Thursday, 5 June 2008

Questions (8, 9)

Jimmy Deenihan


7 Deputy Jimmy Deenihan asked the Minister for Health and Children the status of the nursing homes repayment scheme; the reason only one appeals officer has been appointed to deal with the large number of appeals; and if she will make a statement on the matter. [22214/08]

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Joan Burton


32 Deputy Joan Burton asked the Minister for Health and Children the reason it is taking so long to process applications and appeals relating to the health repayment scheme; if she plans to address these delays; and if she will make a statement on the matter. [22149/08]

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Oral answers (22 contributions) (Question to Minister for Health and Children)

I propose to take Questions Nos. 7 and 32 together.

The Health (Repayment Scheme) Act 2006 provides a legal framework to repay recoverable health charges for publicly-funded long-term care. The Health Service Executive, HSE, has advised that as of 16 May 2008, more than 14,000 offers of repayment totalling more than €250 million have been made. Further offers continue to be issued every week. As a result of these offers, almost 10,500 payments worth in excess of €200 million have been made. The HSE has indicated that the time taken to process each application varies depending on the complexity of the application and the availability of accurate records. Every effort is being made to complete repayments as quickly as possible. However, there have been some delays in making repayments under the scheme due to legal and technical issues.

A very high number of deficiencies have appeared on claim forms and these must each be rectified before claims can be processed. These claims have taken longer to process because the scheme administrator must be provided with certain information in order to ensure that the correct amount is repaid to the correct person. The scheme administrator and the HSE have taken a proactive role in clearing these deficient claim forms. They have conducted an intensive roadshow campaign throughout the country in order to address these issues. This campaign was widely promoted through advertising on local radio and in regional media.

More than 12,000 estates which lodged claims to date had not extracted a grant of representation in respect of the estate of the deceased patient. In these instances, the person entitled to extract the grant of representation must be identified before an application can be processed. To date, more than 11,000 certificates of entitlement permitting individuals to apply for repayments have issued. The scheme administrator is confident that the majority of claims submitted by the public will be dealt with by the end of this month.

The health repayment scheme appeals office is independent and was established to provide an appeals service to those who wish to appeal decisions made by the scheme administrator. Following the establishment of the office, a temporary appeals officer was seconded from the Office of the Chief State Solicitor. Subsequently, a recruitment process was undertaken by the Public Appointments Service and a panel of appeals officers has been established. A second appeals officer is due to begin work shortly. In addition, four administrative staff have been appointed to support the current appeals officer.

Up to 23 May, the health repayment scheme appeals office had received 3,173 completed appeal forms. The appeals officer must investigate each of these independently and his investigations can require additional reviews by the HSE and the scheme administrator. Certain appeals present a high level of complexity. In addition, a high percentage of appellants have requested oral hearings. Up to the end of May, the appeals officer had completed 471 oral hearings at locations throughout the country. Up to 23 May, the appeals officer had carefully, thoroughly considered and assessed 1,293 appeals and issued decisions in respect of all of them.

I am impressed that a single appeals officer has been able to deal with so many appeals. If that sort of productivity existed throughout the health service, we would be doing extremely well.

It is extraordinary that KPMG has been paid €23 million — €15 million exclusive of VAT — to administer the scheme. Some 70,000 claims were expected, 39,000 were lodged and 14,000 have been settled and it is hoped that the matter will be dealt with in its entirety in the near future.

People feel bamboozled and intimidated. When they appeal, it becomes clear to them that the process is not about fairness but instead revolves around saving money. That money was taken from the elderly illegally and now these people are being thwarted, in their later years, from obtaining justice. Some 12% of processed claims have been appeals and only 25% of the appeals lodged and considered to date in respect of these claims have been successful. A further 10% of applicants whose claims rejected were subsequently judged to be entitled to payment.

It is clear that a great deal of activity is being focused on preventing people from recouping what is rightly theirs. Despite the fact that 130,000 people work for the HSE, KPMG is being paid €23 million to administer the scheme. When people undergo the claims process and are obliged to appeal, they discover that there is only one appeals officer. The Minister indicated that a recruitment process has been completed, that a panel has been established and that a second appeals officer will be appointed shortly.

What is happening is nothing short of scandalous. What sort of message is being sent to the elderly? Having being short-changed by the State, the latter is now doing everything in its power to obstruct them from obtaining what is rightfully theirs. Will the Minister indicate the number of appeal officers she intends to have in place by the end of the month so that this major issue might be dealt with?

I will be very brief. What exactly is the role of KPMG and why was it brought in? Does the Minister consider its service good value for money?

It was brought in because the HSE felt it would not be able to cope. It has dealt with 39,000 claims and €15 million exclusive of VAT would be regarded by any standards — especially with the overtime bills I see — as enormous value for money.

There are many administrators in there already.

If we were to make the system, with its current staffing complement, deal with this issue, it would have been dealt with on an overtime basis. It would have taken substantially longer and cost substantially more. An assessment was made and that was the recommendation.

What about the thousands in the HSE who do not know what their jobs are? They could be seconded for this.

Perhaps some of the Deputy's friends in some of the vested interests could have done it. Perhaps the Deputy should have put in a bid for it. Some 39,000 claims have been dealt with.

That is desperation.

This money must be paid in accordance with the law enacted by the Oireachtas. We must ensure, in the first instance, that the correct people are paid their money. We do not want a family member or distant relative who may never have visited the old person getting money that somebody else may be entitled to. There is no doubt that it is a very complex legal process but this is necessary because of the law.

With regard to the scheme, we appointed at the beginning an oversight group representative of various groups advocating older people. Ms Sylvia Meehan is on it, for example, and it is chaired by Bernard Walsh, a geriatrician in St. James's Hospital. They oversee this and have given me three reports. I know they remain very satisfied and confident in the manner in which this scheme is being executed. The purpose is to get money to the right people as quickly as possible.

As I indicated in my initial reply, the HSE has told me that by the end of June, all the applications will have been processed and determinations will be made. We expect to finish it during this calendar year and do not envisage it going to 2009. I am delighted this is the case.

Sometimes, as a result of what we are dealing with, people who make the applications pass away. We are dealing with very old people in residential care who may have been there for some time. Many issues arise but the administrator and the HSE have operated this scheme very professionally and thoroughly. Unfortunately, when legal letters are sent to individuals, particularly older people, I accept they can be intimidating. Every effort is made to talk to people and I understand approximately 800 people were spoken to by telephone about their applications. For example, different parts of the form may have been filled out that were not required or were inaccurate. Every effort is made to deal with these people in as human a way as possible, particularly where older people are concerned.

I have no wish to row with the Minister on the issue, which is very important. I am glad she at least admits that letters can be intimidating, as can telephone calls. People are confused. I wish to ask her questions which require a "Yes" or "No" answer. Is she concerned at the high level of successful appeals, at 25%? That is very significant. Considering the large numbers, how many additional appeals officers will the Minister put in place by the end of the month if she hopes to finish the work? The Minister has indicated the process is expected to finish at the end of this year.

The Minister might clarify the case of those in psychiatric institutions and the procedure for refunding such patients. What is the position for psychiatric patients in community groups or supervised houses where deductions have taken place?

On those phone calls which have been made to elderly people, I understand they are mainly for clarification purposes. Have there been any complaints regarding people feeling intimidated about phone calls received?

The only one I am aware of is that which arose in the newspaper last week and which was the subject of a Dáil question by one of the Deputy's colleagues. When I sought to establish the facts, they were very different from what had appeared. The individual who made the application was in her early 80s, which in itself was unusual because generally the applicants are younger relatives or members of the family of the older person.

I understand it related to the form not having been completed accurately, and a legal letter was sent. The person who received it felt somewhat intimidated by the letter and thought the letter was indicating she would not get her money, which was not the case. The letter — in legalese, which is intimidating for most of us — simply asked the applicant to clarify the documentation.

Many of the applications are made by lawyers on behalf of individuals and I know of a large number of people where the solicitors have made an application on an applicant's behalf. I understand that with the high number that came in just before Christmas, many were applications made by legal representatives of deceased persons. The same procedure applies for everybody under the Act in terms of the application process and scrutiny.

On the appeals officers, we have indicated we need whatever number of appeals officers required to deal with the level of activity. It has not been brought to my attention that there is a shortage, as I indicated. More are being appointed on a temporary basis, and there are four administrative backup staff to help. I have not heard that there is a shortage of appeals officers but if additional manpower is required to clear the appeals in a short space of time, it will not be a problem.

Is the Minister concerned at the high number of successful appeals at 25%, given the amount paid to KPMG?

Is it 35%? I do not have that data.

It is what I have in front of me.

I do not have it. If there was a high level of successful appeals, it would indicate first that the appeals process is working. I do not have the figure read out by the Deputy from some note I presume he has from the HSE. It is not in my note that it is as high as 35%. I did say that of the number of appeal applications made, 35% have been dealt with.

I stated one in four — 25%.

Yes, one in four has been dealt with but my note does not tell me they have been successful. I am sorry I do not have that information.

There is no point in me staying here if the Minister will not answer my question.

I wish the new Minister of State, Deputy Mary Wallace, well in her new position.