As Senator Rose Conway-Walsh is not in the House, we will begin with Senator Colm Burke. I welcome the Minister of State at the Department of Health, Deputy Finian McGrath to the House.
Commencement Matters
Nursing Homes Support Scheme Appeals
I welcome the Minister of State to the House and thank him for dealing with this Commencement matter, which relates to the private nursing home sector. At present, there are over 23,500 people in private nursing home beds under the fair deal scheme. An issue has been raised with me by representatives of a number of private nursing homes regarding the fact that when the price is fixed - and it is fixed at different levels in different areas - there is no right of appeal for them. There is no process by which they can have the price that is fixed reviewed. They have concerns about this because private nursing homes would all have similar costs, including wages, insurance, heating and food but there is a variation in different parts of the country in the price that is set by the NTPF. The nursing homes do not have any mechanism available to them to have the price reviewed. It is in that context that I raise this matter and ask that an appeals process be put in place. I am not saying that everyone would be entitled to appeal but where there are reasonable grounds for an appeal, namely, that the price set does not take into account all of the issues faced by the nursing home on a day-to-day basis, an appeal should be possible.
At the outset, I thank Senator Colm Burke for raising this very important matter.
The legislation underpinning the nursing home support scheme requires each private nursing home negotiate and agree a price for long-term residential care services with the National Treatment Purchase Fund, NTPF, should it wish to be an approved nursing home for the purposes of this particular scheme. The NTPF has statutory independence in the performance of its functions and negotiates with each nursing home on an individual basis. The Department of Health has no role in such individual negotiations. The NTPF examines the records and accounts of nursing homes as part of the process with the objective of setting a fair price which delivers value for money to the individual and the State. In negotiation with the nursing homes, the NTPF has regard to cost reasonably and prudently incurred by the nursing home and evidence of value for money.
The NTPF also has regard to price, prices or prices previously charged, local market price, budgetary constraints and the obligation of the State to use available resources in the most beneficial effective and efficient manner to improve, promote and protect the health and welfare of the public.
When the nursing homes support scheme commenced in 2009, a commitment was made that it would be reviewed after three years. In advance of the review, which was the subject of an extensive and structured public consultation process, submissions were sought from groups or bodies wishing to make a contribution. Nursing Homes Ireland made a submission in this regard and sought an appeals system for nursing home providers.
The report of the review was published in July 2015. A number of issues were identified for more detailed consideration, first, a review of the pricing mechanism of the National Treatment Purchase Fund with a view to ensuring value for money and economy, the lowest possible administrative costs for clients and a minimal administrative burden for providers; second, the need to increase the transparency of the pricing mechanism in order that existing or potential investors can make informed decisions to the greatest extent possible; and, third, to ensure adequate residential capacity for those residents with more complex needs.
Deloitte and Prospectus have been engaged by the National Treatment Purchase Fund to assist in carrying out the review. They have engaged in extensive stakeholder consultation and this includes Nursing Homes Ireland. The pricing review will include consideration of the appeals mechanism. It is not deemed feasible to effectively address this issue in isolation and it must be considered as part of the totality of the pricing system review, which will be completed as soon as possible. In this context, we need to be careful about placing too much reliance on an appeals system. There is little point in establishing an appeals system which quickly becomes the default option for almost all of the operators and, therefore, effectively displaces the main price-setting mechanism. It is more important to develop a robust system that everyone understands and that delivers fair outcomes consistently. If we can achieve this, an appeals system per se will become far less important.
I thank the Minister of State for his comprehensive reply. I agree fully with the Minister of State in respect of his last point. Such an outcome is the last thing we need. It reminds me of every District Court case that is sent to the Circuit Court, and that is not what I want. It may be that only one price agreement in every 1,000 is fixed but some mechanism is needed. The Minister of State referred to arranging this. Do we have a timescale for when the changes under discussion will be put in place? Will some mechanism be in place to deal with concerns or cases where someone believes that not all issues have been dealt with in coming to a conclusion about a price fixed for a nursing home bed?
I thank Senator Colin Burke for raising this important issue. Since we have over 23,000 people in nursing homes in the State, we have to be vigilant and ensure they have the proper services and prices.
Senator Burke raised the issue of no right of appeal. I will bring his concerns back to the Minister for Health, Deputy Harris. Of course I take his point about reasonable grounds for an appeal. That is important. I also think we should not necessarily blow the idea of a mechanism out of the water.
The final issue raised by Senator Burke was on the timescale. I cannot answer the question directly today, but I will bring it back to the Minister for Health, Deputy Simon Harris, and ask him for an update. I will respond to Senator Burke in the coming days.
Palliative Care Services
The palliative care centre is one of three major capital projects being developed at Roscommon County Hospital. I am pleased to report that the €6 million endoscopy project was officially opened recently by the Minister for Health, Deputy Simon Harris. I am also pleased to report that the Minister, Deputy Harris, has given the green light to an €8 million medical rehabilitation unit at the hospital. It will serve as a satellite centre from the west of Ireland to Dún Laoghaire.
An eight-bed palliative care unit is the third major capital development being planned on the grounds of Roscommon hospital, bringing the investment to over €20 million. It is very clear that the demand for palliative care services has never been greater. It is predicted that the proportion of older people in Ireland will increase by up to 30% over the next decade. Within the former western health board region, Mayo and Roscommon are predicted to experience the largest increases which consequently will have implications for palliative care services in the region, specifically the number and volume of services required. The report of the national advisory committee on palliative care in 2001 recommended that there should be up to ten specialists inpatient beds for every 100,000 of population with at least one inpatient unit in each of the former ten health board areas.
Unfortunately, no such facility exists in Roscommon and this often leads to crisis admissions to acute hospitals, waits and long travel to hospice or hospital facilities in Galway and Dublin away from family and friends. People who are very ill, and their families, should not have to go through this. It is unacceptable.
The good news is the proposed building of an eight-bed palliative care unit on the grounds of Roscommon hospital. This is very welcome and timely. This has been going on for the past three or four years. The unit will provide inpatient day care and community palliative care services to patients with advanced life-limiting illnesses in County Roscommon. The key to the success of this project is the recruitment of appropriate staff with the necessary skills to deliver quality palliative care and through its great work, the Mayo Roscommon Hospice will fully fund the building costs of the Roscommon project. The last Minister for Health was very committed to funding staff costs. This is one of three projects and it has been working very closely with the endoscopy unit, which is already built and with the rehabilitation unit for which the funding has been allocated to get the go-ahead. I believe the Mayo Roscommon Hospice will provide funding of €5 million but the main issue is the need for the HSE to fund the staffing. Where exactly is this agreement?
I thank Senator Feighan for raising this very important issue. I know he is a passionate supporter of, and campaigner for, palliative care centres, particularly in the Mayo-Roscommon area. It is one of the great success stories of our age that so many more people are living for so much longer. While many older people enjoy good health for most of their lives, there will also inevitably be increased numbers of people living in the community with chronic diseases and life-limiting illnesses. As a society, we need to plan now to meet the needs of these people and palliative care is one of the components that we must think about and prepare for, hence I support Senator Feighan's proposal today. It is the intention of the Government that people will be provided with the type of palliative care services they need, regardless of what diagnosis they have, how old they are or whether they die in a hospice, an acute hospital, a nursing home or at home. Significant progress has been made in recent years in improving access to specialist palliative care services. We now have 202 specialist inpatient palliative care beds in ten locations across the country. That total will rise to 217 once the 15 beds planned for Kerry Hospice are open. The HSE is also working closely with local hospice groups in several locations to ensure equity of access to specialist palliative care across the country. All HSE areas have community specialist palliative home care teams. There are 38 acute hospital specialist palliative care teams across the country and over 170 palliative care support beds in around 80 locations around the country. At present 92% of people receive specialist palliative care services in the community within seven days of referral while 97% have access to a specialist bed within seven days. That is a figure we should all be proud of.
There are, of course, issues that remain to be tackled. Senator Feighan asked about the palliative care centre at Roscommon University Hospital. The Minister for Health, Deputy Harris, recently met with the representatives of the Mayo Roscommon Hospice Foundation to discuss the development of the new unit. The hospice group is working closely with the local Health Service Executive community health organisation and the Saolta hospital group to progress the development of the proposed eight-bed unit, which will be built on the grounds of Roscommon University Hospital.
With regard to the allocation of Exchequer funding, the HSE's first priority in the region is the opening of the 14-bed special palliative care inpatient hospice in Mayo. That unit is due to open in 2018. The HSE will continue to work closely with the Mayo Roscommon Hospice Foundation to agree the financial and staffing requirements for the new unit. The required funding will be included by the HSE in its annual Estimates request as soon as is feasible. The successful development of palliative care services in Ireland has been based on a long-standing tradition of positive engagement between the voluntary, statutory and private sectors. Organisations such as Mayo Roscommon Hospice Foundation have a vital role to play in this work, both by initiating programmes and by collaborating with the HSE in a positive way on a range of fronts to strengthen the provision of palliative care. The Minister looks forward to continuing to work on this collaborative basis in the future.
I am delighted to be the politician who set up the meeting between the Minister and the Mayo Roscommon Hospice Foundation. Unfortunately, I could not attend as I was getting an ECG in hospital and did not realise how long it would take. I went in at 3 p.m. and left at 9 p.m. I pay tribute to the competency of the staff and surgeons at the Mater Hospital. I saw at first hand the difficult work they do.
I welcome the significant developments at Roscommon University Hospital, which serve as a strong reminder that the hospital is very much open for business. In fact, it has never been busier, which the critics did not envisage five years ago. Roscommon is a shining example to all small hospitals around the country. I take this opportunity to commend the air ambulance service, which saves dozens of lives in towns and villages throughout Roscommon and the wider region. I look forward to the continued development of the palliative care unit in order finally to address the critical lack of inpatient hospice facilities in County Roscommon.
I pay tribute to Ms Cynthia Clampett, Mr. John Murphy and everyone involved in the Mayo Roscommon Hospice Foundation for their hard work and commitment to improving palliative care services and enhancing the quality of life of people in both counties. I look forward to the Minister making an announcement in the coming weeks that the staffing for this vital facility will be progressed. I thank the Minister of State for all the work he is doing in this area.
I take the Senator's points about the long waiting and travel times for people with serious illnesses. It is an issue that requires our focus. However, the main message I will take back to the Minister is the need to progress the staffing issue. I am pleased to hear the Senator received great care in the Mater Hospital and am glad to see him well. I strongly agree with his comments on the magnificent work done by the staff at Roscommon hospital and the brave and caring work of the hospice movement in Roscommon and throughout the country. Hospice staff provide a great service and have an excellent relationship with the voluntary and public sectors. There is a warmth and energy there which one does not always see in other services. It is something of which we can all be proud. I assure the Senator that I will bring the message regarding the staffing requirement directly to the Minister.
Unfortunately, there has been a breakdown in communication with Senator Conway-Walsh.
She has withdrawn her matter which we will take on Thursday. I thank the Minister of State and call Senator Robbie Gallagher.
Agricultural Colleges Courses
Cuirim fáilte roimh an Aire Stáit go dtí an Teach seo inniu fosta. There are already 460 students completing part-time and distance education programmes in Ballyhaise Agricultural College, County Cavan, and there is a commitment that an additional 105 students will start those programmes before the end of 2016. There are 605 students on a waiting list in Ballyhaise Agricultural College to complete these courses. To commence additional new courses, Teagasc would require sanction for temporary education staff on a two year contract basis as the contracts for some of the existing temporary staff are due to expire by the end of 2016. Currently, Teagasc has no commitment from the Department of Agriculture, Food and the Marine on education staff for 2017 and, as such, it is unable to plan any further courses at this time until this staffing situation is resolved.
The green certificate qualifies a person as a trained farmer, and that could be in horticulture, agriculture, forestry or equine studies. It is, first and foremost, about education. Having a green certificate is one of the conditions of stamp duty exemption and a transfer of land to a son or a daughter. It also meets the criteria for schemes or grants that may be available from time to time. In other words, it is about incentivising education. It has been hugely successful in educating young farmers in proven farm practices, and in incentivising the succession of farms.
As the Minister of State is aware, the contribution by the agricultural community to the economy of this country is immense. Thousands of jobs depend on it. At the very foundation of its success are the primary producers, the farmers, working the land, milking the cows and growing the crops. We can all see how agriculture has developed and changed over the decades. Our farmers and our agribusiness compete on global markets. Each generation of farmers brings new methods and better ways of doing things. Education and the green cert is central to all of that. I ask the Minister to sanction the funding necessary for the colleges to put the required staff in place to ensure that these very worthwhile courses can commence and be completed without delay.
I thank Senator Gallagher for raising this matter. On my own behalf and on behalf of the Minister, Deputy Creed, I wish to thank Teagasc education staff for their hard work and dedication in managing the unprecedented demand for the adult green certificate programme, which is delivered on a part-time and distance education basis at Teagasc agricultural colleges and at its local and regional education centres.
While I am not in a position to comment on the staffing issues that pertain in particular locations as that is an internal operational matter for Teagasc and not the Department of Agriculture, Food and the Marine, I understand that Teagasc target available teaching resources where demand for training courses is greatest. The Department has worked closely with Teagasc to address staffing issues with regard to the delivery of the adult green certificate programme.
The current exceptional demand reflects renewed interest and opportunities in agriculture but is also directly linked to the educational requirements of the young farmers scheme and the national reserve, which require applicants to have a prescribed level 6 agriculture qualification - a green certificate or an equivalent in order to qualify for payment. This was to ensure that payments were targeted at trained young farmers with a genuine interest in farming as a career. Approximately, 2,000 young farmers require places on the adult green cert arising from the education requirements of the young farmers scheme and the national reserve. The Department was concerned that if the additional green certificate places were not made available, young farmers who would otherwise qualify for EU-funded payments would be refused payment or would fail to qualify for full payment.
In order to address this situation, it was agreed that the additional temporary resources would be provided to Teagasc to enable it to rapidly expand the number of green certificate places and clear the backlog of applications in the shortest possible timeframe. In conjunction with the Department of Public Expenditure and Reform, Teagasc was approved to appoint 20 new temporary education officers in 2014 and again in mid-2015 on two-year employment contracts. It enabled Teagasc to dramatically increase enrolments from a typical year of 500 to over 1,500. As Teagasc continued to experience strong demand for the adult green certificate over and above the pre-existing high levels of demand, it was allocated 30 temporary posts in November 2015 bringing the overall number of teaching posts sanctioned to 70. In addition, the Department also approved seven temporary administrative staff for a two-year period to address the huge volume of course administration that arose from the unprecedented demand.
I understand that while a small number of temporary teachers have still to be recruited by Teagasc, most have been hired and are now working on the green cert programme helping to deliver record numbers of enrolments, which are forecasted to top 4,500 for the period 2014 to 2016. It is our expectation that the 70 additional posts will substantially clear the backlog of applications for the adult green certificate ensuring that those young farmers who formally applied for a place can be accommodated. The question of renewing some of these posts for a further two-year period was raised with my Department recently. However, it is important to note that the conditions attached by the Department of Public Expenditure and Reform stipulate that all temporary contracts - 77 in total - must be phased out as their expiration dates arise. In addition, under the delegated sanction framework governing staff numbers in Teagasc, there is a prohibition on the establishment of contracts of indefinite duration for temporary staff, which would arise in this instance if the 77 temporary contracts approved to date were renewed for a further two-year period.
More generally, the agreed delegated sanction arrangements for Teagasc provide it with greater flexibility over permanent staff appointments in research, advisory and education. The arrangements enable Teagasc to replace staff when they retire and to make 75 new permanent appointments, subject to compliance with multi-annual pay ceilings. While Teagasc must remain within its overall pay budget, the flexibility provided by the new arrangements will allow it to fill critical vacancies and to react faster when such vacancies arise in the future. I understand some appointments have been made in the education area to meet the current demand for places. Within the parameters of that overarching policy, the question of allocating additional resources to particular locations remains an operational matter for Teagasc. The arrangements implemented to date have greatly assisted Teagasc in meeting the current exceptional demand for the adult green certificate. Of course, the training of so many young farmers since 2014, which is 4,500 to date, is a very positive development for the agrifood sector both in terms of supporting structural adjustment and encouraging young educated farmers to remain in and enter farming. In prioritising supports for trained young farmers under the young farmers scheme and the national reserve, the Minister believes we can look forward to an increasing number of young farmers playing a central role in the future development of the agricultural sector in the years ahead.
The Minister, Deputy Creed, and I commend the Teagasc education staff on its proactive approach to enrolling such exceptional volumes in a very short time. We know that Teagasc teachers give substantial time and commitment over and above their everyday responsibilities in training the next generation of farmers and encouraging the adoption of new technology and practices on Irish farms. The Department was pleased to secure approval for 77 temporary posts to enable Teagasc to provide almost 3,000 extra green certificate places that would otherwise not have been made available. The allocation of 75 new permanent posts will also greatly assist Teagasc in delivering services to the farming sector, including education and training.
As can be expected, the young farmers scheme and national reserve has stimulated added interest in the adult green certificate among other farmers who have registered an interest with Teagasc in completing the course. It is not apparent, at this stage, how many of those expressions of interest will convert into formal applications. Historically, leakage between expressions of interest and formal applications is approximately 50%, however current demand may be stronger. My Department has asked Teagasc to explore other staffing measures beyond temporary recruitment to ensure any residual demand for the green certificate can be accommodated within a realistic timeframe. The Department will continue to monitor the green certificate situation in Teagasc closely. Sorry, I have to go.
The Dáil bell is ringing. We had better excuse the Minister of State.
I have to go, but I am a graduate of the farm apprentice scheme. I did my first year exams in Ballyhaise. I appreciate the value of it and I will be there launching a timber harvesting simulator course. I understand the need to get as many people in as quickly as possible. I am sorry I have to go.
We understand. Is that all right, Senator?
I understand. Perhaps the Minister might have a look at the specific case and the fact that some education providers' contracts are expiring at the end of the year and people cannot complete the courses they commenced.
Yes.
Sitting suspended at 3.05 p.m. and resumed at 3.30 p.m.