Priority Questions

Hospital Charges

Billy Kelleher

Question:

71. Deputy Billy Kelleher asked the Minister for Health the measures he will take to reduce hospital costs for persons with health insurance; and if he will make a statement on the matter. [30750/13]

I have consistently raised the issue of managing costs with health insurers and I am determined to address rising costs in the sector in the interests of consumers. I want insurers to address the base cost of each element of claims which they pay. This is the real issue as costs and the manner in which they have been rising in recent years are unsustainable.

Last year I established the consultative forum on health insurance to generate ideas to address health insurance costs, while always respecting the requirements of competition law. I have made it clear to the health insurers that I believe significant savings can be made, ultimately reducing the impact of rising health costs on health insurance premiums for the consumer. Last week I announced the appointment of an independent chairperson to work with my Department and the insurers under the auspices of the consultative forum on health insurance. The chairperson will oversee a process of review to give effect to real cost reductions in the private health insurance market. Specific areas that I have asked insurers to address include an audit of the volume of procedures; a clinical audit to determine the appropriateness of procedures being claimed for; procedure-based payments, in particular with a view to their extension to the public health sector; and benchmarking to determine the underlying basis for the cost of specific procedures, with a view to driving costs downwards.

I am strongly of the view that all procedures should be provided in an appropriate setting that is safe and provides value for money for consumers. There have been criticisms from insurers of the decision to charge private patients in public beds. The new charge makes sense. We cannot continue with a situation where private patients pay only €75 per night in a public bed where the economic cost is closer to €1,000. Insurers need to address their own cost base urgently, rather than simply blaming others for their inefficiency. The independent chairman of the forum, working with the insurers and my Department, will be charged with identifying real scope for effective cost-management strategies that all insurers can adopt to ensure the long-term sustainability of the private health insurance market. The new chairman of the forum is Mr. Pat McLoughlin.

Additional information not given on the floor of the House

The continued participation of younger customers is important in keeping the health insurance market on a sustainable path. In addition to the work of the forum, my Department established a subgroup of the consultative forum earlier this year to consider regulatory issues relevant to the health insurance market, including proposals to encourage greater participation of younger, healthier people in the market. The appointment of an independent chairman to identify cost reductions and the ongoing work of the consultative forum to promote the participation of younger customers will address the cost of providing hospital care for the population who have private health insurance.

The most prohibitive cost is the cost to people who are trying to retain private health insurance. The Minister says that the insurers can do a lot more to drive down costs but equally, the Department of Health could do a lot more to assist in driving down costs. For example, private health insurers negotiate with private hospital providers on payments for procedures, but this is still not possible in the case of public hospitals. Private health insurers cannot negotiate because the Department has set the prices in stone and this makes it very difficult for private health insurers to negotiate costs on the basis of procedures.

I accept that health cost inflation is well above the consumer price index, but the biggest issue causing private health insurers to force up premiums is the policy changes being announced by the Minister. The most recent policy change was that involving payment for private patients in public beds, which will have a catastrophic effect on the private health insurance market. Families will simply be unable to sustain the escalating cost of private health insurance and this will cause further difficulties in the private health sector - and more important, in the public health sector, as more people will depend on it solely.

The bottom line is that it is the insurer, not the Department, that negotiates with private hospitals and consultants. Only insurers can address these ever-rising costs. They have to examine why they pay the level of costs they pay. I acknowledge the argument made by the Deputy. I am happy to engage, through my Department, with the insurers to talk about paying per procedure instead of paying per day in the public hospitals. I want both private and public hospitals to be efficient. I do not want people to be treated as inpatients when they could be treated as outpatients; nor do I want people being admitted to hospital the night before a procedure when they could be admitted on the day of the procedure. I am quite happy to discuss all these matters, through my Department, with the insurers. However, I remind the House that the health insurers are the only ones who can act on costs in the private hospital sector, and these costs are increasing all the time. In the past, the insurers have just passed on price increases to the consumer. Not enough has been done.

As Deputy Kelleher is aware, the Health (Amendment) Bill is before the Seanad this evening. I have to make a choice between being here to reply to his Topical Issue matter and being in the Seanad to deal with that Bill. The bottom line is that provisions to deal with the amounts to be charged for procedures will be introduced on Committee Stage. The insurance forum and the insurers now have an opportunity to propose some real and meaningful changes with regard to their costs and how they plan to address them. This will very much influence what figures will be included in the Bill on Committee Stage.

The issue at stake is the private health insurance market per se, which is in crisis. The number of insured people is dropping all the time, with less than 50% of the population covered by private health insurance. This will put further pressure on public hospitals. In the meantime, private health insurers are incapable of negotiating with the public hospital system because the Department of Health sets the terms and costs for the public hospitals. There is a need to ensure competition between insurers and to ensure that public hospital services are used efficiently. Therefore, the Minister will need to allow private health insurers to negotiate with the public hospital system until we achieve this utopian system of universal health insurance. In the meantime, families cannot wait. The figures bear this out because they show the alarming number of families who are dropping out of health insurance altogether or reducing their cover.

I am dealing with a problem that was not addressed by the previous Government. We all know why we find ourselves in the current position, which is as a result of the Fianna Fáil-Anglo Irish Bank axis and the damage it did to this country. We will deal with the present-----

That has nothing to do with private health insurance costs.

It has everything to do with the fact that 450,000 people are unemployed and many people cannot afford health insurance because they do not have a job. This is because of Deputy Kelleher's party and its Government's engagement with Anglo Irish Bank; the Government was hoodwinked by it.

It gives me more reason to believe this Government is incapable of having an investigation as a coalition.

Either criminal negligence or utter incompetence on the part of the Government was the cause of the problem we have to deal with. That Government was supposed to be in charge of the situation; the banks will be dealt with in due course.

The bottom line is that we have an opportunity now to do something real to address the ever-escalating cost of private insurance - why we pay what we pay for particular procedures, why we pay per day instead of per procedure and why we do not have proper audit or clinical audit. If we address those matters, we can get real value for customers again and minimise increases into the future.

Is that criminal negligence on behalf of banks or politicians?

Childhood Obesity

Caoimhghín Ó Caoláin

Question:

72. Deputy Caoimhghín Ó Caoláin asked the Minister for Health his plans for the introduction of a national strategy for a childhood obesity prevention and intervention service; if he has engaged directly and, if not, if he will engage with the anchors or providers of the W82GO childhood obesity treatment programme at Temple Street Children's Hospital, Dublin; and if he will make a statement on the matter. [30747/13]

As Minister for Health, I have made excess weight and obesity a public health priority. I have established the special action group on obesity, or SAGO, with which I meet regularly to further the obesity agenda. The range of measures being implemented by my Department seeks to promote healthy lifestyles, encourage adults and children to make healthier food choices and increase activeness. SAGO is working on a combination of priority actions which, taken together, should make a difference in the long term. These measures include calorie posting in restaurants, healthy eating guidelines, addressing the marketing of food and drink to children, treatment algorithms, opportunistic screening and monitoring for excess weight and obesity, addressing vending machines in schools and a physical activity plan. SAGO is also looking at ways to promote healthy eating in accordance with my Department's healthy-eating guidelines.

The health and well-being programme in the Department of Health is working with the HSE and safefood to develop an integrated advertising and promotional campaign for September 2013 to increase awareness among parents of the health challenges posed to their children by excess weight. The target audience of the campaign includes primary carers of children aged between one and 12 and key influencers, including health professionals, community development workers and educators. Key partners are being identified, as are opportunities for them to come on board and deliver some of their existing projects in the context of the broader campaign. The core message of the campaign will be broadly focused on families in general and will inform them of what to do if they recognise unhealthy behaviours, rather than focusing specifically on weight status. Body image issues and the stigma of being overweight or obese are critical factors to be borne in mind in all aspects of the campaign.

As Minister for Health, I arranged an informal EU ministerial meeting during our Presidency, of which, I am pleased to say, childhood excess weight and obesity issues were a key element. The European Union is drafting an action plan for member states to take this work forward.

Additional information not given on the floor of the House

The HSE has a significant involvement in addressing childhood obesity. This includes three intervention programmes and 18 national prevention programmes targeting children. There are also regional obesity intervention and prevention programmes. The HSE is also involved with the W82GO programme and has recently agreed that the programme will be expanded in Dublin. The HSE has also advised me that it will be training a further 12 people across the country and may extend the programme further next year.

Will the Minister clarify his plans, about which I asked in the first part of my question, for the introduction of a national strategy for a childhood obesity prevention and integration service? I am particularly keen to know if it is part of what he proposes to introduce.

At the meeting of the Joint Committee on Health and Children on Thursday, 13 June 2013, we were addressed by experts from Children's University Hospital Temple Street and the Irish Nutrition and Dietetic Institute. They were very clear in their analysis of the current and impending crisis of childhood obesity. They put forward recommendations to help address what the Minister and I agree is a very disturbing and serious issue. Among the recommendations made by the witnesses were sustainable Government funding for the evidence-based programme W82GO, which is run by Temple Street hospital for children who are clinically obese, co-ordinated and sustainable funding of an evidence-based community treatment programme such as Up4it, which was funded and supported by CAWT and had an impact in my constituency, and the appointment of a national post for obesity management. The other critical points made were on consistency and delivery and the engagement of the Government and the HSE with clinical experts, including those I mentioned. As I asked in the substantive question, will the Minister take the opportunity to meet with these expert voices?

I am in regular contact with the Department's team and its strategic action group on obesity. There has been a lot of involvement by the HSE in this regard. We are always happy to meet with people who have an interest in the area to support the initiative. This is the Department of Health but I often think it is the Department of ill-health, given that we are always dealing with disease and cure rather than prevention and trying to keep people well. We have a new Government initiative, involving all Departments, and an acknowledgement that the Department of Health alone cannot keep people healthy. We require the support of the Department of Education and Skills to educate children early on healthy lifestyles and good diets, the assistance of the Department of Justice and Equality in keeping places safe for people to exercise at night, the co-operation of the Department of Transport, Tourism and Sport to make it easier for people to walk and use public transport rather than driving from A to B, the assistance of the Department of the Environment, Community and Local Government in providing well-lit, safe footpaths and the assistance of the Department of Finance in respect of how it taxes various products, putting a lien on what is unhealthy and making fruit and healthier foods less expensive. It can also examine the VAT rate on vending machines. I will be making proposals to the Government about vending machines offering fresh fruit, water and perishables rather than sweetened fizzy drinks, chocolate and crisps.

I welcome the Minister's acknowledgement that this is a cross-departmental issue. He is right. It will require the enthusiastic involvement of the Departments of Transport, Tourism and Sport, Education and Skills, Children and Youth Affairs and, as the Minister mentioned, Justice and Equality. Is there cross-departmental engagement in a structured co-ordinated way as the Minister suggests is necessary?

With regard to the points commended to us by the experts at Temple Street hospital and the Irish Nutrition and Dietetic Institute, will the Minister give serious consideration to the appointment of a national post for obesity management? It is in the context of prevention rather than a fire-brigade reaction to situations that have gone far too wrong. We need prevention, and the appointment of such a post would be of huge importance. Is the Minister seriously commending to colleagues an increase in tax on sugary foods and fizzy drinks?

On the last topic, my position is known. We should be travelling in that direction, but I realise there are broader economic factors at play in the considerations of other ministries. I will pursue my goal and I believe it to be the most appropriate direction in which to travel.

The Healthy Ireland initiative is in its early stages and we are working to bring greater cohesiveness to it. We are the first Government to bring in an individual at principal officer level across the Departments of Health, Children and Youth Affairs and Education and Skills with responsibility for obesity. We are serious about tackling this and I am pleased Deputy Caoimhghín Ó Caoláin has raised it. If we do not tackle the epidemic of obesity and the resulting diabetes epidemic we see coming down the tracks, we may be the first generation to bury the generation behind us. That is not a legacy any parent wants.

Mental Health Services Provision

Luke 'Ming' Flanagan

Question:

73. Deputy Luke 'Ming' Flanagan asked the Minister for Health if he will confirm the location within County Roscommon of the units (details supplied) referred to in A Vision for Change for the care, treatment and rehabilitation of persons with difficult to manage behaviours; the date on which they will be operational; the location of the regional forensic mental health units; the location at which patients currently in need of this provision will be treated and detained; with regard to the Roscommon mental health service, if he will give details of the development plan for the roll out of A Vision for Change and the timescale envisaged; and if he will make a statement on the matter. [30653/13]

Addressing the generally accepted historic deficiencies in both the capital and non-capital aspects of our mental health services remains a priority for the Government. This is reflected in the fact that we are following through on our programme for Government commitments, with some €70 million provided this year and last year for a range of new posts and other specific initiatives relating to mental health and suicide prevention.

Notwithstanding progress on addressing the overall financial pressures still facing the country and the demands being placed on all areas of the care system, the HSE mental health budget increased this year, from approximately €711 million in 2012 to €733 million in 2013. The HSE service plan for this year indicates that the Galway-Roscommon local health office will receive approximately €69 million for mental health services in 2013.

The Deputy will appreciate that the HSE has statutory and operational responsibility for the planning and delivery of services at local level, including for the Roscommon area. It should be noted that the per capita spend on mental health services across Galway-Roscommon is the second highest in HSE West, at €220 per head of population, and is significantly above the national average spend of €160 per head. In short, there are significant resources in Galway and Roscommon mental health services, but there is also a need to review the current configuration of services. Both community and inpatient services are provided in Roscommon and are deemed to be the one entity in the context of the Galway-Roscommon local health office area.

Replacing the Central Mental Hospital, CMH, with an appropriate modern facility is one of the priority health projects set out in Infrastructure and Capital Investment 2012-2016: Medium Term Exchequer Framework. The Minister for Health announced in November 2011 that the CMH would be located at St. Ita's, Portrane, County Dublin. This project includes replacement of the CMH and also development of associated new facilities. Four regional intensive care rehabilitation units, ICRUs, are also planned, one of which will be located at Portrane. The further three ICRUs will be located in Cork, Galway and Mullingar.

Additional information not given on the floor of the House

A steering group for this project is in place and members include representatives from the Department of Health, the HSE, the Central Mental Hospital, the National Development Finance Agency and representatives from appropriate non-statutory stakeholder groups. The design team appointed in July 2012 is advancing the design for the project and this work is progressing satisfactorily. The most up-to-date position on reconfiguration of the national forensic mental health service facilities is contained in the current HSE capital programme.

On the wider implications raised in the question, implementation of A Vision for Change, the report of the expert group on mental health policy in 2006, and the reform of mental health services are a priority for the Government. Although implementation of A Vision for Change has been somewhat slower than expected, a great deal of progress has been made with the accelerated closure of old psychiatric hospitals and their replacement with bespoke new facilities, better suited to modern mental health care. Progress also includes shorter episodes of inpatient care and the involvement of service users in all aspects of mental health policy, service planning and delivery. There has been a considerable decline in the number of patients resident in psychiatric facilities, with numbers falling from 10,621 in 1987, to 2,812 in March 2010, representing a reduction of 73%.

A modern mental health service is best delivered in the community and in this regard the Government has provided an additional €70 million and almost 900 additional posts in the past two budgets, primarily to further strengthen community mental health teams in both adult and children’s mental health services, to develop forensic services, to advance activities in the area of suicide prevention, to initiate the provision of psychological and counselling services in primary care specifically for people with mental health problems, and to facilitate the relocation of mental health service users from institutional care to more independent living arrangements in their communities, in line with A Vision for Change. It is expected that the appointment by the HSE of a new director for mental health in the near future will greatly accelerate the pace of implementation.

I know the Minister of State is trying and is putting money into the service, but people are not happy with it. It is a very sensitive issue to discuss, but if people who have relations in the unit in Roscommon hospital are worried about it and telling me it is an appalling situation that must be addressed immediately, one must make a choice. One can either talk about it openly and potentially be accused of making people wary of using the services, or keep quiet about it, which lessens the chance that something will be done to solve the problems. There are problems, regardless of what people might admit is causing them, be it staff shortages or the requirement for a secure unit or whatever acronym one wishes to use for it. In fact, the lack of a secure unit is causing a major problem. It is causing a logjam which means that nurses and staff must be taken out of the community to deal with difficult situations in the unit. As a result, people who go to the local services in order that they can avoid going to the acute services end up having nowhere else to go but the acute services. Obviously something must be done.

I thank the Deputy for his question. The language used today is better. Ultimately, it is about language and we must be very careful not to discourage people from using the service when they need it. This is not a resources issue. There are 890 people working in the Galway-Roscommon service. They might not be in the right place, but they are in that area.

Those who work in this service have always dealt with very difficult people. It is the nature of the illness that people are unpredictable and do things unexpectedly. That is the reason we have professionals working in this area. We are working on this issue and must reconfigure the service. If we can have a service with the same number of staff relative to the same population base in other areas of the country that is an excellent, community-based service, clearly we must examine why that is not happening in Galway-Roscommon. I genuinely believe people must embrace change. I constantly hear calls for the roll-out of A Vision for Change and people saying it is not happening quickly enough, yet when one starts to do this, one tends to meet these bottlenecks. We really must begin to look at putting the service user at the centre of all of this.

I have no doubt that people are worried. Having listened to debate of the type heard on the radio over the past two weeks, I would also be worried if I had somebody requiring the service. However, there is no need to be worried as we have a service that can be excellent. It is a safe and secure service.

The bottleneck is not created by staff being unwilling to do X, Y or Z; it exists because when a very difficult patient who requires a far higher level of care than others is put in an unsuitable unit without CCTV and one-to-one care, rather than a purpose-built unit to ensure both staff and patient are safe, it creates a pull from the very community services that the Minister of State is advocating people should use. The lack of a secure, purpose-built unit is one of the major problems, although I acknowledge it would not solve the problem entirely. This needs to be dealt with quickly.

I understand that Ms Catherine Cunningham from the PCCC service and others are to meet the Minister of State in the next week or so on this issue. Even if they receive the thumbs-up and the Minister of State has a cheque on the day, progress will take some time. In the meantime, there will be a backlog. Even today, two families have contacted me on this matter, and they are still expressing serious concern. I hate to have to say that because it worries those who need to use the service. If it is a fact, however, it is a fact. All of these people cannot be wrong and they have nothing to gain from taking their stance. All they are getting out of it is absolute worry about their nearest and dearest who are at their lowest possible ebb.

Worry is not a basis for not using the service. The types of language and debate we have heard on this issue are such that I am not surprised people are worried. People who present with very challenging behaviour have always been dealt with by the service. That is what the mental health service does. In the main, 95% of people can be dealt with in the community but there will always be those who will require the acute unit and those who present with challenging behaviour.

The Central Mental Hospital, under Professor Harry Kennedy, has now developed a very good outreach service to guide local services for people who present with challenging behaviour. Before any call was made, he was already working on this because that is what the service does. The staff, who are specialists, are good at this, and that is what they do.

I acknowledge that Deputy Luke 'Ming' Flanagan has an interest in this area; there is no doubt about it. I plead with people to allow us to get on with what we need to do with mental health services. Let us reassure families who need reassurance that when their loved ones seek to avail of a service, it will not only be available but will also be safe and secure. We need to reconfigure, however. We cannot have a community-based service if all our staff are in the acute unit.

With regard to the review of the Mental Health Act, whose outcome I cannot predict, I have asked that the Mental Health Commission, which licenses only the acute unit, thereby resulting in the unit's very specific numbers, to start to license community-based programmes also so there will not be a continuous draw from those programmes.

Primary Care Services Provision

Billy Kelleher

Question:

74. Deputy Billy Kelleher asked the Minister for Health the timeframe for the delivery of the primary care commitments in the programme for Government; and if he will make a statement on the matter. [30751/13]

The Government is committed to introducing, on a phased basis, a universal GP service without fees within its first term of office, as set out in the programme for Government and the future health strategy framework. This policy constitutes a fundamental element in the Government’s health reform programme. This is the first Government in the history of this State to commit itself to implementing a universal GP service for the entire population.

It has become clear that the legal and administrative framework required to provide a robust basis for eligibility for a GP service based on having a particular medical condition is likely to be overly complex and bureaucratic. Relatively complex primary legislation would be required to provide a GP service to a person on the basis of him or her having a particular illness. The assessment system for such an approach would have to be robust, objective and auditable to have the confidence of this House as well as the general public. This legislation would have to address how a person could be certified as having such an illness, and who could do this, and how to select the diagnostic basis for medical conditions. There would also be a need for secondary legislation to give full effect to this approach for each condition. While it would not be impossible to achieve this, it would take several months more to finalise the primary legislation, followed then by the preparation of statutory instruments. This would entail putting in place a cumbersome legal and administrative infrastructure to deal with what is only a temporary first phase on the way to universal GP service to the entire population.

However, the Government is firmly committed to introducing a universal service within this term. The Cabinet committee on health has discussed the issues relating to the roll-out of the universal GP service. In doing so, it has considered the delay in the initial step and the importance of weighing the balance between, on the one hand, resolving the legal issues but with a further delay and, on the other, the need to bring forward an important programme for Government commitment with the minimum of further delay.

It has been agreed that a number of alternative options should be set out with regard to the phased implementation of a universal GP service without fees. The Minister and I have updated the Taoiseach on this matter and we expect to report back to the Cabinet committee in the near future. As part of this work, consideration is being given to the approaches, timing and financial implications of the phased implementation of this universal health service.

Additional information not given on the floor of the House

The Government has already made clear its commitment to delivering on the implementation of a GP service for the entire population by providing additional financial resources in the two most recent budgets. The HSE Vote now contains funding of €30 million for this year for an initial phase of the provision of GP services as part of this programme for Government commitment. The Government is determined to expedite the implementation of a national GP service for the entire population, something to which no previous Government has ever aspired.

The Government's credibility on this issue has been shattered. The programme for Government states, "Access to primary care without fees will be extended in the first year to claimants of free drugs under the long-term illness scheme at a cost of €17 million". We are in year three and there has been no roll-out of free GP care for long-term illness claimants nor has there been any form of expansion. We are no wiser about the Government position on the need for primary or secondary legislation or as to what will happen to ensure the programme for Government commitment is honoured during its term. The Minister of State said the Cabinet has been apprised of the issue and a decision will be made in the near future. Five weeks ago, we were told it would take six weeks for the Minister to come back with proposals on the best way forward to address this issue. The cost to the Exchequer of the full roll-out of this service will be €500 million in year five of the Government's term but the Minister of State could not even secure the €17 million required to cover long-term illness claimants. The senior Minister snaffled that last year. What is the position on the long-term illness commitment and the commitment to roll-out primary care in the programme for Government?

The Deputy referred to credibility. Not only did the Government of which he was a supporter and a member not get around to extending universal GP care but it had a policy opposing it. It is extraordinary for him to raise the credibility of this Government in those circumstances, given the policy position of the previous Government in opposition to universal health care. He will be wiser within weeks. We told the House that we will come forward with our alternative workable and achievable proposals in this regard by the summer. We are on course to do that and the Minister and I have discussed the issue as late as this week. We are having intensive work done. I have been engaged in intensive work on this in recent weeks. I have worked harder on this issue than any other in the Department to put together a set of proposals with their delivery times outlined, which is something we have not witnessed from any Government in the history of the State in the context of universal GP care, given its importance in the management of chronic illness and across the board. Money will be available and the Government has made clear its commitment to delivering on the implementation of this service. The HSE Vote contains funding of €30 million for this year for the initial phase of the provision of the service. The Government will deliver, as distinct from fail to deliver, on this fundamental element of health policy of the party opposite.

I never questioned the Minister of State's commitment but his delivery of this proposal is at stake here.

The difficulty is that while we are discussing these grand plans, letters are being circulated to people throughout the country, some in their 70s and 80s, by the primary care reimbursement service requesting a review of their medical card entitlement. I have raised this issue time and again, including with the Taoiseach. A constituent came to me in recent days whose wife has undergone a double mastectomy but who, because the household income is just above the threshold, will not retain her medical card.

People who are entitled to a medical card will retain it. The Deputy is misleading the House.

I certainly am not. I have raised this issue on many occasions. The case I mentioned is just one example of the circumstances in which people throughout the country now find themselves, as every Member of this House will attest. While we are discussing the Government's grand plan for primary care provision, people are being terrorised because they have been randomly selected by a computer system to have their eligibility for a medical card reviewed.

The Deputy is being irresponsible in the language he is using.

Some 40,000 people have already been selected for review, as far as I can ascertain. The grand plan has been announced but the day-to-day reality is that medical cards are being withdrawn and people who would previously have qualified on discretionary grounds are no longer being accommodated. That is the truth of the matter.

The Deputy should not use words like "terrorise" in this context. An additional 100,000 medical cards are being issued this year, although I accept that 40,000 have been reduced to GP-only cards. Additional cards are being issued all the time by the Health Service Executive.

Not on a discretionary basis.

To be clear, any person who is entitled to a medical card will retain it. I absolutely support the HSE's efforts to ascertain people's continued entitlement to a medical card. This will ensure that the huge resources necessary to maintain the medical card system will be used in the best way, for the benefit of those who are genuinely entitled to it. That is what the Government is about, and I expected to secure the Deputy's support in this regard.

Discretion has been withdrawn.

That is not true.

Residential Care Provision

Joe Higgins

Question:

75. Deputy Joe Higgins asked the Minister for Health if he will consider making budgetary provisions for specialist care available in respect of a person (details supplied) in County Cork. [30837/13]

The HSE has advised that the individual concerned was previously accommodated in a 24-hour residential facility up to her recent admission to St. Finbarr's Hospital. She receives medical input by means of twice weekly ward rounds from the treating consultant. A structured timetable of activities at a day centre has also been developed, and staff members at the centre continue to encourage the individual to attend these activities. Senior clinical psychologist support by the nursing staff continues to provide the necessary ongoing support and interaction for the client.

The HSE has stated that the north Cork mental health services will continue to provide the best available care to the individual in line with HSE resources and priorities and that the ongoing recovery of the person is of paramount importance to the multidisciplinary team responsible for her care. As there is no budget provision for any private care options at this time, the HSE indicates that it is not in a position to provide any additional services over and above the assessed requirement for the specialist acute service currently provided by St. Stephen's Hospital.

My question relates to a 40 year old autistic woman, whom I shall call Emma, who received a diagnosis only six years ago. As the Minister of State knows, a highly functioning autistic person can be bright and intelligent while also facing very serious issues in regard to social adjustment and so on. To clarify, Emma is currently being cared for in St. Stephen's Hospital, not St. Finbarr's Hospital.

Yes, I referred in my reply to St. Stephen's Hospital.

I accept that the Minister of State simply made a mistake.

The problem here is not the quality or commitment of Emma's carers. In fact, her mother, who is in the Gallery today, has expressed her appreciation for what the staff have tried to do. The problem is that Emma is not being cared for in the appropriate location, having been dealt with more as a patient with mental health or intellectual disability issues rather than specifically autism issues.

I appeal to the Minister of State to talk to the HSE, even to get the 12-week residential assessment in a particular location that has been pinpointed by her specialist. That would be a good beginning.

I do not think there is any disagreement here. We know that there are people who have a dual diagnosis, who have anxiety, depression and other mental health issues, even people who have a disability diagnosis. Last year we did not allocate any posts in the areas of disability and old-age psychiatry. That is the priority issue for this year. With regard to this woman's mental health difficulties, she is in a very good service. Obviously, it would be better if the service could have been provided in her previous location, but that could not happen. The priority in this instance is to ensure that she recovers to good mental health and that she can return to a more appropriate setting, as the Deputy rightly says. The priority at the moment is the mental health issue.

We are talking about a human being with very specific needs, as we are whenever a difficult situation such as this arises. The problem is that this woman will not make the necessary progress if she is not receiving treatment in a location that is specifically geared towards the special needs of a person with autism. That is the issue, not the quality of care or the staff, whom her family praise. She really needs the specialist input of those who deal on a daily basis with autism issues. This is in the Minister of State's area. Will the Minister of State have a real dialogue with the HSE and, even if it will not make a long-term commitment about a specific health care centre that has been named, at least ask it to provide the opportunity for a 12-week residential assessment? The matter can then be taken from there.

I cannot give any commitment. It is very clear that there is no budget for private facilities. The only commitment I can give is that I will contact the director of services for disabilities in Cork. We will see what can be done but I am not making any promises.