I apologise for being late. I was awaiting a reply to a question at the health committee. This issue is about the provision of a national office for rare diseases. Much work is being done in this area and I was asked to raise this issue in view of the fact that there would be a national conference in Belfast at the end of the month and that it would be helpful if we could have some idea when it was proposed to put this office in place. It is accepted that there is a need for it and that it is the long-term plan. We await the long-term plan and I want to know when it will be announced. My Adjournment matter sets out clearly what I seek and I wonder if I could have clarification.
Adjournment Matters
Rare Diseases Strategy Implementation
I thank the Senator for raising this important issue on the Adjournment and providing me with the opportunity to update the House on progress in the development of the national plan for rare diseases. Rare diseases are life threatening or chronic debilitating conditions affecting no more than five in 10,000 people. Between 5,000 and 8,000 rare diseases have been described, affecting approximately 6% to 8% of the population in the course of their lives. Approximately 80% of rare diseases have a genetic origin and the life expectancy of patients with rare diseases is significantly reduced. Many of these conditions are complex, severe and debilitating.
Ireland has been supportive of EU proposals on rare diseases and my Department is finalising its national plan for rare diseases accordingly. Two national conferences and a public consultation day were organised to discuss what might feed into the development of a national strategy for rare diseases. In April 2011 the Minister for Health, Deputy James Reilly established a national steering group to develop a policy framework for the prevention, detection and treatment of rare diseases based on the principles of high quality care, equity and a patient-centred approach. The policy will operate over a five year period, take account of the Council recommendation on rare diseases in 2009 and define priority actions, subject to resource availability.
The national steering group is working on many areas relevant to the issue of rare diseases, including the identification of appropriate centres of expertise, access to appropriate medication and technology, research as an integral part of overall care for rare diseases, including access to clinical trials, where appropriate, and the empowerment of patient organisations. The steering group is also considering for its report the development of a national office for rare diseases, as referred to by the Senator. Its purpose would be to facilitate the co-ordination and timely access to centres of expertise for rare diseases, both nationally and internationally. Such an office could act as a national point of reference on services, diagnostics, care pathways and information on rare diseases.
The report by the Department on recommendations for dealing with rare diseases, including the establishment of a national office, is being finalised and the Department's officials are meeting the HSE to discuss implementation of the report. The HSE has established a national clinical programme for rare diseases, NCPRD; a national clinical lead has been appointed and a programme manager is in place. The programme aims to improve and standardise patient care for individuals affected by rare diseases in Ireland by increasing detection and prevention, facilitating early and timely diagnosis, intervention and co-ordination of care and increasing awareness, information and support. The programme is progressing with the establishment of a rare diseases national working group which will consist of experts in various fields to identify best practices. The programme will also be supported by the advice and guidance of a clinical advisory group appointed by the Royal College of Physicians of Ireland. A key priority of the NCPRD is to assist with the provision of information and helpline access for patients and families through the establishment of a centralised rare disease information office. Regrettably, I do not have a specific date for publication of the report. I assure the Senator that I am aware of this work and regard it as important, as he does. I am aware of the conference to be held in Belfast at the end of the month and the report will be published as soon as possible.
I thank the Minister of State for his comprehensive reply and apologise, again, for being late. I understand there are many demands on his Department; however, having worked with a number of the organisations, we should do everything possible to progress this matter. If the national plan was published, it would help. Is it possible for the Minister of State to give any guideline as to when the report is likely to be issued? The reason I was delayed in coming was there was a discussion at the health committee about a clinic in Cork where funding was provided and €500,000 worth of equipment is lying idle because of the embargo on taking on staff. I hope we do not have a scenario where we cannot go ahead because of the restrictions which are not looked at in an overall context. We might try to receive some clarification at an early date on the matter.
I would like to give the Senator the clarity on specific dates and timelines that he seeks. Unfortunately, I am not in a position to do so today. I know about this area of work. The Senator has raised this issue before; he has been very good at raising it and pressing for action. I will take his raising of it again very much as a spur to engage in further action and specifically to try to establish for him as soon as I can what the timelines are likely to be. There are pressures and resource issues in the Department. The Senator's point on the importance of having this office established is very well made.
I will take it very much on board.
I thank the Minister of State.
Health Services Staff
I welcome the Minister of State to the House and thank him for taking this matter on the Adjournment on overcrowding in the accident and emergency department at University Hospital Galway and the potential for nurse prescribing to be used as a means of alleviating the ongoing crisis.
The Minister of State may be aware it was reported on 20 January that 44 people were waiting on trolleys at University Hospital Galway, but this figure was accurate only if one counted the trolleys visible in and around the accident and emergency department. I am led to believe a further 38 trolleys were spread among a number of wards, which meant the real figure was 82. I am also informed it took up to three days for some of these sick and elderly patients to get beds. Now is the time to examine viable solutions for these figures, which are quite regrettable.
As the accident and emergency department crisis continues throughout Ireland the practice of nurse prescribing is a resource which is not utilised to its fullest extent. Last year approximately 7,000 patients spent time waiting on trolleys in accident and emergency facilities, as reported by the Irish Nurses and Midwives Organisation. Nurse prescribing is considered a forward-thinking development in the health care sector and would help reduce the overcrowding we face in hospitals throughout the country, in particular in Galway.
The nurse prescriber qualification permits nurses to examine, diagnose and prescribe for residents in nursing homes and residential health care facilities when the patient's general practitioner signs an agreement to this arrangement. Health care professionals find many elderly patients are sent from private nursing homes and residential health care facilities to accident and emergency facilities to receive IV fluids, antibiotics and other such drugs which may need administering because nurses employed at such operations are unable to prescribe them. This further exacerbates the overcrowding crisis at accident and emergency departments throughout the country.
Nurse prescribers are able to provide services to private sector patients but a problem arises with medical card patients. The HSE will not issue a GMS prescription pad to nurses employed at non-HSE facilities, therefore effectively barring this practice. Utilising nurse prescribing would not only be of great benefit to the residents of such facilities who would have timely access to medical treatment and would not have to wait for a house call from already under pressure general practitioners, but there would also be benefits for taxpayers who would not have to pay for accident and emergency department visits where patients can be treated at a private facility. The HSE policy does not encourage competition in the health care industry as a result of what I have stated. To provide an equal level of care to patients residing in private nursing homes and care facilities it is important this practice be abolished and nurse prescribing be embraced. I look forward to hearing the thoughts of the Minister of State on this matter. I apologise for gasping; I had to run upstairs to get here on time.
I thank the Senator for raising this issue. Between 2012 and 2013, a 14% reduction was achieved nationally in the number of emergency department patients waiting for ward bed accommodation. When compared to the baseline year of 2011, there was a 33.8% reduction in 2013. This is equivalent to 29,200 fewer patients waiting on trolleys, a reflection of the willingness and ability of the system to manage each temporary crisis that occurs. A total of 4,015 fewer patients have had to face trolley waits since we began to actively address this problem in 2011, quite an achievement in the face of the ongoing crisis referred to by the Senator.
The trolley counts for the first few weeks of 2014 in some hospitals are disappointing for the Department, the INMO, the HSE and the special delivery unit, but much more so for the patients and their families for whom these delays add discomfort and further distress. However, as Minister Reilly has stated regularly in recent weeks, these pressures are anticipated in the early part of the year and time and again the system has proved it can come through these peaks, stabilise and continue to improve.
One of the elements which assists in all areas of acute hospital practice, including emergency and acute medicine, is the introduction of medicinal product prescribing by trained and registered nurses and midwives, as the Senator correctly outlined. Nurse and midwife medicinal product prescribing has been in place in Ireland since 2007, underpinned by legislation and the Nursing and Midwifery Board of Ireland, NMBI, regulatory framework, whereby nurses and midwives must be registered as nurse prescribers. There are currently 650 registered nurse prescribers. Professional guidance is in place with regard to the scope of nursing and practice, and specifically on nurse and midwife medicinal product prescribing. There is, therefore, no barrier to advanced nurse practitioners who are registered as nurse or midwife prescribers with the NMBI prescribing to patients in the accident and emergency department at University Hospital Galway or in any other acute hospital.
No single trend or factor is wholly accountable for the peak pressure encountered at this time of year and no single action will address these pressures. However, University Hospital Galway has made steady improvement using a combination of actions, such as prioritising diagnostics of inpatients over outpatients to enhance patient flow; the transfer of patients to other hospitals within the west and north west hospital group; increased ward rounding; the use of a surgical day ward; the use of a medical assessment unit in tandem with the emergency department; and a focus on the use of nursing home and long-stay beds with colleagues in primary care.
These actions aid progress, with numbers awaiting admission reducing from 29 on Monday, 27 January to 22 on Monday, 3 February and 17 yesterday, Monday, 10 February. While these numbers are still unacceptably high, I am confident that with sustained effort, supported by senior management, Galway can achieve the type of reductions it has shown it is capable of, namely, a 34.1 % reduction, or 266 fewer patients on trolleys, between 2011 and the end of 2013.
I thank the Minister of State and appreciate the very detailed response he has given. I wish to clarify one issue. Is it the case the HSE will not issue a GMS prescription pad to nurses employed at non-HSE facilities? This is where my issue arises.
I heard the Senator raise this issue in the course of her contribution, but I did not have notice of this specific issue when I came to the House. I will ensure the Senator obtains an answer to this particular question.
I thank the Minister of State.
Medical Card Eligibility
This matter relates to the medical card eligibility for individuals aged between 18 and 26 years who, due to changes made, will have their social welfare entitlement reduced to as low as €100 per week if they are not undergoing a course of study. One would presume anyone in receipt of a social welfare payment of €100 a week would receive a medical card but this is not the case. These people fall between two stools.
The national assessment guidelines on medical card eligibility state a person aged between 16 and 25 may have entitlement to a medical card or a GP visit card if they meet a number of criteria, including being a dependent of a person with a medical card or a GP visit card; being financially independent, which in this case means they earn or are in receipt of a social welfare payment in excess of €164; or if they face extenuating circumstances such as financial hardship. It is very difficult to prove such hardship given the new manner in which medical cards are assessed.
There is a loophole here as one should not have to prove financial hardship or undue hardship just because one earns less than €164. A 27 year old person who receives a social welfare payment of €188, whether living at home or not, will receive a medical card, but just because one is 24 not only is one's social welfare payment reduced to €100 per week but because one is in receipt of less than €164 per week one will not receive a medical card either. It is very unfair. For those aged between 18 and 26 the national assessment guidelines for medical card eligibility should be changed because it is not fair or right they must comply with a raft of eligibility criteria.
I know a number of individuals in my county aged between 18 and 26 years who are not living with their parents, are in receipt of €100 per week and struggling to survive but who are not entitled to a medical card. That seems daft in the extreme and throws into question the entire medical card eligibility criteria if such individuals are not deemed eligible because they are in receipt of too little from the Department of Social Protection. That is the only reason they are being refused a medical card. It does not make any sense to me and I know it is an issue that many community welfare officers are dealing with in various parts of the country. A change must be made quickly because people are finding themselves in very difficult circumstances.
I thank the Senator for raising this issue. People aged 16 to 25 years, including students, who are financially independent of their parents may be entitled to a medical card if they pass the means test. If they are financially dependent on their parents, they are normally only entitled to a medical card if their parents have one. They may be entitled to a medical card or a GP visit card if obtaining GP, medical or surgical services would be the cause of "undue hardship" or "unduly burdensome" on themselves, if financially independent, or the person on whom they are dependent. Financial independence, as it relates to persons aged between 16 and 25 years, is the standard rate of income set out in the HSE's medical card or GP visit card national assessment guidelines for a single person living with family, that is, €164. Financial independence may be achieved through student loans, education grants, employment, self-employment, part-time employment, savings or social welfare payments. Rent supplement payments are not included in establishing financial independence. Historically, when there was a single rate of social welfare allowance in the Department of Social Protection, the HSE used this rate to establish financial independence. However, under budget 2014, with the age-related rates of jobseeker's allowance set by the Department of Social Protection, the HSE's test to establish financial independence is no longer linked with social welfare allowance rates.
To reiterate, financial independence is defined as "in receipt of income equivalent to or greater than the current income guideline for a single person living with family", that is, €164 per week. The current national assessment guidelines state an applicant whose weekly income is derived solely from social welfare allowances, benefits or Health Service Executive allowances will be granted a medical card if this social welfare income is in excess of the medical card income qualifying limit that applies to the application. Social welfare payments being made at a rate less than the maximum weekly rate may be indicative of other income or means. This provision cannot be relied on by persons aged 16 to 25 years receiving only social welfare income less than €164 per week as entitling them to a medical card. There are no proposals to change the income thresholds for standard means-tested medical card eligibility.
That is the normal Civil Service response. This is discrimination against 18 to 25 year olds and deeply unfair. I ask the Minister of State to examine the issue again. I do not expect him to provide a solution tonight, but I had expected a response which suggested 18 to 25 year olds were playing a meaningful role in society and that their eligibility for a medical card should not be scuppered just because another Department had cut their weekly social welfare income. This is essentially one Department working against another. Someone needs to sit down and work this out. Can a meeting be scheduled between the Department of Social Protection and the Department of Health to come to some arrangement to assist the people concerned? The fact that they are earning too little should not make them ineligible for a medical card. It makes absolutely no sense. If such individuals get sick, how will they be able to afford to go to a doctor? They are being left high and dry. I am not making a political point because this is beyond politics. I ask the Minister of State to examine this issue again because it is simply unfair.
I do not have anything to add to the response I gave other than to say any issue which arises in the operation of the GMS is and ought to be kept under review. If there is a specific issue in respect of a particular cohort, I am happy to look carefully at it. However, I do not want the Senator to think there is any intention to make any change in what we are doing. That said, I will certainly consider carefully what he has said.
Further Education and Training Colleges
Ba mhaith liom buíochas a ghabháil leis an Leas-Cathaoirleach as ucht an deis seo a thabhairt dom an cheist seo a ardú ar an Athló. I also thank the Minister of State for being here.
This is an important issue for County Meath as a whole. Dunboyne College of Further Education is the only such college in the entire county, although there is a college of further education in Drogheda and several in Dublin; therefore, the area is reasonably well served. Dunboyne College of Further Education is actually a constituent part of St. Peter's College, Dunboyne and therein lies the difficulty. St. Peter's College is a very large secondary school which is doing a great job in a new building. The college of further education is located in office accommodation in Dunboyne. It is also doing a great job and providing an enormous range of courses, including language, pre-nursing and a full range of post-leaving certificate courses. It is also engaged in link-ups with the Institute of Technology, Blanchardstown and NUI Maynooth. It does not, however, have independence. There is one principal in charge of the two institutions because they are, in fact, deemed to be one institution with one roll number. This is not satisfactory. The college believes it should have its own roll number, separate access to the Department of Education and Skills and be independent of the secondary school in order that it can provide a real education service for the people of County Meath. It would, in effect, then form an educational triangle with the institute of technology in Blanchardstown and NUI Maynooth. Those involved in the college of further education cannot go anywhere until it separates from the secondary school. The college is seeking independence and its students would be better served if it had that independence. I look forward to hearing the Minister of State's response.
I thank the Senator for raising this Adjournment matter which I am taking on behalf of my colleague, the Minister for Education and Skills, Deputy Ruairí Quinn.
The PLC programme is a self-contained whole-time learning experience designed to provide successful participants with specific vocational skills to enhance their prospects of securing lasting, full-time employment or to progress to other studies. It caters for those who have completed senior cycle education, as well as adults who are returning to education and require further vocational education and training in order to enhance their employment prospects. There are 32,688 approved PLC places nationwide. The number of approved PLC places is set at its current level because there is a continuing requirement to plan and control numbers and manage expenditure within the context of overall educational policy and provision. For each approved place, the Department of Education and Skills provides a staffing allocation and non-pay capitation. The majority of PLC places are provided by education and training boards, ETBs, in recognised schools and colleges, with the remainder in voluntary secondary and community and comprehensive schools. Places are allocated to ETBs and other providers on an annual basis following an application process and ETBs are responsible for the further allocation of these places to schools and colleges within their remit.
Dunboyne College of Further Education is part of St. Peter's College, Dunboyne, which is managed by Louth Meath ETB. Louth Meath ETB has an allocation of 1,526 PLC places for the current academic year. Enrolment data indicate that the total PLC enrolment in Louth Meath ETB is 1,809. The only stand-alone PLC college in Louth Meath ETB is Drogheda College of Further Education which has an enrolment of 790 PLC learners. O'Fiaich College, Dundalk has an enrolment of 511 learners, with Dunboyne College of Further Education having 429. The other ETB schools offering PLC places are Beaufort College, Navan, which has 64 learners and St. Oliver's post-primary school, Oldcastle, which has 15. Sanction as a stand-alone PLC college would require additional financial and staffing resources in terms of teacher allocations and management structure, including a principal and other posts of responsibility. In the context of the current budgetary situation, the moratorium on public sector recruitment and the employment control framework, it would be very difficult to provide these resources.
In addition, the Government's medium-term infrastructure and capital investment framework, published on 10 November 2011, sets out the demographic challenge facing the education system in the coming years. To ensure every child has access to a school place, the delivery of major school projects, as well as smaller projects devolved to schools to meet the demographic demands nationally, will be the main focus for capital investment in schools in the coming years.
SOLAS, an tSeirbhís Oideachais Leanúnaigh agus Scileannathe, the new further education and training authority, is responsible for the integration, co-ordination and funding of the wide range of further education and training programmes available around the country. It is working on a strategy for the development of a unified further education and training sector. This strategy will form a framework for future developments in the sector, including the post-leaving certificate sector.
I am disappointed with this reply. While I do not expect the Minister to announce that the Department will sanction a new building for the college next week, the provision of a separate roll number which would entail appointing a principal is not a significant ask for a college that, as the Department states, officially has 429 students. Unofficially, as I understand it, the college is providing a service for hundreds more students within its departmental financial allocation. It is managing to maintain a good service, taking pressure off the Government which would otherwise be under severe pressure to provide these courses.
The immediate issue is that the school be separated and a principal appointed. There is already a teacher acting as principal who is not being paid for it, despite the fact that the principal of St. Peter’s College is in charge. They are at least a mile away from each other and it is not conducive to good learning. While a new building is required in the medium to long term, the Department should examine the short-term solution of putting a principal in charge to allow the college to grow and develop. I know that the college is looking forward to taking part in SOLAS and bidding for the provision of courses, as well as contributing to the resuscitation of the economy in general.
From what the Senator said, there is terrific work being done in the school with a dedicated staff. It is, however, a question of how we address priorities. The Senator’s request is not unreasonable, but it must fall to be dealt with within the assessment of priorities in the allocation of limited resources. He has made a good case for the school, but it must be seen in the context of the wider work the Government is doing in expanding and improving infrastructure in the years ahead.
The Seanad adjourned at 7.15 p.m. until 10.30 a.m. on Wednesday, 12 February 2014.