Vol. 874 No. 2
1. Deputy Billy Kelleher asked the Minister for Health his plans to implement his proposals for free general practitioner care for all children under six years of age; the projected annual cost of this plan; and if he will make a statement on the matter. [14852/15]
Will the Minister of State outline how she intends to implement the proposals for free general practitioner, GP, care for all children under the age of six and the projected annual cost of this plan?
I thank the Deputy for tabling this question. It is a significant announcement by the Government and in the future will be seen to be so. The announcement last week that agreement had been reached between the Department of Health, the Health Service Executive, HSE, and the Irish Medical Organisation on terms for the delivery of free GP care for all children aged under six years represents the first step in the phased introduction of a universal GP service without fees. This development underlines the Government's commitment to enhancing primary care and keeping people well in the community. It marks a shift towards promoting health and well-being and away from the old "illness model" of care.
The commencement of the service during the summer will make a real difference to the lives of the youngest in society. It is a major step forward in improving access, the quality and affordability of health care. Under the new arrangements, an additional 270,000 children under six years of age will benefit from GP care free at the point of service. All children under six years will benefit from the new enhanced service under the proposed GP contract. This will involve age-based health checks focused on well-being and the prevention of disease. These assessments will be carried out when a child is aged two years and again at age five, in accordance with an agreed protocol. The contract will also include an agreed cycle of care for children diagnosed with asthma. Under this cycle of care, GPs will carry out an annual review of each child diagnosed with asthma, not just the two health checks, as was said in the House last night.
It is estimated that in a full year the additional cost of the universal under-six service, including the preventive wellness checks and arrangements for the management of asthma in general practice, will be approximately €67 million. As the service is based on the “choice of doctor” principle, the next step is for the contract to be issued to GPs in order that they can decide whether to sign it. Contracts will be issued to doctors in the next few weeks.
The service should be ready to commence by early July. It will be preceded by a public information campaign and simple online arrangements for parents or guardians to register their children for the service. This registration can be completed by their GP in the surgery.
In the context of the announcement having taken place eventually and given that there is concrete evidence of some effort to roll out the commitments made in the programme for Government, will a Supplementary Estimate be required for this measure? If not, it could be interpreted that there has been a withdrawal of funding from other areas or that the funding will come from savings that have not yet been identified. Perhaps the Minister of State might clarify the matter. There appears to be an underspend in the mental health area, for example, and other key areas. If no Supplementary Estimate is required for this measure, is the funding coming from savings that have been identified but not yet published or from moneys that have not been spent?
I have said publicly that the money for the scheme will not be taken from other areas of the health service. In the budget for this year we estimated that it would cost approximately €37 million. The additional funding, for which we had to secure agreement from the Department of Public Expenditure and Reform, was signed off on by the Minister for Public Expenditure and Reform, Deputy Brendan Howlin. It will not be taken from any other budgetary area. We have not underspent in the area of mental health. Incidentally, we are still examining how we will spend the additional €35 million allocated for mental health services this year and have not yet made a decision on the matter. We are looking at different ways of providing services because clearly there is a blockage in delivering them. However, the funding for this scheme will not be taken from any other stream.
We need further elaboration on this issue. As the Minister of State said, only €37 million was identified as the figure that would be required to fund free access to GPs for children under six years of age. We now discover that the anticipated cost for the year will be approximately €67 million. Is the Minister of State hoping or envisaging that only some GPs will take up the contract in an effort to find savings in the scheme? Clearly, the money will have to be found somewhere because it was not identified in the original Estimates. There must either be a Supplementary Estimate, savings accruing in some other area or there will not be a full drawdown of the full €67 million identified as the cost of the scheme over a 12-month period.
If there is a need for a Supplementary Estimate towards the end of the year, there will be a Supplementary Estimate introduced. We are determined that not only will the scheme be taken up by everybody, to the advantage of every child in the country, but also that it will be funded in the way we have proposed. A Supplementary Estimate might be required towards the end of the year. At present, one is not required. However, the funding will not come from any other health area.
2. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if it is the case that the Health Service Executive recruitment embargo has resulted in a crisis in the executive's counselling services and dangerously high caseloads; that certain individual addiction counsellors in the executive working in the Dublin region are tasked with over 200 client cases; that no new counsellors have been appointed in the past year; that this is the first Government in 21 years not to have a Minister with responsibility for dealing with the issue of drug abuse; that the Government has presided over a 37% cut in drug rehabilitation services in the past five years; that there has been a failure to fill the 1,000 ring-fenced places for drug rehabilitation participants; and if he will make a statement on the matter. [14806/15]
I again point to the fact that there is no designated Minister with responsibility for dealing with the issue of drug abuse and seek to highlight the level of cutbacks in drug addiction services in the past five years, the HSE recruitment and replacement embargo, the reduction in the number of women accessing addiction services, the embargo on the recruitment of addiction counsellors in the HSE, the restrictions and difficulties experienced by support workers and the restrictions on access to rehabilitation schemes.
I am advised by the HSE that there are three addiction counsellor posts vacant in the Dublin region. Recently, these positions were offered to candidates on the relevant HSE national recruitment service panel. As no candidate accepted the offer of work in the Dublin area, a recruitment competition specifically to fill these vacancies is under consideration by the HSE. The ending of the moratorium on recruitment announced by the Minister for Public Expenditure and Reform in budget 2015 will give the HSE greater autonomy to manage its staffing levels within the overall pay framework.
Average current counselling caseloads within the addiction service are dependent on where a clinic is situated. The HSE has indicated that the average caseload ranges from 25 to 50 individuals and that there are no addiction counsellors with caseloads in excess of 200 clients.
Drug-specific community employment schemes make a significant contribution to the rehabilitation of recovering drug users. At the end of December 2014 there were 936 referred clients in drug rehabilitation places, which is close to full capacity. In any given year participants may exit for a variety of reasons, but there is a cycle of places becoming vacant and being filled on an ongoing basis.
Despite the economic downturn, cross-departmental provision for drugs programmes continues at a significant level, with over €240 million allocated for drugs initiatives last year. An extra €2.1 million has been provided in the HSE national budget for measures to target vulnerable drug users in 2015, in line with the Government's ongoing commitment to the national drugs strategy. This additional funding will support the expansion of residential detoxification and rehabilitation services, the continued provision of needle exchange services outside Dublin and a demonstration study for the use of naloxone in the prevention of opioid overdose. This initiative forms part of a major effort to reduce drug-related deaths by increasing access to naloxone for non-medical staff, such as the families or friends of a drug user.
I am fully committed to the drugs brief, and am eager to tackle the issues in the area in as comprehensive a way as possible. My Department is beginning work on the development of a new national drugs strategy for the period after 2016, and as Minister with lead responsibility I will play an active role in the development of the strategy. I look forward to engaging with all interested parties on the matter.
This is an area of major concern, yet it is the first Government in, I understand, 21 years where we have not had a designated Minister with specific responsibility for drugs. There has been a 37% cut to drugs services over the past five years, and this is showing itself in the strain experienced by people entrusted with the delivery of drug addiction services. They have to cope with significant caseloads, in particular in Dublin city where addiction counsellors are trying to cope with more than 200 individual cases each.
The challenge in any one of these is significant and that any one counsellor would be asked to cope with 200 client cases presents difficulties. It is very important that the real breaking points are noted in the current service, not only in the Dublin region but across the country. I ask the Minister, apart from the response he has given, to outline the measures he now intends to take to address this most serious area which is currently seriously under-resourced.
It is important to point out that the total cross-departmental budget for the drugs programme was reduced consistently throughout the period of the recession. It was reduced in 2009, 2010, 2011, 2012 and again in 2013. In 2014 in was increased from €237.5 million to €240 million and this year it is being increased again. When we had a dedicated Minister of State with responsibility for this area the budget was cut every year. Now that we have a dedicated Minister who is a senior Minister in the Department the budget is being increased. That may be lost on people, but when one controls the entire budget it is much easier to move small amounts of money into priority areas, which is what I have done.
Some 97% of those who are waiting on treatment will receive it within weeks, which is a very short waiting list compared to some of the waiting times that people may face in other areas. If people require treatment they can get it within weeks in almost all cases.
The Minister is correct when he refers to small amounts of money. What we need, given the crisis we face with drug addiction, is not the proposition that we add to the already chaotic situation additional areas of responsibility, such as alcohol or cannabis. We need to properly resource the area, if we are to take on board these other critical areas and not add to the impossible situation with which the current cohort of counsellors and those working with the services have to cope.
Before the Ceann Comhairle clips me once again with the clock, I would like to highlight the situation of women, in particular, and the fact that there has been a 13% drop in the number of women on special community employment schemes following the adoption of measures in a number of social protection Bills. These are being highlighted as responsible for the withdrawal of a significant number of women from drug rehabilitation services. I ask the Minister to comment on that, as well as the fact that the Government has failed to fill the 1,000 ring-fenced places for drug rehabilitation participants.
My final point is that despite three additional posts being offered we cannot get away from the fact that the Minister also confirmed that they have not been filled. No positions have been filled in this area over the past 12 months, something which needs to be addressed. It is not good enough to report that posts have not been filled. We need to proactively seek to recruit the additional supports that are absolutely necessary.
It is true that positions have not been filled in a number of areas across health, but this is not because of a lack of finance or effort by the front-line managers involved. We have moved from a situation where for years, all of the effort involved paring down staff, so when one then tells managers to start hiring a lot of people it creates difficulties. We are finding it difficult to recruit in some areas and in some parts of the country, but we are not giving up on that by any means.
Under the dormant accounts scheme, local drugs task forces did not have their budgets cut for the first time in seven years which was in recognition of the fact that they now have responsibility for alcohol. I can confirm that their budgets will be increased slightly this year because some of the money from the dormant accounts fund will be given to each local drugs and alcohol task force to do a specific project on alcohol in the area. The sums involved are modest but we are getting to the point where we will have an increase in funding this year.
Community employment schemes are the responsibility of the Department of Social Protection, as the Deputy will know, but I have been informed that considerable progress has been made on increasing the number of participants on community employment drug rehabilitation schemes. In December 2014, there were 936 referred clients, which is almost the full capacity of 1,000, of whom 644 were male and 292 female. Of the support workers, 103 were male and 117 were female. In total, 1,156 places were taken up, compared to only 655 when the Government came into office. I am also advised that there has been no change in the entry requirements for community employment schemes. Places are available only to service users who are in drug rehabilitation and are referred to a place by an addiction service practitioner, referral practitioners, key workers, case managers or counsellors, GPs, treatment centre practitioners or other health service practitioners.
3. Deputy Finian McGrath asked the Minister for Health if he will ensure there are no further cuts to ChildVision services for multi-disabled and blind children in Dublin 9; and if he will make a statement on the matter. [14804/15]
I ask the Minister of State to ensure there are no further cuts to ChildVision services for multi-disabled and blind children. For those who do not know, ChildVision is the national education centre for blind children and is based in Grace Park Road in Drumcondra, Dublin 9. It is an excellent service and over the past six years it has had to take cuts of some €821,000 or approximately 20%. Its costs of governing are in excess of €70,000 a year and it recently had additional costs in terms of registration feeds for HIQA of €50,000.
I thank the Deputy for tabling the question. I am pleased to take this opportunity to outline the current position in regard to the provision of financial support to ChildVision, the national education centre for blind children, Dublin which is an excellent service. It is funded by the HSE under section 39 of the Health Act 2004. Services are provided through a service arrangement which is signed on an annual basis and reviewed regularly. The HSE is committed to working with all voluntary disability service providers, including ChildVision, to ensure that available resources are used to respond to the needs of people with a disability, including blind and visually impaired people.
ChildVision was allocated funding by the HSE of over €4 million in 2014 to provide educational opportunities and support to over 500 blind and partially sighted children and young adults in a safe and nurturing environment. The HSE has held discussions with all voluntary health service providers regarding funding and service arrangements for 2015. The HSE has informed the Department that funding allocated to ChildVision remains at the 2014 level with no reductions planned. I understand that this was relayed to ChildVision recently. As I am sure the Deputy is well aware, the HSE will spend over €1.4 billion this year to provide specialist services and supports to those with disabilities.
I thank the Minister of State for her response and I hope the commitment to no reduction in funding in 2015 will be kept. I hope that is on the Dáil record. ChildVision is an excellent service, as the Minister of State has indicated, and the work and dedication of Mr. Brian Allen and the staff is above the highest standards. I visited the facility recently and was very impressed by the warmth and energy of all the staff and the people dealing with a very difficult issue.
Over the past couple of years, staff have had a take voluntary wage cuts of 10% and maternity leave was reduced by 50%. Staff costs have been reduced for lower-paid staff and there have also been changes to sick-pay policy and reduced staff numbers. ChildVision has also had to increase funding activity to meet the annual shortfalls. It has seen cuts in excess of €821,000. It has taken a hit and now we have an opportunity to ensure the service takes no further hit. It is an excellent service that must be developed and not cut.
I will not get into the reasons why people in this country had to take reductions in pay or the amount of money that the State could allocate to certain bodies. Even people at ChildVision would agree there were very difficult choices to be made. In 2014, ChildVision had its budget reduced by €25,000 and all disability agencies had similar reductions in that year. This represented half of the reduction required to meet the overall efficiency target reductions in 2014. ChildVision feared that in 2015 the reduction would be €54,000; however, the HSE undertook an evaluation of the impact of this reduction on voluntary agencies and has decided not to apply the full reduction in 2015.
I have been told by ChildVision that the shortfall for the 2015 budget is in the region of €120,000. We should focus on these issues. We can see the work the service is doing and it is delivering on efficiencies, reform and administration of services. ChildVision still needs basic services. It has a waiting list of 45 children, which must be dealt with in 2015. I urge the Minister of State to stay focused on services for these children who are visually impaired and blind, as well as the broader disability issues. We cannot have a position where people jump up and down about tax cuts in the next budget but we do not have adequate funding for services for blind or otherwise disabled children.
It is important that we clarify a point. It is not that I do not believe what the Deputy or ChildVision has indicated about the shortfall. However, the HSE imposed a reduction of €25,000 in 2014. That may have contributed to the shortfall but the reduction was €25,000.
4. Deputy Colm Keaveney asked the Minister for Health the way he proposes to address the increase in cases of electroconvulsive therapy being used against a patient’s will; and if he will make a statement on the matter. [14853/15]
The UN special rapporteur on torture has urged countries to place an absolute ban on forced medical interventions against people without their consent. That includes the practice of electroconvulsive therapy, ECT. The purpose of this question is to ask the Minister of State how she intends to address the increase in the number of cases of ECT being used on patients against their will. Will she comment on the matter?
Under the Mental Health Act 2001, the written consent of a patient is required where a programme of electroconvulsive therapy, ECT, is to be administered. When an involuntary patient is "unable" or "unwilling" to give consent, ECT may be administered if it has been approved by the consultant psychiatrist responsible for the care and treatment of the patient and also authorised by another consultant psychiatrist. Both consultant psychiatrists must be of the opinion that the administration of ECT would be of benefit to the patient and they must give reasons for their opinion. The Mental Health Commission has published rules regarding the administration of ECT. Adherence to these rules is monitored on an annual basis by the inspector of mental health services.
ECT usage in Ireland is low and in line with other European countries. The latest analysis carried out by the Mental Health Commission for which there is a breakdown available on the administration of ECT was published in March 2014. This relates to 2012 figures. The Deputy recently received figures on the total number of patients who received ECT without giving consent for the period 2011 to 2014. Of the 22 such patients recorded in 2011, I can confirm that only three were recorded as unwilling, while the remaining 19 were recorded as being unable to give consent. The Commission has not yet published a 2013 or 2014 analysis but provisional figures made available confirm that the number of patients who received ECT without giving consent in 2014 was 42. I am informed that only five of these patients were recorded as unwilling, while the remaining 37 were recorded as being unable to give consent. While the total number of patients receiving ECT without consent has risen from 22 in 2011 to 42 in 2014, it is important to note that there has only been a limited increase from three to five in the small number of involuntary patients administered ECT who were recorded as unwilling in that period. These figures need to be considered in the context of a total of 18,173 admissions to psychiatric units for treatment in 2012, of which 2,141 were involuntary admissions.
I have recently published the report of the expert group set up to review the Mental Health Act 2001. The group has made 165 recommendations, which include some important points on the administration of ECT. The main recommendation is that in future, it will no longer be possible to administer ECT to an involuntary patient who has capacity and does not consent to such treatment. I fully agree with the recommendations of the expert group and have instructed my officials to deal separately with the proposed amendments relating to ECT and ensure the legislation is amended as soon as is practically possible. This will ensure that in all cases where a patient who has capacity refuses ECT, this preference will be respected.
I thank the Minister of State for the response. In the absence of appropriate legislation, the manner in which the Minister of State approaches the political description of whether consent has been achieved is self-serving. Last year, 42 patients received ECT without their consent. The rate increased significantly.
It is true.
It is not.
If somebody is not in a position to give consent, there is no appropriate legislation to address capacity in the area.
There is robust legislation.
The Deputy should just put the points to the Minister of State, who may then reply.
It might not be what we would like.
When can we expect the assisted capacity legislation that would provide for the fairest approach to protect vulnerable people who are receiving a treatment that many people would not believe is applied in this day and age? It can be described as Dickensian or barbaric. Some medical experts in the area believe it is an appropriate intervention but it can be applied without consent.
We have legislation for the area, although it is not appropriate for the circumstances. Nonetheless, we have legislation. The Deputy is the Opposition spokesperson on mental health issues and he should be a little more measured in what he is saying. This is the Mental Health Commission's response and not mine; it is an independent body which takes these issues very seriously. The commission has now confirmed that, based on provisional 2014 figures, 42 patients were administered ECT without consent, with only five recorded as being unwilling. Whether the Deputy and I agree with that is entirely a different matter. The total number of patients administered ECT without consent has risen from 22 to 42 in the period 2011 to 2014, and hence there is reference to a surge in numbers. Those recorded as being unwilling in that period only rose from three to five.
The Deputy makes regular statements on mental health issues which are inappropriate. He is a spokesperson and this is a very serious issue. For example-----
The Minister of State's time is exhausted. I will let her speak again after the Deputy's contribution.
The Minister of State would like us to believe mental health decisions are not political and that, therefore, we cannot ask questions, but we live in a parliamentary democracy and I will hold her to account. On her response to Deputy Billy Kelleher's question, in the past two years the mental health budget was underspent by €70 million, which equates approximately to the budget for free GP care for children aged under six years.
Let us get back to the question.
It is politics. I know that the Minister of State does not like opposition or accountability, but she will be held to be transparent on the expenditure of public money and the delivery of public policy. She may not like this, but it is the ethos of parliamentary democracy. To return to the question-----
Thank you.
ECT is extremely traumatic and research suggests its effectiveness is debatable. According to the figures provided by the Minister of State, 42 involuntary mental health patients were forced to undergo ECT last year, which is an increase from 34 in 2013, 29 in 2012 and 22 in 2011. There is very clear evidence that non-consensual ECT on the increase in the public health service.
The word "forced" is nowhere to be found in the mental health commission's report. This is what the Deputy does. He had a story in the Irish Daily Star on Tuesday, 9 April and the alarmist element of his statements really worries me. I have a copy of the story in which he states people under 18 years who are admitted to adult acute units are left unsupervised. He also states that while staff may be vetted by the Garda, he wonders about the other patients. This is really striking fear into the parents of children in distress.
On a point of order-----
The Deputy had his say.
May I respond-----
This is Question Time. Will the Deputy, please, resume his seat?
From the minute under-age persons are admitted to an adult acute unit, they are "specialled", which means someone is with them one to one on a 24-hour basis in a single room.
Children are admitted to adult wards.
The Deputy should inform himself about his brief.
The Minister of State should inform herself about the cuts she is making to children's-----
This is Question Time.
The Minister of State is not answering the question.
Nowhere in the mental health commission's report is it stated anyone was forced. I inform the Deputy that I will bring forward legislation in the immediate future to outlaw the administering of ECT to people who are unwilling.
Finally.
That has always been my position as the Deputy would know if he took an interest in his brief.
If the Minister of State took an interest in anything, it would be an action.
5. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he will confirm from where the minimum 2% to 2.5% reduction in hospital budgets this year is envisaged to come; if he will address the deficit in acute services, as outlined in the Health Service Executive's most recent performance review; and if he will make a statement on the matter. [14938/15]
I seek to establish from the Minister how the acute hospital network is to function with what is described in the health service performance report for January as a minimum of a 2% to 2.5% reduction in the financial provision for the current year.
For the first time in seven years, the overall budget for health services has increased. The HSE will have €635 million more available in 2015 than was provided in the original Estimate for 2014. In addition, a minimum savings target of €130 million has been set in areas such as procurement, drugs and agency costs in 2015 and, in a welcome new development, further savings that can be achieved over and above the minimum savings target will go back into the delivery of health and social care services. In the past three weeks additional funding has been sanctioned for primary care, the fair deal scheme and the opening of community and district hospital beds.
Approximately €4 billion is being made available to acute hospital services in 2015. A further €900 million comes from insurers and charges paid by patients to hospitals. This represents a very significant increase in hospital budgets compared to the original provision last year. When compared with the 2014 expenditure outturn, taking account of overruns which should not have happened in the first place, there is a modest reduction of approximately 2%. These savings are to be achieved in the manner set out in the HSE service plan and include savings in procurement, reductions in drug costs and the reduction of agency and overtime expenditure through more appropriate staffing and workforce planning, including taking on additional staff.
The HSE national service plan includes a robust accountability framework and the HSE is in ongoing engagement with the hospital groups to ensure a comprehensive and robust assessment of emerging financial pressures and appropriate measures to deal with same. The service plan recognises that the allocation of more realistic budgets brings with it a requirement for greater accountability to ensure services are delivered within the budget provided. The commitment of the management and staff of hospitals will be key in ensuring the best possible outcomes are secured from the €4 billion budget within which hospitals must operate in 2015.
After saying so much the Minister finally acknowledged that the acute hospital network was expected to function within a reduction of the order of what he stated was 2%, but it was stated in the health service performance report for January that at a minimum the reduction would be 2% to 2.5%. We already know that the acute hospital network is facing severe resource difficulties. Last year there was a Supplementary Estimate and we know that legislation has been passed whereby, allegedly, there will be no more Supplementary Estimates and that so-called overspend figures will be carried forward. This is only laying the foundations for a future crisis. There can be no other way to describe it. The report indicates that acute hospitals reported a €10.6 million deficit for January alone. I do not yet have the figures for February and March, but perhaps the Minister might. If he does, do they mirror the January figure? If that is the case, does it not tell him that we are simply not able to deliver even on the same level, let alone more with less? The heroic efforts of those working at the coal face on hospital sites face ever greater difficulties.
Budgets vary from hospital group to hospital group and from individual hospital to individual hospital. All hospital groups and hospitals have had an increase in their budget allocation in 2015 over 2014. What we have not done is allow them to incorporate their entire overrun last year into their base for this year. This is very different. We cannot have a situation where hospitals overrun by 15% or 16% and receive a further 2% on top of this for the next year. We will not allow this. The Deputy has clearly read the performance assurance report, PAR, but he has been quite selective in the sections he mentioned. What is very interesting and of concern about the figures for January and February - the figures for both months are similar - is that hospitals are spending more money and have more staff but fewer patients. The numbers attending emergency departments decreased in January. The number of elective admissions also decreased. What happened in January and February was that hospitals hired more staff and spent more money but saw fewer patients. That is not acceptable. It is very important that hospital managers and chief financial officers understand this and get to grips with it in the coming months.
When it comes to selectivity, the Minister is the ace player, about which there can be no question. He spoke about fewer people presenting, but we have not forgotten what January was like. As I understand it, it was a crisis time with the numbers presenting.
No-----
I am most curious to see the statistics to which the Minister referred.
They are included in the report which clearly the Deputy has not read.
The fact of the matter is that there was a crisis period through January, February and into early March. The report to which I referred states very clearly that while a more realistic budget for acute services was provided in 2015, it was not possible to provide a budget at the full level of the 2014 spend. The Minister is very happy to speak in terms of what was allocated at the outset of 2014, but he is completely ignoring the reality in terms of the additionality which had to be provided to meet the real cost o the provision of acute hospital services through 2014. The report clearly states final expenditure levels for 2014 mean that costs in acute hospitals need to be reduced by approximately 1.2% to 1.4% below 2014 expenditure levels and pay and that other cost pressures must also be dealt with. These will result in a likely cost reduction in 2015 of approximately 2% to 2.5%.
The Deputy is over time.
I beg your pardon. These are the facts and I want to know what the Minister will do about them. Will he ensure the allocation of proper resources?
Other Deputies, called backbenchers, want to have their questions answered also.
It is clear to me that somebody compiled a briefing note for the Deputy, but he has not read the HSE's PAR for January.
Not true.
If he had read it, he would know that attendances at emergency departments were down in January compared to January in the previous year.
The numbers of emergency and elective admissions were down. Despite this, there were problems with overcrowding. There were additional staff and an additional spend. That is not acceptable.
There was overcrowding despite the reduced numbers.
That cannot continue for the next couple of months. It seems that one of the major factors was the fact that there were so many delayed discharges, which was reducing bed capacity. That is why the additional money is being provided for community beds under the fair deal scheme, to free hospitals of the current level of delayed discharges in order that they can operate more effectively. That is under way. It will happen in the next couple of weeks and should allow them to employ their resources more effectively. Savings are supposed to come from turning very expensive agency staff into staff with proper contracts, whether fixed-term or permanent, from savings in procurement and from any reduction in drug costs we can achieve during negotiations with the industry. Reference pricing will also help to bring down bills for hospitals.
