This question is in the name of Deputy Emer Higgins but will be put by Deputy Richard Bruton.
Ceisteanna Eile - Other Questions
Home Care Packages
Emer Higgins
Question:6. Deputy Emer Higgins asked the Minister for Health the steps his Department is taking to address the long wait times for home care packages in CHO 7; and if he will make a statement on the matter. [61343/22]
How far are we from achieving consistency in the delivery of home care packages? CHO 7 is highlighted in the question, but I would also like to hear what progress is being made in developing the statutory home care system, which I understand is being piloted? I believe this would achieve the sort of consistency we have not been able to deliver to date.
In 2023, the overall budget for home support will exceed €700 million. Over the last three budgets, I have secured more than €200 million in additional funding for home care support, a 42% increase since 2020. I thank the Minister for Health, Deputy Stephen Donnelly, for his support, and that of the whole Government and Cabinet, in ensuring this particular funding has been provided.
I am in the unique position that I have the full provision of funding I need to deliver home care to 56,500 people every day. The problem, unfortunately, is that as of today, we still have 6,200 people on a waiting list. Their care is funded - I cannot be clear enough about that - but we do not have the staff to provide the services at the moment.
Last year, we delivered 20.9 million hours of home care. Already, we are 6% ahead of target this year. We are seeing more people being referred for home care supports. The three main provisions to protect people and support people to age well at home are home care, day care centres and meals on wheels. We are doing a huge amount of work in this area. I am very concerned about the lack of staff, especially at weekends and in rural areas, when it comes to delivering home care. This year, I put in place strategic workforce advisory group. This is a very important committee that works across Departments. It also includes representatives of those who provide supports from the private, public and voluntary sectors. The group made 16 key recommendations and I have endorsed every one of them. The Deputy may have heard that last week, the Minister of State, Deputy Damien English, and I announced the provision of 1,000 permits for home care workers from outside of the EU who will be able to apply from January. We know this initiative has been successful because to date more than 2,540 people have come into the nursing home sector on these permits.
I commend the Minister of State on her efforts. I am interested to know how close she is to getting some sort of consistency across the country. The intent of the statutory home care scheme being piloted is to achieve consistency in standards and access.
Are we in a position to plan for the delivery of that statutory scheme? That would give staff more confidence in the long-term prospects of a career in this sector. Will the Minister of State update us on whether we can move to that type of design? That would deliver across the country.
We have been working very hard on the statutory home care scheme over recent years. We lost time during Covid. I would be the first to admit that.
The Deputy is right that we need the same standards in respect of home care the length and breadth of the country. The interRAI, which is the single assessment tool, is what will provide that.
I secured funding in my very first budget to hire 128 assessors, and they are being recruited at the moment. We have four pilot sites operational. The pilot sites started early last year. We had challenges in respect of staff. I have asked that the pilot be allowed to run longer because we need to get the relevant data in respect of the four pilot schemes. They are under way in Cork, Galway, Dublin and the midlands. I look forward to receiving those data.
We want to make home care a really attractive career proposition for people who enter the home care market. The recommendations, which I will address in a moment, will help.
I need not remind the Minister of State of what the Minister said recently when answering questions about Beaumont hospital. The big problem is that we have a very expensive resource but delayed discharges because we do not have this service. I remind the Minister of State, although I do not think she needs reminding, that this is key to the efficient working of the entire health service.
There are a great many home care workers the length and breadth of the country. To be fair, 56,500 people will receive home care today. Many will receive more than one visit during the day. However, we are seeing many more complex cases as a result of Covid and more referrals from GPs and public health nurses for people to avail of this service. The Deputy is right that if there are blockages in the community system, there will be blockages in the acute system. Two of the main recommendations were that when people are paid for providing home care, the minimum they be paid is the living wage, which is currently €12.90, and that they should receive mileage if they have to travel. I hope all these changes will make a significant difference.
I am aware of cases in which the patient is in hospital and has been deemed eligible for a home care package but has not been able to get it, and then the hospital charges the patient for the extended stay. The hospital charges the patient because the other end of the HSE service cannot provide the home care that is necessary. Will the Minister of State make it clear today that hospitals should not charge for extended stays where, through absolutely no fault of their own, patients cannot go home for health and safety reasons because home care is not in place? Will the Minister of State instruct the hospitals not to charge those patients? Where bills have been issued, can they credit those bills? It is not the patients' fault that they cannot get the care for which they are eligible and which is necessary for their health and safety.
I thank the Deputy for raising this matter. I was not aware of it. I know that in my area, for example, there is huge provision of community and step-down beds and transitional beds for up to 11 weeks for people who it is deemed no longer need to be in an acute hospital and whose consultant has said they need only community or step-down care. As the Deputy will know, we are abolishing all inpatient charges in hospital settings next year. If she wishes to forward me any of the details of those cases, I will certainly have them looked at.
I will do so. I thank the Minister of State.
Question No. 7 taken after Question No. 8.
Hospital Facilities
Colm Burke
Question:8. Deputy Colm Burke asked the Minister for Health if he will put in place a new mechanism to fast-track the process for the design application for planning permission for the building of the new elective hospital for Cork, in view of the fact that over 12 months have already passed from the time the HSE made its submission to his Department; and if he will make a statement on the matter. [61133/22]
I thank the Minister for the announcement yesterday identifying the sites for the new elective hospitals in Cork and Galway. Is it possible to put in place a new mechanism to fast-track the process for the design, the application for planning and the building of new elective hospitals? This project, from the time the HSE lodged the documentation with the Department of Health, has already taken over 12 months for a decision to be made. I know it has to go through a process but from now on can that process be fast-tracked?
I thank the Deputy for the question. I was delighted yesterday to secure Government agreement on both those elective hospitals. I know Deputy Connolly has tabled a question on the Galway one.
It is worth spending a moment to reflect on what a difference these hospitals will make. The Cork hospital, which, as Deputy Burke will be aware, will be at Sarsfield Court, will have nine operating theatres, a number of outpatient clinics and a lot of diagnostics facilities. It will employ more than 300 staff. Critically, because it will be an elective hospital, patients and clinicians will know that when patients are scheduled, those surgeries, procedures, appointments and scans will happen and will not be pushed out by emergencies coming through the emergency department. There will be about 180,000 healthcare events in the hospital in any given year, about 44,000 day-case and minor operations, about 23,000 endoscopy procedures and about 76,000 outpatient diagnostics and treatments. That is equivalent to about 600 patients a day, every day, and will make a major difference.
The question Deputy Burke poses is exactly the one I have been posing. We are working on it and it has taken time to get to where we are now. Unfortunately, that is because of the public spending code. There are, I think, 17 steps involved. I was looking this up this morning in preparation for these questions. There are 15, 16 or 17 steps. It takes a very long time. We know this was put in place after the national children's hospital cost overrun in order that we could manage the risks in respect of cost. The plan is that we would have the two hospitals in Cork and Galway open with patients in them by the end of 2027, five years from now. As part of the agreement yesterday, I have requested, and the Government has agreed, that my Department and the Department of Public Expenditure and Reform work together to find additional opportunities to speed the process up.
I very much welcome the decision. The Cork site is the right one. The fact that it is over 100 acres means that even if it is started with a small step, there can be expansion in the next ten, 15 or 20 years. I therefore very much welcome the decision by the Minister and the Cabinet. However, the issues are how long it will take to get a design done, then go through the planning process and then go out for tender to get the builders in. It is important we try to speed this process up. It should be remembered that the population of the Cork area has gone up by 170,000 in the past 25 years. That is a huge increase without any increase in real terms in hospital facilities. That is the reason this issue needs to be prioritised and delivered at a very fast pace in order to cater for the demands on services in the area.
I fully agree. If we think through what is required now, while five years seems like a very long time, and, obviously, we would love these facilities to be in place tomorrow, tendering for detailed design, the detailed design itself, securing planning, tendering for construction, the construction itself and then commissioning, unfortunately, take quite a bit of time. One of the advantages we have on both sites is that it is our land and we are not looking to take private land with any complexities that might entail. Critically, as the Deputy said, one of the attractive features of this site is that we have an awful lot of room to expand. As he will be aware, what was agreed yesterday is phase 1, which is the day-case element. There is an agreement that the design will incorporate both phases, which would include an inpatient facility as well.
I welcome that, but there is also a need at a very early stage for the HSE to engage with the local community. Sometimes the way we do planning is such that incorrect information gets out. I ask that this be taken on board because I do not want any delay on this. It is important that we work with the local community in Glanmire as well. There has been a huge increase in population in the area and it is important there is that engagement. However, we must fast-track this project for the benefit not only of all people in Cork but also everyone in Munster.
I fully agree. I will add two points to that.
The other thing we secured agreement on yesterday was five new surgical hubs. These are based on the Reeves day surgery centre in Tallaght hospital, which has been successful. It consists of four operating theatres for day cases only. It has not been fully open for two years, yet Tallaght hospital has seen a 58% reduction in its day case list over that period. Believe it or not, the number of patients waiting more than three months for day case surgery in Tallaght has fallen over 90% since the Reeves day surgery centre was opened. Cork will get one of these centres, as will Galway, Waterford and Limerick, and there will be a second one in Dublin. Critically, based on how long it took Tallaght, we believe we can have patients in these centres within 18 months, which will help.
A lot of extra investment is required in healthcare in Cork. A really nice investment in the Mercy hospital is coming on line, while Cork University Hospital has five large and important capital investment projects that we are looking to prioritise.
Hospital Waiting Lists
Richard Bruton
Question:7. Deputy Richard Bruton asked the Minister for Health if he will indicate the new capacity planned for 2023 in clearing waiting lists within the public system and through the NTPF; the estimated number of additional outpatient first-time consultations and the number of additional procedures which will be facilitated in each case; and if he will make a statement on the matter. [60854/22]
I know €450 million has been set aside for next year to address waiting lists. What can this deliver in terms of the number of procedures? In respect of interventions delayed during Covid being prioritised, how will that work?
A very large amount of money, €443 million, has been allocated. The figure for this year is €350 million, while there was a lower figure in quarter 4 of last year. All of this is beginning to accelerate and provide improvements for patients. Of the €443 million for next year, €123 million is recurrent funding being sought to improve and speed up various patient pathways. Dr. Colm Henry, the chief clinical officer, is taking the lead on those.
There is €240 million to continue tackling the waiting list backlogs. This includes funding for the NTPF and it is making very good progress. There will be additional and one-off funding for the HSE to use across the country.
Part of the remaining €80 million will be used to ensure access to the diagnostics scheme increases. This has been a really successful scheme. Last year, we allocated €25 million. It was the first time GPs had direct access to diagnostics for their patients. We got very positive feedback from GPs. I think 138,000 scans were done with that €25 million. This year, we have increased the allocation to €35 million. My understanding is that we will exceed 200,000 scans this year, again keeping pressure off hospitals and emergency departments. The figure will increase to €47 million next year so in two years, we will have gone from zero to €25 million to €35 million and then €47 million. This gives a sense of the scale of the money and how it is being deployed.
I know the NTPF has tended to prioritise certain high-volume procedures. Will the resources be concentrated on those or can we expect the NTPF to extend the procedure list? How is it proposed by Dr. Colm Henry or others to identify the delayed interventions that occurred during Covid and have no doubt resulted in a need to reassess the priority of different patients on the list? Will there be a process to ensure that with this money, we get to the patients with the greatest priority?
The NTPF is working very well. We funded it to provide treatment for any patient waiting more than six months for up to 15 high-volume procedures. That will increase to 20 high-volume procedures. I am pleased to note that as of the end of last month, 80% of patients waiting for more than six months for these procedures have been authorised for NTPF treatment. It is going very well.
How are the bottlenecks in patient flow being identified? Comprehensive work was done last year and this year across the system. It involved going patient pathway by patient pathway and hospital by hospital. It identified bottlenecks at granular level. Sometimes it was additional capacity such as theatres or MRI machines, while at other times it came down to decisions that three more nurses were needed here, two theatre nurses were needed there and a respiratory clinician was needed over there. It is being done at a granular level to do what the Deputy alluded to, namely, identifying the bottlenecks and investing in tackling them.
Question No. 9 taken with Written Answers.
Hospital Facilities
Catherine Connolly
Question:10. Deputy Catherine Connolly asked the Minister for Health further to parliamentary Question No. 314 of 24 November 2022 and the national development plan commitment to deliver a cancer care centre, with appropriate infrastructure, at University Hospital Galway, if the HSE's national capital and property steering committee has commenced its review of the project; the expected timeline for the steering committee to make its decision on the proposed cancer care centre; the details of any planned interim cancer care infrastructural improvements for the hospital, particularly in view of the fact that the 2019 options appraisal for model 4 hospital services identified the existing facilities as "in urgent need of replacement"; and if he will make a statement on the matter. [61359/22]
I welcome the news of a new elective hospital yesterday. I hope it is the start and part of the overall new hospital that is needed but in due course, we might get clarification on that. My question is one of five seeking clarification on the situation in Galway and concerns a cancer care centre. I wish to know precisely what the position is with that. I ask this question in the context that there were 51 people on trolleys yesterday in Galway, most of whom were in the accident and emergency department, and in the context of the options appraisal.
I thank the Deputy for her comments on the elective hospital. The national cancer centre is being looked at. I have had meetings on it in the past few weeks. It is an important project. As the Deputy rightly says, it is one of several significant investments in healthcare in Galway. We had agreement yesterday on the elective hospital. A proposal, which I support, is in for a seven-storey emergency and women and infants' block, which is actually the size of a small hospital. It is a huge piece. I have been discussing with the hospital team the need to upgrade the laboratories. The hospital also has a proposal in for additional bed blocks.
An ambitious proposal is being developed for a cancer care centre in Galway. The project would cost significantly in excess of €100 million so we will go through the public spending code and the HSE capital projects manual and approvals protocol. The strategic assessment report, which is one of the important stages, is being reviewed internally in the HSE. It is intended that this report will then be submitted to the national capital and property steering committee as soon as possible. If that is approved, it will be sent to me for consideration.
The Government is committed to ensuring the continued improvement of cancer services at University Hospital Galway and the region. As the Deputy will be aware, an important new service, a radiation oncology facility, will come on line in the coming months. This is a state-of-the-art facility with several linear accelerators and will be cost €56 million. It is only one thing that is needed but it will be an important additional service for patients in the region.
That was the options appraisal. I have a small library in my office related to Galway. "Not fit for purpose" is the comment from former Taoisigh and Ministers. A letter from the hospital's consultants and doctors to all Deputies and Senators, dated 1 November, told us about the state of the hospital. They tell us the main hospital was built in 1956, while Merlin Park was built in 1954. They told us that 95% of Merlin Park and 64% of University Hospital Galway is not satisfactory, unacceptable and not fit for purpose. Given this context and years of asking for a brand-new hospital, not an elective hospital but a brand-new one, as identified in the options appraisal, there is now confusion regarding this.
Regarding cancer care, the region has between 800,000 and 1 million people. I am concerned that we are going backwards. I am very familiar with these gates. I do not wish to be familiar with them but I must be. We are at gate zero. On the last occasion, the report told us that the national capital and property steering committee was reviewing the matter. The Minister's reply today tells us it is being reviewed internally. Will the Minister clarify this inconsistency?
The proposal is being progressed and is working its way through the various stages. The public spending code is a very laborious process. It was put in place after the cost overruns at the national children's hospital. There is a balance to be struck between managing the costs in the public interest and trying to build facilities as quickly as possible.
I would like to see these things moving a lot quicker. I do not think we are good at putting in place healthcare infrastructure quickly enough. When it gets put in place it tends to be of a very high quality and capacity, but I share the Deputy's frustration. However, the project is moving forward and it is worth noting that a lot of investment is going into the hospital, for example, in the radiation and oncology building, as I said. There is a new 12-bed cardiothoracic ward, in which have made a €5 million investment. I met the team there recently, and the ward is making a big difference to patient waiting lists. It is true that projects of this scale unfortunately take a very long time and I think they probably take too long, but it is only one of several very big healthcare investments that are being made in Galway and the hospital.
There are 150 acres at Merlin Park University Hospital. A site has been identified for a new hospital within that. I welcome the fact that we are progressing with the development of an elective hospital. On 24 November I was told that the Saolta University Healthcare Group has made a capital submission to the national capital and property steering committee. Today, we have learned that it is not with the steering committee, and that it is with the HSE for an internal view. I appreciate that the Minister has a difficult job. Like other Deputies, I have taken the trouble to put questions to the Minister for Public Expenditure and Reform. We have not even got to gate zero in the process. One question is undermining the other question. It is extremely difficult for the Minister to be on top of the stages of the process from gate 1 to gate 5 or 6, or whatever it is. We are not making progress. If we were, we would not have received a letter from the consultants appealing to all Deputies to act on a cross-party basis to do something about this issue. I have many other questions, but I will keep within the time limit.
I am more than happy to look at whether there is a discrepancy in the answers that the Deputy has received. The update I have received is that the submission will be going to the property steering committee shortly. I am more than happy to look at that. Importantly, I reiterate that I have met the clinicians and I have visited Galway a few times. I was there recently and we talked about various capital investments. I have met colleagues from around the House to discuss the issue. I fully acknowledge the strength of the case for a regional cancer centre. University Hospital Galway has one of the eight national cancer centres, and as has quite rightly been pointed out, there is a deficit in the capacity available for cancer care. It is something that we are very aware of and we are looking at. We will prioritise it.
Apologies, I meant to bring in Deputy Conway-Walsh before the Minister responded.
I appreciate the fact that the Minister has met with the clinicians. He will know that the clinicians have done a huge amount of work on this. They are really busy people, but they have an expertise and they really care about what is happening in the region. The truth is, as the clinicians have pointed out, if you live in that region and you are accessing the cancer services there, it is not the same as accessing them in another part of the country. We need to bring equity and fairness to the situation there. That is why the centre is so important. What concerns me is the number of hours that are lost because the beds are not available for the cancer patients. I do not know if any evaluations or studies have been done on the number of hours that are lost when there are consultants there but no beds are available to bring the patients in. Appointments are cancelled, sometimes at the last minute, because there are no basic beds there for patients.
There are two sides to this. I would agree with Deputy Conway-Walsh's comments and indeed, those from the clinicians and the hospital that we need more beds and facilities. However, there is an awful lot more that they could be doing with what they already have. For example, the last time I met with the team not long ago, they said that they needed more diagnostic suites and theatres. I asked how often they run the diagnostic and theatre services. Broadly, those services are run from 9 a.m. to 5 p.m., Monday to Friday. The first thing we need is not more theatres, but more theatre nurses to run the theatres that are in place for longer. In fact, it is one of the core points in the new consultant contract. We have to get away from running theatres, diagnostic suites and outpatient clinics from 9 a.m. to 5 p.m. or 9 a.m. to 6 p.m., Monday to Friday. It does not work for patients. Yes, we need more investment, but we must also put the question back to the hospitals and the clinics. Theatre and diagnostic services need to be available outside the hours of 9 a.m. to 5 p.m., Monday to Friday, and patients need to be discharged at the weekend, which typically does not happen, to free up more of those beds. That needs to happen as well as the additional investment.
Disability Services
Marc Ó Cathasaigh
Question:11. Deputy Marc Ó Cathasaigh asked the Minister for Health the steps that his Department is taking to address the barriers to the recruitment of occupational therapists into the HSE, particularly to address the delays in the provision of handwriting assessments for children; and if he will make a statement on the matter. [61337/22]
I will start with a specific question and then broaden the discussion out. The specific question is on the issue of handwriting assessments, and the broader issue concerns occupational therapy. I ask the Minister the steps his Department is taking to address the barriers to the recruitment of occupational therapists into the HSE, and particularly to address the delays in the provision of handwriting assessments for children; and to make a statement on the matter.
I am taking this question on behalf of the Minister of State, Deputy Rabbitte. The Government is committed to delivering real and tangible solutions to enhance services to better support the needs of children with special needs in Ireland. The current delays in accessing therapy services, directly related to vacancies across the children’s disability network team, CDNT, network are acknowledged. Work is ongoing by the HSE to maximise the capacity of CDNTs via recruitment campaigns.
Funding has been provided for additional posts in recent years to enhance the capacity of the teams to ensure services can be provided. This funding provides for over 600 whole-time equivalent posts. The funding of these additional posts, including occupational therapists who can assist with issues relating to handwriting, is intended to increase capacity across teams and shorten waiting times. These additional posts are testament to this Government’s firm commitment to support the established CDNTs to prioritise interventions for children with complex needs. However, the HSE is experiencing ongoing challenges recruiting staff across a range of disciplines to fully staff each team. The HSE continues to work to ensure timely access to children requiring occupational therapy services, and to reduce waiting times for these important services.
Like so many of these things, this question arises from a specific query. The Minister of State, Deputy Butler, will know the lay of the land well. It concerns the reconfiguration of services in County Waterford. A constituent in Tramore was transferred to the Dungarvan CDNT. After making an inquiry on her behalf, first of all I was told that the child's mother had waited for a number of weeks for a reply and an apology was made. That did not surprise me because I waited a number of weeks for a reply. If you contact the office, you get an automated response saying messages will be checked once a week. The child in question was told that unfortunately, the CDNT manager was not in a position to confirm when the child, who is 15, will be able to access the service. The child was further told that they will be able to access adult services when they turn 18, in three years' time. I find it very difficult to go back to that parent and tell her that we are instigating a recruitment campaign to shorten waiting times some time in the future, when she has been told that her child will not be seen for services as a child and has to wait to become an adult.
I assure the Deputy that the HSE is committed to delivering efficient, high-quality occupational therapy to all eligible service users. The Minister of State, Deputy Rabbitte, is aware of the situation. I understand that she has met with representatives of CHO 5 in the hope that it can be resolved. She is aware of the issue. The Government is committed to delivering real and tangible solutions to enhance services to better support the needs of children with special needs. The current delays in accessing therapy services, which are directly related to vacancies across the CDNT network, are deeply regretted. Funding has been provided for additional posts. This funding provides for 475 whole-time equivalent posts. The additional posts are intended to increase capacity across teams and shorten waiting times. I will bring the Deputy's concerns back to the Minister of State, Deputy Rabbitte.
I have corresponded with the Minister of State, and I acknowledge that she is very proactive in this space. However, there is a persistent problem in the particular CDNT to which I have referred. It needs to be addressed and the issue needs to be resolved for the sake of the children and parents who so desperately need access to those services.
In October of this year, a survey of occupational therapists in Ireland found that more than two thirds of occupational therapists have experienced burn-out as a result of the job in the last 12 months and cite lack of staffing as a significant factor. They are being asked to carry too much in terms of workload.
There is a need for the Minister of State's Department to engage very proactively with the Department of the Minister, Deputy Harris, to make sure we are producing a sufficient number of graduates. The Minister of State needs to engage with the Department of Enterprise, Trade and Employment to ensure people are brought in and given the proper work permits. We need career guidance in secondary schools to tell people there are huge opportunities to make a difference here while having a worthwhile and productive career. I cannot just keep going back to parents to identify the problem. I have to start identifying solutions.
I thank the Deputy again for raising this issue. The HSE is continuing to explore a range of options to enhance the recruitment and retention of essential staff across all aspects of the health service. The Deputy suggested there is a role for the Department of the Minister, Deputy Harris. I absolutely agree with him. We can highlight these vacancies but also the opportunities for young people.
In addition, the HSE is working collaboratively with the CDNT lead agencies at CHO level to market CDNTs as an employer of choice in a competitive employment market. Each lead agency is responsible for recruitment of staff under CDNTs and is using a variety of approaches to fill funded vacancies.
Question No. 12 taken with Written Answers.
Health Strategies
Steven Matthews
Question:13. Deputy Steven Matthews asked the Minister for Health the position regarding a review of the community ophthalmic services medical treatment scheme; if he will request this process to be expedited in view of ongoing concerns related to reimbursement from medical professionals in this sector; and if he will make a statement on the matter. [60831/22]
I raised the issue of the community ophthalmic services medical treatment scheme with the Minister previously with regard to reviewing the reimbursement to medical professionals in this sector. I asked whether that is under consideration. My understanding is that the reimbursement paid to them has not kept pace with the costs of delivering that service. This is an extremely important community-based eye medical service.
I thank Deputy Matthews for the question. One of the locations in which the ophthalmic service is provided is in our own constituency in the Deputy's home town of Bray. I value the important role that community ophthalmologists play. I am fully committed to the development of the community service to facilitate the integrated provision of eye care in local communities.
As the Deputy said, the community ophthalmic medical services treatment scheme was established as a pilot quite some time ago in 2004. There are four practices across seven locations providing medical and minor surgical care to patients outside of hospitals, which is important because it frees hospitals up to do the more complex work.
The treatments and fees payable were agreed nine years ago in 2013. The HSE has advised that a detailed evaluation of the operation of the scheme would be needed to see whether we extend it further. I am very happy to tell the Deputy that I am asking the agency to conduct this review in 2023, which I know is something people have sought for quite some time.
The HSE's 2017 primary care eye services review group report outlines a blueprint for the future development of services in accordance with population needs. It calls for the establishment of primary eye care teams that would include primary ophthalmic physicians, orthoptists, nurses, technicians and administrative staff. A priority for this year has been the development of the primary care teams in CHO 6, CHO 7 and CHO 9. I have asked my officials to review the current fees payable under the scheme as raised by the Deputy.
I thank the Minister. It is welcome news to hear he has requested an evaluation to be carried out on the expansion of the scheme. I hope it will also include the payments that are made under the scheme to the practitioners. As the Minister outlined, it is a very valuable service and one I recently experienced. The Minister might have noticed the black eye I have at the moment. Many people have been asking me about it. I have had to tell them I underwent a small eye procedure recently. It really brought home the value of having practitioners, such as the one to which the Minister referred in our constituency of Wicklow, available to the community.
The Minister quite rightly stated that people do not have to go into a hospital setting to have a procedure carried out. If we could expand this service across the country, it would fit very well with the primary healthcare model he has been so successfully implementing whereby services that are suitable and appropriate take place in the community setting. There are far better outcomes from it. It is far better for the practitioners and people working in those services and for the patients, which is our primary concern.
It is a valuable service. I hope the Deputy got taken care of. Areas covered include acute treatments such as inflammatory or infectious eye conditions, chronic treatments such as cataracts, pre- and post-op care, age-related macular degeneration, surgical treatments such as corneal ulcer surgery and eyelid injuries.
The treatment fees are set out in schedule 3 of SI 274 from 2013. The fees are set at either €59.51 or €75.76 depending on the service. The payments were reduced in 2009 and they were reduced again in 2013. Those reductions were not reversed after the financial emergency measures in the public interest, FEMPI, period came to an end. As the Deputy said, they are considered by the IMO and some of the contractors not to be sustainable. To that end, we will do a review next year to see whether there is an argument for a change in the fee.
I welcome that news. I will leave it in the Minister's capable hands to look at that. I know he understands the importance of this service. I am glad to receive that response this morning.
Nursing Homes
Jennifer Murnane O'Connor
Question:14. Deputy Jennifer Murnane O'Connor asked the Minister for Health the measures that he is taking to address the current challenges in the nursing home sector; and if he will make a statement on the matter. [61025/22]
My question to the Minister of State, Deputy Butler, seeks to ascertain what measures are being taken to address the current challenges in the nursing home sector. I ask her to make a statement on the matter.
I thank the Deputy for her question. The Government is conscious of the financial challenges faced by the nursing home sector and has acted accordingly. The cost of residential care to the State was €1.4 billion last year. We received approximately €350 million back from people who avail of the fair deal support mechanism. As of today, there are 22,613 people living in nursing homes receiving support under fair deal. The full cost is €9.45 billion. Private nursing homes received nearly 70% of this funding under their agreements made independently with the National Treatment Purchase Fund.
I am conscious that small and voluntary nursing homes are facing challenges at the moment. In November, I announced the €10 million temporary inflation payments scheme to alleviate the pressures faced by nursing homes as a result of increasing energy prices. Private and voluntary nursing homes can claim 75% of year-on-year cost increases up to a maximum payment of €5,250 per month. I backdated this to 1 July. Therefore, a nursing home can claim in total up to €31,500 from 1 July of this year to 31 December. We will keep it under review.
More than €145 million has been claimed by nursing homes under the temporary assistance payment scheme, TAPS, since it was introduced in 2020. I have also continued this scheme for any nursing home that currently has an outbreak of Covid-19 and needs those extra financial supports to deal with it. Last month, for example, 72 nursing homes had an open outbreak of Covid-19.
Substantial other supports have been provided. Since April 2020, the State has been providing free personal protective equipment, PPE, and free oxygen to the private and voluntary nursing home sector. The estimated cost is €72 million to date. This year's cost was €23 million in those types of supports.
The Minister of State and I often talk about how we are all getting older. We know from the Department of Health report that was just published that Ireland's population is ageing faster than anywhere else in Europe. It is important that we make sure services that provide support, such as nursing homes, are adequately funded.
I met with representatives from some nursing homes recently. One of the issues that came up is that while the HSE is recruiting, some of them feel they are losing staff to the HSE from their nursing homes. The reason they are saying this is that the benefits with the HSE outweigh what they can provide.
The other issue raised was that the majority of smaller nursing homes cannot compete with the HSE. In the fair deal scheme, private nursing homes are on an average of a little over €1,000 per week per resident but the HSE is on double that amount, over €2,000 per week. That has become a huge issue.
The Department of Health acknowledges that there are variations in the cost of care across public community hospitals as against private nursing homes. I visited Sacred Heart Hospital, Carlow with the Deputy.
You did.
It is a fantastic facility. Does the Deputy remember, on the day we were there, the amount of work being done with the integrated care programme for older persons, ICPOP, team, in relation to supporting people to age well at home, nutrition and dietary requirements and the risk of frailty and falls?
The HSE will always step in where a resident's needs are sufficiently complex that they cannot be cared for elsewhere in the community. The HSE needs to be staffed to deliver that kind of complex care. The average price per person for a private nursing home is €1,050 per week; the average cost for complex services in HSE hospitals is approximately €1,650.
I know how hard the Minister of State works and how dedicated she is. At a recent meeting, I was informed that, by the end of 2022, almost 500 beds will be wiped out and closed in smaller nursing homes in rural communities. These are owned by the single owners, not the big companies. That is the biggest issue. We have spoken about this on several occasions. I know the Minister of State's commitment and dedication. When I met with the nursing homes, they said during Covid the payments were exceptional. They were happy with the payments and know the work the Minister of State has done but there are huge challenges. I know the Minister of State is aware of them. It is important we do not lose any small or private nursing homes because they feel they cannot compete with the HSE.
I thank the Deputy for the way in which she addressed this. I am in discussions with Department officials to examine ways in which funding can continue to be used to support, where necessary and appropriate, those nursing homes not scheduled to renegotiate their deeds of agreement this year. We are also looking at an expected extension of the temporary inflation payment scheme.
The Department's records show that 18 nursing homes have closed this year with a reduction of 514 registered beds. This includes two nursing homes with a total of 43 beds that were not active. Four nursing homes have opened with a total of 448 registered beds so the number of residents who have needed to move to other facilities will be lower. I take on board the Deputy's point that we are losing small and voluntary family-run nursing homes in communities where they are hugely important. This is an area I am focusing on.
Thank you. I know you are.
Question No. 15 taken with Written Answers.
Health Services Waiting Lists
Aindrias Moynihan
Question:16. Deputy Aindrias Moynihan asked the Minister for Health if his attention has been drawn to the delays for persons accessing and securing appointments in high street opticians for routine eye tests and eye care; and if he will make a statement on the matter. [61365/22]
With many opticians, you can expect to wait from three to five weeks to get an appointment for an eye test. I have raised this with a number of opticians locally and across the area. They are struggling to get enough optometrists; as a result, people have to wait longer to get a service. Has the Minister's attention been drawn to it? Is there a way of improving those wait times for people?
I thank the Deputy for raising the issue. The HSE provides routine eye examinations and glasses for people with medical cards under the community ophthalmic services scheme. The Deputy is talking about the medical card scheme rather than private provision.
Private and public.
Both. Okay, thank you. With regard to the medical card, the service is provided by optical practitioners who are contracted by the HSE. This allows people the freedom to choose a practice and time that is most suitable for them. Timely access to services is an important part of maintaining good optical health. While the schedules of private practices are beyond the remit of the HSE, the HSE does process the applications for reimbursement. The HSE has advised that while most applications are processed in five to ten days, some community healthcare organisations, CHOs, as the Deputy pointed out, have encountered difficulties this year. Delays arose in CHO 9 due to staff shortages caused by Covid-19 redeployment. This has now been resolved and processing time is within five days.
The Deputy's question is relevant to processing but is really about patient access to optometrists. For that, we need to hire more staff and have more people available. The number of new optometrists graduating in Ireland has remained steady since 2019. We need to double the number of healthcare professional college places in the country. I have met with various universities to this end. We will feed this in to structurally address the question of whether we have enough graduates coming out in this area.
Many people use private operators, that is, the optician on the high street. They serve the public with the PRSI scheme and so on. They struggle to get staff. Across Cork a half dozen optometrist posts are currently advertised and, for as many again, the advertisement has been taken down because they have not been able to recruit anybody. Locum cover is extremely difficult to get.
Fewer than 30 people graduate from the one course each year. Very often, they are in direct competition with the UK for those people, so the pool of qualified people is very small each year. It is good to hear the Minister has been making inquiries about qualifying more people. Will he elaborate on that? We need to see more people being qualified and available to serve people in the community.
There are two things. The Deputy's numbers may be correct. The information I received from the Department is that about 20 graduate per year.
One thing that will help is that it is proposed that the standard eye exam fee will increase for medical card holders. That will mean more money will come into the practices and they may be able to offer more attractive salaries. The issue is structural; it is not a short-term issue.
I want to see a doubling of college places for healthcare professionals. We are approaching it strategically and have been doing a lot of work in the background to figure out how many extra nurses, midwives and health and social care professionals we need across the board. I have engaged directly with some universities to gauge their appetite for a big expansion of health places. They have been very open to it. I met the excellent team in University College Cork, UCC, and it was a very positive meeting. Ultimately, we will solve these issues in the long term by providing about twice the number of healthcare graduates we currently do.
The need is there and is growing. On top of driver licence applications, there are people with more complex conditions. The pandemic saw people having more screen time and that will have a knock-on effect. Demand is growing each year. There is only a very small pool qualifying from that one course. It takes up to four years to qualify so there is a greater urgency there.
Is there a college that will start a course in the short term so that, in four or five years time, we could expect to see further growth? Opticians are struggling to recruit. The need is there from the public so we cannot wait for the colleges. People need to be doing the course already if it takes four years to qualify a person. Is there a way to get those courses started in the colleges?
I believe there is.
The health and social care professional field is a diverse group of professionals in skills and training. As the Deputy said, we are not talking about a lot. We have 20 graduates a year and we probably need 40 a year, given the scale of what we are looking at. We are looking at nursing places moving from 2,000 to 4,000. The scale of the move from 20 to 40 should be able to be facilitated quickly. In the meantime, private practices will just have to look at international markets to see what they can do. However, I acknowledge that it is not easy.
Questions Nos. 17 to 27, inclusive, taken with Written Answers.
Protected Disclosures
Rose Conway-Walsh
Question:28. Deputy Rose Conway-Walsh asked the Minister for Health if his attention has been drawn to the protected disclosures made to the HSE regarding individualised services provided by an organisation (details supplied) in County Mayo; and if he will make a statement on the matter. [61350/22]
This is the third time in two days that I have raised the issue of Western Care and what has come across my desk. I have deep, grave concerns about what has been reported on protected disclosures. The Minister knows what I am talking about. I want an independent investigation into these serious concerns. This is a matter relating to the most vulnerable people in our community. The information that has been put to us has to be investigated independently. I will make two comments to the Minister. First, there is no point in people conducting investigations into their own behaviours. Second, the staff need to be protected, as do former staff and families who are coming forward with all these stories. Please do not do a cover up on it. I am asking the Minister for an independent, transparent investigation into these serious matters.
I thank the Deputy for raising this issue. The Protected Disclosures Act 2014 aims to protect people who raise concerns about wrongdoing in their workplaces. The Act provides for redress for employees who are dismissed or otherwise penalised for having reported possible wrongdoings in the workplace. In general, people who receive the protected disclosures or those who subsequently deal with them may not disclose any information to other persons that may identify the person who made the disclosure. I am, therefore, not routinely made aware of protected disclosures that are made to the HSE for that very reason. It is part of the protection of those who are making them.
The Department has put in place policies and procedures for handling these protected disclosures in line with the Act. I recognise the Deputy has raised this issue on several occasions and the Department is aware of it.