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Dáil Éireann debate -
Wednesday, 12 May 2010

Vol. 708 No. 4

Adjournment Debate

Medical Cards

I would like to share time with Deputy Clune.

I wish to raise the issue of the cuts to the dental treatment services scheme. As Deputies are aware, the scheme is designed to provide basic dental treatment to medical card holders. While I appreciate the need for budgetary cuts to ensure we get the public finances on the right path, this cut could have been managed far better. When the Minister for Finance made his Budget Statement on 9 December 2009, the HSE knew that the 2010 budget for this scheme would be €63 million. However, it decided to wait until 26 April last to issue a directive to dentists on how the scheme might come in under budget for 2010. Four months of the year had passed by the time any corrective action was taken. The depth of the cuts was far more severe and harsh than would have been required if corrective action had been taken in December, when the budget for the year was made known.

It seems from my cursory knowledge of the dental profession that the circular issued on 26 April is unworkable and impractical. As a result of the circular, a person with a medical card is no longer entitled to a basic cleaning from his or her local dentist. That is unacceptable. I will read an excerpt from an e-mail I have received from a dentist I know well:

I am embarrassed when I have to deal with my Medical Card patients because of this HSE directive. I looked after one of my patients today when he presented in pain. I was able to relieve the pain by the removal of two infected teeth. He has had 5 operations on his throat over the last 3 years for cancer treatment and the remaining teeth are in a poor state. Before the HSE directive arrived, I would have filled 4 of his remaining 7 teeth to preserve them and his dignity and prevent further pain. Now I must wait under the new terms as these teeth are not causing pain, until he presents in pain, so that I can remove the offending infected and painful tooth. This will be a gradual and painful exercise that as a caring health care professional I will not tolerate. This is unethical, unprofessional and unfair. This patient has no teeth from the lower jaw that meet with the teeth in the upper jaw, that is, he has no teeth to bite with. Up until a few days ago, I would have gladly made him a set of dentures to improve his ability to chew, speak and give him some dignity in his appearance. Now I am unable to, unless he qualifies under ‘'approved emergency circumstances'' [as set out in the HSE circular] and I have no idea how and what the qualification for this is.

That sums up very well the difficulty this directive is presenting to dentists in the profession. This is a savage cut. Sufficient funding should be made available to allow basic dental care to be provided to medial card holders. I call on the Minister to ensure that can be achieved.

I am grateful for the opportunity to raise this issue, which has come about following a circular from the HSE dated 26 December 2009. As Deputy McGrath pointed out, the budget provided that expenditure on the scheme this year would be €63 million. There was no consultation with the dental profession. There are four principal dental surgeons in the State and they attempted to engage with the Department and the HSE on the changes they wanted to see implemented but their suggestions were ignored.

There is a total of 1,352 dentists in the State and a large proportion of their patients hold medical cards. They are now not entitled to basic routine dental treatments such as scale and polish, cleaning, fillings and extractions. The new guidelines have been described as "unethical, impossible to operate and a retrograde step in dental care for medical card patients". We have reached the stage where removal of teeth will be the only option available to many dentists. Restorative and preventative treatments had advanced to ensure better quality oral care and oral hygiene for patients. Their general health will be affected by these changes. Will the Minister review the scheme and how it will be implemented? In its new guise, it will not serve patients and it will store up a great deal of trouble down the road. It needs to be addressed and examined to ensure the dental health of patients is protected.

I thank the Deputies for raising this matter. I also met a dentist yesterday who gave me a similar briefing to them. Clearly the impact of the changes on medical card holders may result in more cost to the State than what may be saved initially. I intend to engage with the HSE over the next few days to establish what other proposals could be made to ensure people will not be victims of this serious cutback. I will try to respond to the Deputies as quickly as I can.

I am happy to have the opportunity to address the issue of the changes to the dental treatment services scheme, DTSS. The scheme was set up in 1994 and its financial aspects are administered by the primary care reimbursement service on behalf of the HSE. It is monitored at a local level by HSE principal dental surgeons. The two objectives of the DTSS are to improve the oral health of adult medical card holders and to provide dental services to adult medical card holders in a cost-effective and equitable manner. The scheme has provided a range of basic dental treatments to adults who are medical card holders. These have included routine examinations, fillings, extractions as well as amputation of roots and the provision of dentures. The service is offered by approximately 1,400 dentists nationwide who hold contracts with the HSE. The dental treatment is free to the patients and dentists working in the DTSS are reimbursed on a fee per item basis.

Expenditure on the scheme was approximately €85 million in 2009, which was a substantial increase on the 2008 figure of €63.4 million. In addition, over the past five years expenditure on the DTSS increased by approximately 60%. In view of this increased expenditure and the current position of the public finances, the Government decided in the context of the budget last December that it was necessary to reduce expenditure on the scheme. The decision was taken to limit 2010 expenditure to the 2008 level of approximately €63 million. This reduction in funding reflects the imperative to achieve overall reductions in public expenditure, while providing essential health services to patients and the public. Having carefully considered the issue, and after obtaining clinical and other advice on the issue, the HSE advised DTSS contracted dentists that the new measures would be introduced from 28 April last. These changes to the scheme will allow the HSE to contain DTSS expenditure at the 2008 level. I have taken on board the points made by both Deputies and I will make them aware of the outcome of talks with the HSE within the next two weeks.

Accident and Emergency Services

I thank the Ceann Comhairle for permission to raise this important matter. I hope the Minister of State has good news because the Government has spent more than €11.5 million on a state-of-the-art accident and emergency unit in Our Lady of Lourdes Hospital, Drogheda, which has lain idle since the end of last year. It is, therefore, in its fifth month without use. In the meantime, every week dozens of patients lie on trolleys in the hospital. Patients, staff and the good name of the hospital are suffering as a result. The hospital has received bad publicity in the past but the medical staff want this facility to work. The people need the unit, which should have been built five years ago. It is well behind schedule and we want to look forward to its opening.

A total of 34 additional staff are needed for the new unit but I understand this is an issue. The taxpayer has made a commitment to a state-of-the-art facility in the north east and it is imperative that the Government recruits the necessary staff. The HSE has not made a decision to prevent the unit opening. It is prepared to hire the staff but the issue is whether the Minister will give consent in order that specialist nursing and care staff can be appointed.

This week the Drogheda Independent described the appalling conditions in which people must work and in which patients must stay. A 91-year old lady suffering from Alzheimer’s disease spent more than 28 hours on a trolley while a 70-year old woman spent more than 32 hours on a trolley in recent months. It is not good enough. When will the unit open? Why has consent not been given to recruit staff? The people of the north east need this facility. The Government has closed services in Dundalk and Monaghan, which people have not accepted, and there is significant pressure on the Our Lady of Lourdes Hospital, which is chock-a-block day and night. Sick people need the new unit and medical staff, who have waited patiently for many years for this facility are becoming increasingly angry that they have to look at a ghost department. State-of-the-art beds and equipment are covered in plastic and cannot be used. Doctors and nurses with tremendous skills need this equipment and they need to provide a service to save lives. Patient care is suffering as a result. I hope the Minister of State has good news.

I apologise on behalf of my colleague, the Minister for Health and Children, who could not be present. I thank the Deputy for raising this matter.

The transformation programme for the north east involves widespread and fundamental change. It is designed to build a health system that is in line with the model of care emerging internationally. This can be achieved by centralising acute and complex care in order that clinical skill levels are safeguarded by ensuring access to a sufficient throughput of cases. The need to reconfigure health services in the north east was highlighted, along with identified patient safety and quality of care issues, in the 2006 teamwork report to the HSE: Improving Safety and Achieving Better Standards — An Action Plan for Health Services in theNorth East. This report demonstrated that the service configuration in the region was unsustainable.

This report demonstrated that the service configuration in the region was unsustainable.

The first step in transforming services in the north east is to develop a fully integrated regional health service to ensure that people in the north east have local access to both routine planned care and immediate life saving emergency care. The HSE began this process with the transfer of acute inpatient services from Monaghan Hospital to Cavan General Hospital on 22 July 2009, which was supported by the opening of the medical assessment unit, MAU, in Cavan General Hospital in March 2009, the development and implementation of an enhanced ambulance and pre-hospital thrombolysis service, together with enhanced primary care services.

The immediate focus is now on service reconfiguration in the Louth and Meath area, which involves transferring acute services to Drogheda, strengthening existing medical services, enhancing emergency department capacity, developing appropriate ambulance protocols, completing surgical reconfiguration and providing additional community packages of care. The new emergency department at Our Lady of Lourdes Hospital Drogheda will provide an improved service to both patients and staff within the Dublin north east region. This new department, which encompasses best design principles, is approximately 1,300 sq. m in size, and represents a 300% increase in size from the existing department in use today. The increased size of the department and the specific entrance points will allow patients access the department in a more timely manner by segregating patients at first point of contact with a separate entrance for ambulance and stretcher-borne trauma and another separate entrance for the walking wounded, as it were.

Once the department opens, all paediatric patients presenting to it will be assessed and treated in a designated paediatric area. Adult patients will be allocated to one of three distinct assessment and treatment areas; the minor injuries department, the major treatment department and the resuscitation area. Patients will have more immediate access to diagnostics with an on-site emergency department, dedicated X-ray facility and staff. Patients will benefit from more immediate treatment, enhanced outcomes and a more patient-focused environment. Staff will benefit as the new infrastructure and design of the department will facilitate easier access to patients and ultimately earlier admission or discharge.

The increase in size of the emergency department means that staffing levels must be examined. That is the nub of the issue. Under the 2010 employment control framework the filling of posts is in the first instance to be by redeployment from within current services. Once redeployment options have been explored, external recruitment may then proceed in line with this framework. The HSE is committed to opening the new emergency department at Our Lady of Lourdes Hospital in Drogheda at the earliest possible date. Negotiations are in progress between the HSE and unions in order to agree a mechanism to redeploy staff at all grades and in some instances to consider outsourcing or contracting. Unfortunately, it has not been possible to reach agreement on these matters to date but the HSE will continue to try to achieve an agreement as quickly as possible in order to open the facility.

Social Welfare Fraud

I thank the Acting Chairman and the Ceann Comhairle for allowing this motion on the Adjournment tonight. I welcome the Minister for Social Protection, Deputy Ó Cuív, and thank him for attending. We live in times of great financial difficulty. At the moment every citizen of our country is suffering from reduced income, in some cases, much reduced income. The Government is to be commended on taking the corrective action needed to stabilise the national finances, painful and all as it is. Among the people who have suffered are the recipients of social welfare who have seen a dramatic reduction in their payments. In the light of the reduced money available to Government, it is essential that those who are genuinely in need of social protection receive it. We must do all in our power to ensure they are protected from further cuts.

In that context, any abuse of social welfare payments must be eradicated. In recent months I have become aware of anecdotal evidence of false

claims made by some people on social welfare. That evidence has become stronger recently. I pay tribute to the citizens who have brought that to my attention, some of whom are themselves social welfare recipients.

A recent letter in the Irish Independent on 24 April summed up in a succinct way the point I am making. It asked how a non-national living and working in Norway for the past three years can still receive €600 per month jobseeker’s allowance from the State. I suggest that the following measures, if implemented, would save a considerable amount of money, which then could be used to protect the genuine recipients of social welfare payments. We must examine the possibility of ceasing the payment of unemployment benefit-jobseeker’s allowance into bank accounts. The money should be collected by the recipient presenting himself or herself in person at the post office. If that is not feasible and the money continues to be paid into a bank account, it should be collected personally in the bank. Those measures would prevent a serious abuse of the payment system.

We could also introduce a change in the practice of giving one month's notice of signing on. That could be reduced to one week's notice. Thus, if someone is out of the country, he or she would not be able to obtain a cheap flight to return to the country to collect the money, thereby making it uneconomic for him or her to claim the allowance while abroad.

The Minister is innovative. I urge him to devise schemes whereby worthwhile community work could be done by those who are able to work but who through no fault of their own are unemployed. Such people want to work. In his previous Ministry the Minister initiated many very good schemes, such as the rural social scheme, which were and still are highly regarded by those who partook in them. Asimilar scheme in this area would be very welcome. There exists a serious abuse of our social welfare system by a small minority and it is imperative that the majority of social welfare recipients who are genuinely in need of social welfare support are supported.

I thank the Deputy for raising this issue. As he rightly pointed out, every euro that is fraudulently claimed is a euro taken out of the pockets of those who urgently need those payments. We must view fraud in that context.

The prevention of fraud and abuse of the social welfare system is an integral part of the day-to-day work of the Department. I listened with great interest to what the Deputy said and I will examine all of the suggestions he has made. The expenditure of the Department exceeded €21 billion in 2009 in respect of approximately 50 schemes. During 2009 the Department processed 2.5 million claims and issued in excess of 83 million payments. It must be emphasised that the majority of people are receiving the entitlement due to them.

The objective of the Department's control strategy is to ensure that the right person is paid the right amount of money at the right time. The prevention of fraud and abuse of the social welfare system is an integral part of the day-to-day work of the Department. Approximately 620 staff work in areas related to control of fraud and abuse of the welfare system. At the end of 2009 more than 750,000 individual claims were reviewed and the Department recorded control savings of approximately €484 million. The control savings target for 2010 is €533.31 million.

The level and types of fraud and error vary across schemes but customers typically incur fraud in situations such as failure to disclose their full means or increase in means; failure to disclose the true employment or residential status of their spouse, partner or dependants; claiming jobseeker's payments when they are in fact working; absenting themselves or their dependants being absent from the State; and working while claiming to be incapable of work.

In recent years the Department has undertaken a range of initiatives to tackle the problem, including increased control activity focused on the prevention of fraud and error at claim application stage.

This is the most cost effective mechanism of reducing losses through fraud and error in social welfare schemes. Significant advances have been made to reduce the risk of overpayment through systems "talking" to each other. With the introduction of the new service delivery modernisation, SDM, a greater number of the Department claims and payments are sharing a single technical platform. This basically stops double timing and the various systems being abused in that manner.

The Department is moving to a risk-based system of claim review, which focuses resources on the most appropriate cases. This involves assigning and recording a risk rating at the award and review stage. In order to identify fraud and error levels in schemes the Department carries out detailed fraud and error surveys on individual schemes which provide evidence-based indicators for levels of fraud and error on those schemes at a particular time.

The Department has also introduced a series of certificate processes in its schemes. Certificates issue to the customer for completion, for example to targeted customer groups by age, payment method, location or country. Certificates that fail to be returned or are completed incorrectly may result in suspension or termination of claims.

As a fraud preventative measure the option to receive payments by electronic fund transfer, into a bank account, was removed for new claimants of jobseeker payments and that addresses one of the Deputy's issues. Border regions put an increased emphasis on control of claims from applicants with a previous address in Northern Ireland. One-parent family payment recipients with earnings are the subject of an ongoing review. Data matching requests to other Departments and agencies is considered a vital tool for targeting effective reviews and successfully achieving savings. New anti-fraud measures have been included in the Social Welfare and Pensions Act 2009 which provide for the transfer of bulk information relating to recipients of social welfare payments to the competent authority of another member state, international organisation or other country with which reciprocal agreements have been made.

One of the anticipated advantages of the introduction of the public service card, which will include a photograph and signature, is that it will help to reduce fraud and error which result from the incorrect identification of benefit claimants. The special investigation unit of the Department works with other agencies such as Revenue, NERA, Customs and the Garda to ensure that control activity is being targeted at high risk categories of claimants or employers.

Since January 2010, members of the public can report suspected social welfare fraud anonymously to the Department by completing a new online form on the Department's website at www.welfare.ie. The number of anonymous reports from members of the public has increased dramatically, with over 6,400 made at the end of 2009 compared to approximately 1,000 in 2008. Each report is followed up. The Department is committed to ensuring that social welfare payments are available to those who are entitled to them. In this regard the control programme of the Department is carefully monitored and the various measures are continuously refined to ensure that they remain effective.

I assure the Deputy that I will ask my officials to review the suggestions he has made. We all have a duty to ensure that fraud is minimised so that we can pay those who badly need the support of the State and so that we may retain the money for the targeted groups. Savings can be used over time to make improvements. The Deputy has mentioned the various schemes and I am anxious to see when we get the new transfer of powers as regards CE, RSS, CSP schemes whether we can pay fewer people not to work and pay more to be active in community services.

Malt Barley Industry

I thank the Ceann Comhairle for taking this matter on the Adjournment and I welcome the Minister of State, Deputy Connick.

I raise the issue of the growing of malting barley and the future of farmers, particularly in the south-east. Counties Wexford, Carlow, Kilkenny and Kildare are renowned for growing top-class malting barley. Due to the recent Greencore rationalisation plan, last year's figure of 11,000 malting barley growers is down to 500 this year. All farmers producing under 80 tonnes were dumped by Greencore. Recently the malt side of Greencore has been sold off as well, so it is a double whammy for farmers, particularly in the south east. The 500 who were left had high expectations that they would have a viable malting barley industry for the future, but while there were 130,000 tonnes for Minch Malt last year the figure this year is 75,000 tonnes.

However, I have raised this matter on the Adjournment to question the commitment of Diageo-Guinness to Irish farmers growing malting barley because of a situation that has developed in recent weeks. The south east is renowned for growing malting barley and yet Diageo-Guinness has been sidestepping the local supply. I know for a fact that it has been sourcing malting barley in the UK from a company called Crisp and taking it by lorry to St. James's Gate in Dublin, which is amazing considering the amount of malting barley and malt that is available in Athy at present.

I should like to know where we stand with Diageo and the prospect of it continuing to take malt for the future, and malting barley from Irish farmers. It has shelved its new proposed brewing facility at Grange Castle, Clondalkin and it has not given any great commitment to the farmers as regards the future. I believe it is a shame that it is now importing barley malt from the UK when there is an adequate supply in this country. As a result of the importation of the malt, the Athy malt plant was closed for three weeks, which is an amazing situation.

I understand Diageo-Guinness is again taking malt from Athy but I would like the Minister of State to ensure that we have a strong commitment from the company in this regard. Guinness has always been Irish through the generations and it now seems strange that while Guinness is still promoted as being produced from Irish malting barley, supplies are being sourced from England and indeed, Europe, at the present time.

The other area I should like to raise in relation to malting barley is the fact that Heinekan, which now owns Murphys and Beamish, is purchasing no malt at all in Ireland, and yet it, too, is promoting its product as being Irish to the core. I ask the Minister of State to have discussions with the Minister for Agriculture, Fisheries and Food, Deputy Brendan Smith, and the Minister for Enterprise, Trade and Innovation, Deputy Batt O'Keeffe, because both of them are relevant in this case.

As the Acting Chairman appreciates there is a substantial number of jobs in Dublin at St. James's Gate and we want to see Diageo-Guinness continuing to provide jobs and product in Ireland. We also want it to produce the product but from the adequate amount of malt that is available in this country at the present time.

Farmers in the south east have lost the beet industry in recent years. If they were to lose the malting barley crops in the future, this would have devastating effects on them, in Wexford and the adjoining counties as well. I ask the Minister of State to have discussions with both Ministers as well as directly with Diageo-Guinness as to where it is going in the future, wherein stands the commitment to the 500 growers — reduced from 11,000 — and about the future of the Athy plant.

I am taking this Adjournment matter on behalf of my colleague, Deputy Brendan Smith, Minister for Agriculture, Fisheries and Food. At the outset I should like to thank Deputy Browne for putting down this important matter for discussion tonight. I share his concern as I have seen the impact of the Greencore decision and the difficulties it is now imposing on farmers, not just in Wexford but in the south east in general.

The maintenance in the first instance of an efficient and viable crop sector in Ireland is very important for the well-being of the agrifood industry. Indigenous production of cereals, horticulture and bio-energy crops is, of course, an important part of primary agricultural production in Ireland. In addition to generating an income for our tillage farmers, the cereal sector is a key source of feedstuffs for the livestock sector and, as a consequence, a significant stakeholder in the safety of the food chain. Annual cereal production in Ireland has fluctuated around 2 million tonnes in recent years. It is desirable to try to sustain this level of production in order to avoid over-dependence on imported cereals.

The Department operates a range of services aimed at improving the efficiency, quality and viability of cereal production. These services include seed certification, seed testing and recommended lists of varieties. In addition, Teagasc provides research, training and advisory services for cereal producers. The value of all these support services is reflected in the fact that Irish cereal producers have consistently achieved some of the highest yields in the world.

At present, up to 130 cereal varieties are undergoing testing in the Department. This results each year in a number of new and improved varieties being recommended to farmers and industry due to their suitability for malting, milling or bread-making, as the case may be. While the largest portion of the wheat crop grown in Ireland is used as feed for the livestock industry, a significant acreage of the crop meets the high-quality requirements of the milling industry. The crop variety testing programme includes extensive evaluation of new varieties for bread-making and biscuit-making quality.

Each year a number of new oat varieties are evaluated under the crop variety testing programme. These are mainly used in the production of specialised feed, and only those assessed as having high grain quality characteristics are recommended for cultivation. The demand for organically grown oats for inclusion in breakfast cereals continues to increase. The Department carries out a number of organic oat cultivation trials each year to identify varieties most suitable for this market. There is strong interest among commercial organic growers in the results of these trials.

The Department has had a long association with the malting barley industry in Ireland, dating back to the beginning of the 20th century with the introduction of a Guinness-initiated programme of breeding and testing to improve the varieties of malting barley available to Irish growers. This association was formalised in 1971 when the Department and the company agreed to share the operating costs of the programme. The programme ceased in 2002, mainly because of the withdrawal of the brewing company. However, the company continues to purchase malt manufactured from Irish malting barley.

The malting industry and the Department continue their collaboration in identifying the most suitable barley varieties for malting through the official variety evaluation programme. Quality issues have arisen recently with regard to protein levels in Irish malting barley, which has resulted in the importation of a small quantity of specialised malt by the company involved. Officials of the Department have been in communication with grower representatives regarding this protein deficiency issue.

The Department also continues to support the development of the horticulture sector in Ireland. This support has primarily been provided through the grant aid scheme of investment aid for the development of the commercial horticulture sector under the National Development Plan 2007-2013. The Minister of State, Deputy Cuffe, announced last Friday a grant aid package of €3.8 million under the scheme for 2010.

Funding provided under the scheme underpins capital investment on farms to promote the specialisation and diversification of on-farm activities, improve the quality of produce and ensure the application of environmentally friendly practices. This investment contributes significantly to the growth and development of the horticulture sector across all areas, including the protection of crops, field vegetables, nursery crops, mushrooms, soft fruit, apples and beekeeping. Additionally, aid for the horticulture sector continues to be available under the capital investment scheme for the marketing and processing of agricultural products.

Further financial support continues to be available to those producers who participate in the producer organisation scheme. This EU scheme provides an important mechanism for growers to become part of a larger supply base, to concentrate marketing and improve quality. Bord Bia continues to provide support to the horticulture sector in its efforts to develop new markets through assistance in the areas of product innovation and marketing skills.

The Department has also been providing support to farmers for the production of bio-energy crops. A pilot bio-energy scheme was launched in 2007 to support the planting of miscanthus and willow by providing assistance to farmers up to a maximum of €1,450 per hectare to cover 50% of establishment costs. Grants were paid in two instalments: 75% following establishment of the crop and 25% in the year after establishment. The pilot scheme supported 364 farmers in the planting of some 2,500 hectares consisting of 2,100 hectares of miscanthus and 360 hectares of willow, to the end of 2009, at a cost of some €2.9 million.

A new bio-energy scheme, co-funded by the EU under the rural development programme, was launched in February 2010 to build on the progress made during the pilot phase. Under this scheme, farmers receive a grant up to a maximum of €1,300 per hectare to cover 50% of the establishment costs. This reflects the reduction in crop establishment costs since the launch of the pilot scheme. It is expected that a further 850 hectares, consisting of 470 hectares of miscanthus and 380 hectares of willow, will be planted under the scheme for 2010.

Deputy Browne will be aware that in February this year the Minister launched a major initiative to draw up a long-term strategy for the agrifood, forestry and fisheries sector. I assure the Deputy the position of the crop sector will be examined in this context.

The Dáil adjourned at 9.25 p.m. until 10.30 a.m. on Thursday, 13 May 2010.
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