wish to attend a hospice and have the additional stress of not being able to get anyone to answer a phone for an appointment. They are consequently unsure wherever or not they can obtain such an appointment. The problem also extends to the wider area of making repeat appointments because may wish to check appointment details but cannot get through by phone. We will not digress into the argument about the centralisation of medical cards but it is similar. If people cannot get through they become frustrated, worried and concerned. What action is the Minister taking to guarantee the House that there will be no diminution of services and that this action can be addressed? What action is she taking to prevent the situation from escalating? I believe it is due to escalate from 1 March.
I acknowledge that where issues arose that may have directly affected patient care, responsible action was taken by unions at local level. For example, there was an issue concerning radiotherapy in Cork and I acknowledge that was resolved without patients being affected. I salute that. Clearly, however, everyone who works in the health service has an impact on patient services, including clerical staff who make appointments, process applications and respond to queries. I would like to think that the current difficulties in the industrial relations environment could come to an end quickly. They are not exclusive to the health area, they are across the public service. I understand how public servants feel about the reduction in their income because of the financial situation we find ourselves in.
Before the budget we had exciting discussions with the health unions concerning reforms in the health area, including longer working days, redeployment and flexibility. They were all the things we need to provide a better service to patients within the resources we can make available. As we move the more acute services from one hospital to another, we must be able to redeploy staff, otherwise it will not work as effectively as we anticipate. I cannot tell the Deputy when the current difficulties will pass but it is the Government's wish, as the Taoiseach said earlier this week, to engage with the public sector unions as quickly as possible on the reform agenda so that no further reductions in pay might be necessary in 2011 and 2012.
I thank the Minister for her reply but pay is not the issue, patient care is. I hope the Minister will be able to use her good offices to engage with the unions and ensure that patient care is not compromised. She should not allow the situation to escalate as is clearly planned in March. I hope she will be able to give us some indication of what her plans are to deal with that. Some plans must be put in place to deal with any escalation, although we have not heard what they are.
I accept the Deputy's positive comments in his response to that matter. While the Deputy may say pay is not the issue, at the heart of the dispute is the reduction in public sector pay. I would hope that we can return to the reform agenda with the public sector unions. We have had very responsible engagement with them in the past and I have no doubt that the people who work in the health service are well motivated by patient concerns, want to do the best for their patients and would want to see the kinds of reforms I mentioned earlier implemented as soon as possible. If we can return to dialogue — hopefully that can happen soon — I hope we would be in a position to have that positive agenda agreed.
Is there a provisional plan?
In fairness with regard to a plan, it is not possible to have a big strategy and decide this is how we will do it. We need to deal with the individuals at a local level in the main.
Is there any strategy?
We are doing that. There is a plan. It is reviewed every day. The Department of Finance is the co-ordinating Department. In the health area not a day goes by without the official in my Department who is dedicated to the matter being involved with the HSE at a central and local level regarding the different issues that arise.
Question No. 4 answered with Question No. 2.
5 Deputy Alan Shatter asked the Minister for Health and Children the action she will take to ensure the Health Service Executive engages in discussions with an organisation (details supplied) to provide the estimated €1,970,000 per annum additional financing required to enable the expansion of its home care services for severely disabled children to children under the age of six years; her views on the fact that such an extension of services offers significant cost reductions to the State and also the uniform delivery of better services for severely disabled children and their parents; her further views on the conclusions of the report entitled, There’s No Place Like Home — A Cost and Outcomes Analysis of Alternative Models of Care for Young Children with Severe Disabilities in Ireland, published on 3 February 2010. [7125/10]
The HSE provided funding of €585,000 to the Jack and Jill Children's Foundation in 2009 and will be happy to consider the report "There's no Place like Home" as part of its engagement with the foundation this year. Neither my Department nor the HSE was involved in the preparation of this report. I agree that, in general, children's needs are most appropriately met and provided in the home, and that we need to ensure more efficient use of resources. However, many children availing of services provided by the Jack and Jill Children's Foundation also avail of other disability services and the report did not compare the respective costs of the home-based care provided by the foundation to the cost of similar services provided by the HSE.
The current economic and budgetary position means we can only continue to fund new services by reducing costs and greater efficiency, including achieving greater integration of services provided by the statutory and non-statutory sectors. I should mention in this context that my Department is undertaking a review of the efficiency and effectiveness of the health and personal services provided to people with disabilities. This review is part of the Government's value for money and policy review programme. The review will focus, in particular, on the scope for achieving greater efficiency and effectiveness from the substantial resources expended on services for people with disabilities and will support the future planning and development of such services. I can assure the Deputy that the issues raised in the Jack and Jill Children's Foundation report will be considered as part of that review.
Will the Minister of State acknowledge that it was not possible for the report to consider any home-care services provided by the HSE and the costing of those services with the Jack and Jill Children's Foundation services because the information is simply not available? There is a lack of uniformity across the country in the services available for severely intellectually disabled children. Would the Minister of State agree that the Jack and Jill Children's Foundation catering for 1,200 families with severe intellectual disability since 1997 has done extraordinary work? Would he accept that in the context of the provision of care for such children the annual average cost to deliver acute hospital care for a severely disabled child is €147,365 compared to the average cost of €16,427 per annum for the child to have home care by the Jack and Jill Children's Foundation?
Would the Minister of State acknowledge that it is desirable that the services provided by Jack and Jill Children's Foundation be extended to children between the ages of four and six as many of the State and HSE-provided services do not kick in until a child is six? It would require an additional grant of €1,970,000 per annum to the Jack and Jill Children's Foundation to ensure that a universal service is available to all families with a severely disabled child so that the child could be provided with home care uniformly across the country. Would the Minister of State not merely encourage, but specifically ask the person in charge of these services in the HSE — it is not always clear who that is — to sit down with representatives of the Jack and Jill Children's Foundation to work out how to most efficiently and cost-effectively provide the essential services needed for all children under six with severe intellectual disability?
The Deputy has asked a number of questions. There is no dispute over the figure of €143,000 as compared to the cost of care provided by the Jack and Jill Children's Foundation. I acknowledge the value of care provided by the Jack and Jill Children's Foundation. I dispute the Deputy's contention about availability of comparative information. That information is available.
Naturally, when we consider the €1.6 billion that is now provided to support people with disabilities, that is the main frame for the review. I do not want to use the review in the context of a money saving exercise — it is far from that. It is an attempt to ensure that the €1.6 billion that is being provided provides the maximum level of care. The review is not all about value for money or savings. It is also about policy. It is very important in the context of what the Deputy just said and in particular by the way of the services being provided by the Jack and Jill Children's Foundation that we also look at the proposal by way of direct payment to families and clearly this is part of the policy review.
I must accept the point the Deputy makes that in comparison to the cost to the State of the care provided by the Jack and Jill Children's Foundation, the jury is certainly in on that one — the value is far greater. The review proposals are not long term — they will be with the Department by June. In the meantime, I intend, with the departmental officials, to meet not just representatives of the Jack and Jill Children's Foundation, but also many other providers to ensure they are involved in the review.
I very much welcome that the Minister of State will meet representatives of the Jack and Jill Children's Foundation. That would be a major step forward. I understand that while the Jack and Jill Children's Foundation on occasions works in co-operation with different sections in the HSE, its representatives have found it impossible to identify a person in charge who will sit down and talk to them about the national service it provides. I ask the Minister of State to communicate with me as to who they should contact in that regard and to encourage the HSE to engage in such discussions.
Does the Minister of State have the figure for the cost being incurred on an annualised basis by the HSE service to assist the parents of severely intellectually disabled children who are providing home care to them? I ask him to make the comparator public. What is needed is a coherent uniform service delivered by the most cost effective and well staffed service provider. The Jack and Jill Children's Foundation has an extraordinary imprimatur from all families to whom it provides assistance. I ask the Minister of State to consider a policy direction to the HSE to provide this service through the Jack and Jill Children’s Foundation and to extend it to children aged between four and six.
I take precisely the advice the Deputy is giving. I have already initiated those policy decisions under a number of headings. I have no difficulty meeting the HSE and providing publicly the comparator figures. I insisted that two people from the disability sector — one from the intellectual disability sector and one from the physical disability sector — should be on the review committee examining the funding for disabilities to ensure that everything the Deputy is saying would be put in place.
I agree with the Deputy that probably owing to the changeover from the old health board system to the HSE there has been certain confusion as to who is the lead in disabilities in each area. I do not use the review in the context of a long-fingered approach. I am talking about having the review completed and report published by mid-June. That part will bring total clarity to those in charge in each specific local health area.
That concludes Priority Questions.
Even the Minister of State does not know who is in charge.
I do not want to reduce it to that level of common——
Go raibh maith agat, a Aire Stáit.
Let me just say——
Go raibh maith agat, a Aire Stáit.
