Vol. 709 No. 2
45 Deputy Seán Sherlock asked the Minister for Health and Children the progress she has made to date in drafting legislation to clarify eligibility for health and social services; and if she will make a statement on the matter. [20210/10]
The current legislation governing eligibility for health and personal social services has been in place since 1970. The 1970 Health Act contains the now outdated concept of undue hardship as the basis for providing full eligibility for people who cannot arrange health care for themselves. It is time to move to more modern concepts for the basis of public health care such as financial, medical or social need.
Since 1970 there have been many developments in services with a growing emphasis on the delivery of care in community health rather than institutional settings. For example, both in respect of public and privately funded services, the area of chronic disease management in the community is being given a higher profile than before. To support this change, and better care for all patients, we must develop both the eligibility rules for public benefits and the minimum benefits regulations for health insurance. Both of these, together, should be aligned towards the objective of better primary care and much better and more cost effective chronic disease management.
It is important that people have clarity about what they can expect in public benefits and from health insurance policies, and that both these support best health care and outcomes for everyone. The review of eligibility therefore dovetails with the development of minimum benefits for private health insurance. Work in this area is at an advanced stage and I hope to bring proposals to the Government as soon as possible in the coming months.
It is useful to tease out what will be contained in this legislation which is extremely significant in terms of people's rights regarding health care. We in the Opposition would prefer if it were decided that everybody, whether privately insured or not, has the same rights in the area of health care. How comprehensive will the legislation be? Will it deal with the mental health area, including, for example, the right of access to community mental health care within a particular timeframe? Will the legislation specify timeframes within which people will be entitled to receive care? They have just left the Gallery but I intended to welcome the guests of the cross-party group on mental health who have come from several different countries. They would be particularly interested to know whether mental health will be covered.
Will the legislation include dental services? People's right to dental care has been slashed even though, as I understand it, there is a right to comprehensive dental health care under the 1970 Act.
I join the Deputy in welcoming the guests who have just departed. I hope they will learn from us just as we learn from them. The legislation will be as comprehensive as possible. Although we have had some recent legislation on medical cards and long-term residential care, and legislation is imminent on prescription charges, there is clearly a need for comprehensive legislation on eligibility. There are significant issues to be addressed.
I do not share the Deputy's view, even in the case of primary care, that there should in the short term be free access for everybody to everything. If we were to send Deputy Reilly to negotiate with the Irish Medical Organisation, as he has done in the past, I would not like to imagine the costs he would come back with. Within the available resources we must ensure that those at the bottom have access to all the services they require.
The Adelaide Hospital Society has said it would require only an additional €217 million to provide universal free access to primary care.
I asked the society whether that figure was based on negotiated costs.
The society has done its figures, although the Minister disputed that in The Irish Times.
I did not say the society had not done its figures. I simply said that nobody had negotiated with doctors as to what it would require to provide free access to primary care. I have checked that out with a number of practitioners and have been shown salary levels that would frighten us all if I were to mention them here, salaries far in excess of what we earn.
A set figure has been indicated for every medical card patient.
We should bear in mind the cost of introducing medical cards for all those aged over 70 years. I am simply saying that if we are going to move to salaried GPs, we must know what it will cost.
The Deputy asked whether the Bill will include dental and other services. The intention is that it will be as comprehensive as possible. I personally favour the concept of tiered benefits, with those at the bottom entitled to everything free of charge, those at the top paying the greater portion of their health care costs and those in the middle entitled to such facilities as the doctor-only card. On dental services, contrary to comments made in this House and elsewhere, the figure for 2010 is the amount we spent in 2008. For Deputies to suggest that represents a return to the Dark Ages is unfair and inaccurate.
On the last point, there is tremendous confusion as to dental entitlements. Dentists have been told by circular and other means, in very obtuse terms, that they are to examine patients, and if it transpires that emergency treatment is required, then they will be paid, but they cannot know this until the examination is done. That is a farce.
On the substantive issue of eligibility, the Minister referred to chronic illness care. There is no primary chronic illness care in this country other than the very limited Heartwatch programme. We are paying lip service to the changes required in the community in order to ease the situation in hospitals and to change the way we deliver care, changes we all agree are necessary. However, lip service does not provide services to patients. The front page of the Irish Medical News indicated recently that there are two-year waiting lists for respiratory patients in Cork University Hospital. Even the smallest hospital has a respiratory physician, yet people are waiting two years in Cork University Hospital. The Minister wants to shove everything into that hospital. Everything is being taken out of St. Mary’s Orthopaedic Hospital and shoved into the South Infirmary hospital, with facilities being closed left, right and centre.
The discussion is straying from the issue of medical card eligibility.
Eligibility must be real rather than virtual, as is the case at present.
It will be real and will recognise the financial resources under which we must all operate and which some of the Deputy's policies do not appear to recognise.
Yes, they do.
The Deputy speaks as if we have an unlimited budget for an unlimited number of consultations, procedures and diagnostics.
On the Deputy's specific question, the legislation is long overdue. It is, however, a major piece of work on which considerable work has been done in my Department. The proposals will be brought to Government shortly for decision.
Under the health strategy of 2001, a commitment was given to produce new legislation in 2002 to provide a legislative framework guaranteeing the entitlement to health care and personal social services of every citizen across the State. The 2001 strategy indicated legislation would be produced in 2002. Eight years later, why have we only received the Title of the Bill? We are told in the new legislative programme that the heads of the Bill have not been agreed and it cannot be indicated when the legislation will be published. Noting the Minister's response, I must ask whether there is any real intent on the part of the Government to publish the eligibility for health and personal social services Bill. To clearly state the entitlements of citizens would run totally contrary to the Government's entire policy of promulgating a two-tier health system that provides for those who can afford it and denies to an ever growing number of people who simply cannot afford it.
I totally refute the Deputy's assertion. Everything we have done, including the new consultant contract, medical card arrangements, screening programmes and the establishment of the fair deal, was precisely to deal with people who did not have appropriate access to public facilities. It remains my determination to continue to improve access to our public health services on the basis of medical need, rather than any other basis. If we were to have a free-for-all, those at the bottom would not receive that to which they are entitled.
On the specific question on the legislation, we remain determined to introduce the Bill and I hope a major advance will be made during this calendar year.
Where can people be given a clear indication of their entitlements on the medical card system?
46 Deputy John O’Mahony asked the Minister for Health and Children the details on the recruitment of the next chief executive of the Health Service Executive; the number of candidates that have expressed interest in same; the time line for the interview process; and if she will make a statement on the matter. [20298/10]
The board of the Health Service Executive is continuing the recruitment process for the next chief executive officer of the HSE as the contract of the current CEO, Professor Brendan Drumm, expires in August this year. In accordance with section 17 of the Health Act 2004, the HSE board is responsible for making the appointment. The Act stipulates that the recruitment process must be in accordance with the Public Service Management (Recruitment and Appointments) Act 2004.
I understand the recruitment process is being conducted in accordance with the code of practice issued by the Commission for Public Service Appointments. Public advertisements for the position were placed nationally and internationally in December 2009. In addition, an executive search and recruitment company, Amrop Strategis, was engaged by the board following competitive tender and conducted an international search for the position.
By its nature, much of the information about this competitive process, including information about applicants and interviews, is confidential. It is not appropriate, therefore, for me to speak about the details sought by the Deputy. However, I understand the intention of the board is to complete the process in June.
It is disappointing that Deputies are unable to obtain the information sought as to the number of candidates for the position and how many are external and internal candidates. Does the Minister have a role in the process of recruiting a new chief executive officer of the Health Service Executive? What will be the salary of the new CEO? We have been given to understand it will be in the region of €228,000, which is considerably less than the salary of Professor Drumm.
The Minister referred to a consultancy firm that is involved in the recruitment process. What has been the cost to the State of this firm's role? The Minister also indicated she hoped an appointment would be made in June. I refer her to comments made by Professor Halligan when he declined the job. He described the health service as "over-managed and under-led", adding "You don't need €17 billion. You absolutely don't . . . you need leadership,".
As I stated, under the Health Act 2004, I do not have any role in recruitment. The search company engaged interviewed or met more than 25 persons from around the world and more than 100 people expressed an interest of some form in the position. A cap of €37,000 was imposed on the costs of the recruitment process for the company in question and I understand the final figure will be lower than that. The matter is one for the board of the HSE. Its chairman informed me last week that it was intended to have identified a successful candidate in June. The salary is, as recommended, in line with the salary of the Secretaries General to the Departments of the Taoiseach and Finance. By international standards, this is not considered a high salary in this area of responsibility.
Has the Minister expressed a view to the HSE as to who she believes would be good for the job? She indicated her view that Professor Tom Keane would be a good candidate for the position. We all probably regret that he did not take the job. I am not trying to be vexatious and I put my questions in a positive rather than negative manner. Given that the Minister has experience of many other health systems from visits she has made to other countries, during which I am sure she has met Irish people working in the health services of various countries, has she suggested the names of any individuals who would be good for the job of chief executive officer of the HSE?
I hold Professor Tom Keane in high regard. He impressed me so much when I met him in Canada that I asked him would he consider coming to Ireland. I did not expect to receive a positive response and I was delighted when he decided to come here. He was appointed to a specific position of overseeing the implementation of the cancer control programme on a contract we agreed with his then employer, the cancer agency of British Columbia. I have not expressed a preference, although I stated when asked in Cork about Professor Keane's decision to leave the country that I would love him to stay in the country. I indicated quickly, however, that the CEO of the HSE was not a matter for me but an entirely independent process. That remains the position and I have not expressed a view to the chairman or any member of the board, nor have I been asked for a view on the matter.
I, too, do not wish to be vexatious in raising an option the Minister may not have considered. Pending a complete reform of the structures of health care delivery, would the Minister consider suspending the appointment and giving collective responsibility to the next tier of respective heads and leaders of the various sections of the Health Service Executive and direct the funding to the employment of 14 student nurses who would probably make a much more useful contribution at the front line, given that we are exporting them day and daily? As the people the Minister welcomed to the Gallery were able to share with us, we are training them in order that they can employ them overseas.
I do not know of any health provider which can operate without a CEO. To refer to the words cited by Deputy Reilly, every organisation needs leadership. The HSE requires, in particular, a chief executive officer given that it is responsible for a budget of almost €15 billion provided by taxpayers. I would not consider asking anyone to suspend the recruitment process. It is important that we have a smooth hand-over from Professor Drumm to his successor. If the person is identified in June, this will, I hope, take place in August.
47 Deputy Mary Upton asked the Minister for Health and Children if she will introduce legislation to underpin the provision of services and supports of persons who were injured by thalidomide; if she will engage with the Irish Thalidomide Association in view of the lack of consultation in advance of the settlement offered to them; if an apology on behalf of the State will be offered to those so injured; and if she will make a statement on the matter. [20218/10]
The Deputy will be aware that the Minister has met with the Irish Thalidomide Association on a number of occasions since 2008. At the Minister's request, the State Claims Agency assessed the association's requests in the context of Irish and international provisions for survivors of thalidomide and in the context of Irish case law and precedent. The State Claims Agency also considered the submissions of the Irish Thalidomide Association and the Irish Thalidomide Survivors Society and met both organisations.
Following consideration of the agency's report, the Minister announced, on 27 April last, the Government's decision to provide additional service and financial supports for Irish survivors of thalidomide. The measures announced include: provision for special care packages for thalidomide survivors living in Ireland, following multi-disciplinary assessments by an independent expert to be appointed by the Minister; the designation of a senior manager in the HSE to act as a liaison with regard to the ongoing health and personal social services needs of the Irish survivors; a once-off ex gratia payment of €2 million to be divided equally between the Irish survivors as a practical expression of the Government’s sympathy; the payment of an annual lump sum, in addition to current payments, equivalent to a further German annual payment which commenced in 2009, of up to €3,680, for survivors in the most severe category; provision whereby, if an individual thalidomide survivor has applied for but does not qualify for either the disabled drivers tax concession scheme or the motorised transport grant, their cases will be examined with a view to providing an equivalent level of financial assistance to assist with their transport needs. This is a reasonable and compassionate response, aimed at meeting the medical and other needs of survivors.
Additional information not provided on the floor of the House.
The Minister met groups representing survivors of thalidomide and briefed them on the Government's decision. Issues were raised by legal representatives on behalf of both organisations at those meetings, including the manner in which services and supports will be provided, the question of an apology to survivors and certain legal issues. The Minister has already put in train arrangements for individual assessments of survivors, including the appointment of the independent expert, Dr. Paul O'Connell, consultant rheumatologist, and separate liaison arrangements through Ms Carmel Buckley, a senior HSE nursing official. In regard to the legal issues raised, the Minister informed the survivors that she would have these matters considered urgently, in consultation with the Office of the Attorney General. The Minister will proceed on the basis of advice from the Attorney General.
The Minister also wishes to point out that in 1975, the Government of the day also acted on the then Attorney General's advice and expressed a commitment to ensure that the needs of the surviving children would be met. I know that the Minister joins me in saying that the State has great sympathy for the survivors and it is most regrettable that they should have been put through so much pain and suffering.
I presume the Minister of State knows that this offer has been unanimously rejected by the Irish Thalidomide Association. What is his response to that rejection? I went to the association's press conference last week and the offer was rejected because its members felt that there was no real consultation. They were brought in at the very end of the process with the State Claims Agency. Will the Government consider going back to the drawing board and genuinely negotiating a settlement proposal with the two bodies concerned? The Irish Thalidomide Association represents the vast majority of survivors.
Will the State apologise to the survivors? I realise the State did not produce the drug, but there is a strong feeling among survivors that the State could have protected them better and they would like an apology.
I would have thought that the independent assessment by the State Claims Agency was far from an attempt to exclude submissions by the thalidomide group. The assessment was carried out independently and this was the response. I hope the thalidomide group see that it was not an attempt not to listen to them or to delay their involvement.
The second issue will be considered after the response of the thalidomide groups. It also ties into the third question. I do not want to delay things by talking about the level of funding proposed, but this was an expression of sympathy on behalf of the Government, recognising the huge difficulties caused by thalidomide.
Is the Minister of State expressing that now?
I will not be hung up on words for the sake of them. The Minister met on many occasions with both groups and tried to work out a sensible and sympathetic response. Upon the conclusion of what I hope will be successful talks, we will leave it open to the Government to express sympathy. I do not think I can offer an apology for something that could cause great concern.
While I have listened to what the Minister of State has had to say, I believe he and the Minister should consider an apology because it would go a long way towards appeasing people who have been wronged. The State may not have made the drug, but agents and servants of the State administered it, and it was available in this country for a longer time than in other countries. Therefore, the State has a culpability in this area.
The State Claims Agency operates the clinical indemnity scheme. While it does great work, it can be quite adversarial in its nature. Would the Minister of State consider the Injuries Board as a body to assess the thalidomide claim? It might create a better atmosphere and bring about a different outcome. Victims of thalidomide are upset because the consultation process was merely a listening exercise rather than a hearing exercise. They were not heard.
Finola Cassidy of the Irish Thalidomide Association has described the offer as derisory. There are only 32 surviving victims, and Ms Cassidy said they feel shell shocked and deeply disappointed. They are all in their late 40s or early 50s. We are talking about €60 per week in respect of the annual payment. It is abysmally low, as is the lump sum of €60,000. Whoever was responsible for making this assessment clearly has little understanding or regard for the challenges that these people have faced and will continue to face for the rest of their lives. We should be able to provide more generously and offer language that reflects our collective national sorrow at what has happened. Is it in the Government's gift to revisit the proposals in this instance? They need to be dramatically improved.
I do not want to respond by pointing out that it compares favourably to other countries.
I would like to make a point to Deputy Reilly. I was present for most of the talks between the Minister for Health and Children and the thalidomide groups and "adversarial" is not the word to describe them. It has never been the Government's intention to argue down to the very last detail with the thalidomide groups, and we are still open for ongoing talks, but the offer is there and I have to say it is a generous one.
Written Answers follow Adjournment Debate.
