Wednesday, 19 Dec 2012

Written Answers Nos. 16-29

General Practitioner Services

Questions (16)

Brendan Smith

Question:

16. Deputy Brendan Smith asked the Minister for Health when he will reduce general practitioner remuneration; and if he will make a statement on the matter. [57083/12]

Written answers

Minister of State at the Department of Health

On Budget Day, Dr. James Reilly T.D., Minister for Health announced that the fees/allowances payable to health professionals will be reviewed under the Financial Emergency Measures in the Public Interest Act 2009.

The professionals concerned are General Practitioners, Pharmacists, Dentists, Ophthalmologists, Optometrists and Dispensing Opticians who hold contracts with the HSE, Smeartakers contracted under the CervicalCheck programme and Consultant Psychiatrists who hold contracts with the Mental Health Commission.

The Minister has determined that a consultation process shall commence on 13 December 2012 and shall be completed by 11 January 2013. A press notice was placed in national newspapers on 13 December, inviting interested parties to provide written submissions to assist in deliberations on these matters. Further details are available on the Department’s website at www.doh.ie on the Public Consultations page.

The review shall encompass, but is not confined to, fees and allowances which have been reduced previously under the Financial Emergency Measures in the Public Interest Act, 2009.

When the review has been completed, the Minister for Health will make a decision on whether to reduce, or otherwise, the fees and allowances payable to the above health professionals, including General Practitioners. Where the Minister determines that fee adjustments should be applied, Regulations will be prepared to give effect to such adjustments.

Question No. 17 answered with Question No. 10.

Services for People with Disabilities

Questions (18)

Caoimhghín Ó Caoláin

Question:

18. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he will set out the level of cuts to supports for disability services in 2013; if he will address the funding crisis which is affecting disability services, including day care, residential care, respite and so on; and if he will make a statement on the matter. [57002/12]

Written answers

Minister of State at the Department of Health

The funding situation for the disability sector in 2013 is not yet available pending the finalisation of the HSE's National Service Plan for 2013. Savings required globally from the Health Budget will have an impact on all services, including disability services, and it is expected that these will be outlined when the Minister for Health approves the National Service Plan in the near future.

I have made it clear to the HSE that the frontline services should be protected to the greatest possible extent with the needs of patients being central to any decision making.

National Children's Hospital Status

Questions (19)

Aengus Ó Snodaigh

Question:

19. Deputy Aengus Ó Snodaigh asked the Minister for Health if he will provide an update on the development of the National Children’s Hospital and on the enhanced support, if any, he will provide to the existing children’s hospitals pending the completion of the new hospital; and if he will make a statement on the matter. [57012/12]

Written answers

Minister for Health

Following the refusal by An Bord Pleanála of planning permission for the new children's hospital on the Mater site, I established a Review Group chaired by Dr Frank Dolphin (the Dolphin Group) to advise on next steps. Their report was presented to me on 8 June this year. On Tuesday 6 November, I announced the Government’s decision to develop the new children’s hospital at the campus of St James’s Hospital in Dublin. In identifying the new site, the Government has carefully considered the report of the Dolphin Group along with detailed supplementary information on cost, time and planning which was subsequently sought from those members of the Group with the relevant technical expertise.

This decision has been made in the best interests of children, with clinical considerations being of paramount importance. Co-location, and ultimately tri-location with a maternity hospital, on the St James's campus will support the provision of excellence in clinical care that our children deserve.

The new children’s hospital is a key commitment in the Programme for Government and the largest project within the current Capital Plan. This Government regards the building of the hospital as a priority and no effort will be spared in expediting its completion. Until then, the HSE will continue to support the existing children's hospital who will continue to operate and provide services to patients within the current agreed Service Plans. I have already signalled that the three hospitals will become a single Hospital Group in the near future, and my Department is examining the necessary arrangements to support this.

In parallel, I am moving to put in place the necessary structures and governance arrangements to enable the delivery of the capital project as quickly as possible and to the highest quality. I will bring a Memorandum for Government on these issues to Cabinet shortly. Pending this, work is progressing in relation to the site and site preparation, while a review of urgent care centre(s) configuration is underway and a time-limited review of Dublin maternity services configuration is to commence as soon as possible.

Health Insurance Prices

Questions (20, 188)

Micheál Martin

Question:

20. Deputy Micheál Martin asked the Minister for Health his plans to reduce the price of private healthcare; and if he will make a statement on the matter. [57069/12]

Bernard Durkan

Question:

188. Deputy Bernard J. Durkan asked the Minister for Health the action that has been taken to ensure that health insurance costs here are brought into line with the most competitive in Europe; and if he will make a statement on the matter. [57318/12]

Written answers

Minister for Health

I propose to take Questions Nos. 20 and 188 together.

The Government is committed to keeping down the cost of health insurance so that it is affordable for as many people as possible and remains committed to protecting community rating, whereby everyone pays the same price for the same health insurance product, irrespective of age or health status. The Programme for Government contains a commitment to put a permanent scheme of risk equalisation in place, which is a key requirement for the existing private health insurance market and is designed to keep health insurance affordable for older persons and to maintain the stability of the market.

I was pleased, therefore, to recently publish the Health Insurance (Amendment) Bill, 2012, to give effect to a new Risk Equalisation Scheme (RES) to be applied from 1 January 2013. An effective and robust RES is required in the Irish private health insurance market in order to protect affordability for those who need it most.

I recently announced the rates of risk equalisation credits to apply in 2013 at the Committee Stage debate in the Dáil on this Bill. The rates are funded by a stamp duty payable by all insurers in respect of each insured person. The credit is provided at source – that is, the cost of the policy is reduced by the amount of the risk equalisation credit. The measures are designed to result in no overall increase of premiums paid in the market and to spread the risk more evenly between the healthy and the less healthy, as well as the old and the young. This action is in line with plans to move to Universal Health Insurance, under which everyone will be insured for health care.

The Government remains committed to keeping down both the cost of health insurance, so that it is affordable for as many people as possible, and the general cost of healthcare delivery, as part of measures to ensure the sustainability of the private health insurance market in the transition to a UHI system. In February of this year I established the Health Insurance Consultative Forum which comprises representatives from the country's main health insurance companies, the Health Insurance Authority (HIA) and the Department of Health. This Forum was established to generate ideas which would help address health insurance costs, whilst always respecting the requirements of competition law. The Forum will also give a voice to the insurers in the development of the new Universal Health Insurance model. I have also made it clear to the health insurers that I believe that significant savings can still be made, the effect of which can be to minimise the need for increases in premiums.

In this regard, VHI has commissioned consultants to carry out an external review of their claims. The review is nearing completion and will look at the opportunities and costs involved in possible reductions in utilisation that can be achieved by implementing appropriate utilisation management approaches.

I would also strongly advise consumers to shop around for the health insurance plan that best suits their needs. Consumers have a legal right to switch between or within insurers to get better value and to reduce their premium costs. The HIA provides information to consumers regarding their rights and also on health insurance plans and benefits. The HIA's website www.hia.ie has a useful plan comparison tool which assists in finding suitable and competitive health insurance plans.

Departmental Expenditure

Questions (21, 46, 71)

John Halligan

Question:

21. Deputy John Halligan asked the Minister for Health the cuts he intends to make to reach the target of €780 million; and if he will make a statement on the matter. [57096/12]

Richard Boyd Barrett

Question:

46. Deputy Richard Boyd Barrett asked the Minister for Health the cuts he intends to make to reach the target of €780 million; and if he will make a statement on the matter. [57030/12]

Jonathan O'Brien

Question:

71. Deputy Jonathan O'Brien asked the Minister for Health if he will detail the way in which the projected €781 million reduction in the health budget in 2013 will be achieved; and if he will make a statement on the matter. [57024/12]

Written answers

Minister for Health

I propose to take Questions Nos. 21, 46 and 71 together.

The following table outlines the summary of measures to be taken by the Department in order to adhere to the 2013 Expenditure Ceiling. The table shows the amount of savings to be generated in 2013 following the implementation of each measure and the amount that is expected to be generated in a full year. The Department of Health's own Vote is being reduced by €90m - €30m transferring to the HSE and €60m in savings. Even allowing for additional expenditure related to the EU Presidency , there will be a reduction in the Department's Administrative Budget. There will be savings on the National treatment Purchase Fund and €25m of its budget will be transferred to the HSE. There will also be a range of further reductions including reductions in funding for health agencies.

Measure	Savings in 2013	Full Year Savings
		€ million
		Primary Care Schemes
Reduction in cost of Drugs and other prescribed items	160	330
Increase DPS threshold to €144 per month	10	10
Increase prescription charges for medical card holders	51	51
Reduced professional fees	70	80
Other changes to Primary Care schemes	32	44
		Other areas
Pay-related savings	308	458
Increased generation of private income	65	115
Savings on Department Vote	60	60
Procurement Measures	20	20
Other measures	5	5
Total Net Savings	781	1,173

Ambulance Service Response Times

Questions (22)

Denis Naughten

Question:

22. Deputy Denis Naughten asked the Minister for Health the progress which has been made in the Health Service Executive West region since the introduction of standardised ambulance response times; the steps being taken to improve ambulance response times in the region; and if he will make a statement on the matter. [56889/12]

Written answers

Minister for Health

The Health Information and Quality Authority has developed a suite of key performance indicators (KPIs) within which 999 emergency calls have been classified by clinical status.

Clinical Status 1 Echo calls involve life-threatening emergencies of cardiac or respiratory origin. Clinical Status 1 Delta calls involve life-threatening emergencies of other than cardiac or respiratory origin. The target times for responding to Echo 1 and Delta 1 calls are 7 minutes 59 seconds by a first responder (a person trained in minimum basic life support and use of a defibrillator) and 18 minutes 59 seconds for a patient-carrying vehicle. With effect from January 2012, HIQA have set the standard for first responders at 75% within the target time and at 80% within the target time for patient-carrying vehicles.

Response times around the country vary significantly and are influenced by the nature of the area covered and the rural/urban mix. As might be expected, the percentages for achieving optimum response times are lower in remote areas of the country. The following table sets out response times for August 2012 by the three operational areas.

NAS Area	ECHO First response within 7 mins 59 secs (Target 75%)	DELTA First response within 7 mins 59 secs (Target 75%)	ECHO Transporting vehicle within 18 mins 59 secs (Target 80%)	DELTA Transporting vehicle within 18 mins 59 secs (Target 80%)
North Leinster	74.03%	30.51%	62.99%	69.20%
South	44.44%	28.53%	74.07%	66.60%
West	41.67%	25.98%	86.11%	62.25%

It is important to note, however, that following a review of the validity of time-based KPIs for clinical status data, and in line with international views , it is considered that clinical outcome indicators would be more appropriate, and work has begun on their development. I also welcome the consequential outcome that use of clinical indicators will enable a focus on Clinical Status 1 (Echo and Delta) calls.

The National Ambulance Service (NAS) has been taking a number of steps to improve response times. These include development of a Performance Improvement Action Plan, an intermediate care service, the control centre reconfiguration project and a trial emergency aeromedical service.

The Performance Improvement Action Plan is focused on achieving an improvement in response times performance. This plan has 57 action points for improvement which are being worked through by local managers, in areas such as faster mobilisation times for crews; improved processes for call taking and dispatch; engagement with and development of community first responder schemes.

The intermediate care service (ICS) is intended to provide non-emergency stretcher-based transport, such as for inter-facility journeys, so emergency vehicles are available for emergency duties and response times can be improved. In this context, the NAS and staff representatives have signed off on a Framework Agreement for the development of an ICS within the NAS, specifically to free up emergency resources for emergency calls. Almost 50 intermediate care operatives have been appointed across the country, in areas including Cork, Galway, Sligo, Letterkenny, South Dublin.

Through its control centre reconfiguration project, the NAS is continuing to rationalise the number of ambulance control rooms across the country, with a target of one system across 2 sites - Tallaght and Ballyshannon. The current total is nine. is project is focused improving call taking and dispatch functions and on delivering improved technology. is will assist in improving response times and will allow the NAS to deploy resources in a much more effective and efficient manner, on a regional and national basis rather than within small geographical areas.

The Emergency Aeromedical Service (EAS) was initiated as a 12 month trial in June 2012, with two purposes - to reduce the transit time to an appropriate facility for certain conditions, particularly in the west, and to determine the extent, if any, of the need for aeromedical support to the NAS and, if required, how best to provide it. The trial involves the Irish Air Corps providing aeromedical support to the HSE NAS, from a base in Custume Barracks, Athlone. The aircraft is operated by the Air Corps, with clinical staffing from the NAS. The Irish Coast Guard also provides additional support to the primary aircraft, using its new search and rescue helicopter in Shannon, which is staffed by its own paramedics and an NAS advanced paramedic when necessary.

Health Care Inflation

Questions (23)

Michael Moynihan

Question:

23. Deputy Michael Moynihan asked the Minister for Health the reason healthcare inflation here is the second highest in Europe; and if he will make a statement on the matter. [57078/12]

Written answers

Minister for Health

Ireland recorded the third lowest rate of inflation in the Health Category in the EU 15. Greece and Portugal were the countries which were lower. The type of prices included in the health category include medical products, appliances and equipment, hospital charges and out patient services supplied by doctors, dentists, opticians, physiotherapists and practitioners of alternative and complimentary medicine.

The Harmonised Index of Consumer Prices (HICP) for November 2012 indicates that Ireland has the second highest inflation rate in health care cost in EU 15 except for Netherlands over the last 6 years. However, figures for the UK are not available, but it is normally slightly above Ireland which would indicate that Ireland has the third highest rate.

The HICP is based on the Consumer Price Index (CPI) survey, which is designed to measure the change in the average level of prices (inclusive of all indirect taxes) paid for consumer goods and services by all private households in the country and by foreign tourists holidaying in Ireland. Therefore it does not reflect price changes in the cost to the Health Service Executive of providing treatment. As the Deputy will be aware, very significant reductions in the cost of human resources, medications and in fees paid to professionals have been achieved in Ireland over the last few years - however, these are not comprehended within the HICP.

Prescription Charges

Questions (24, 58)

Gerry Adams

Question:

24. Deputy Gerry Adams asked the Minister for Health the estimated sum to be raised by the trebling of prescription charges for medical card patients; and if he will make a statement on the matter. [57004/12]

Billy Kelleher

Question:

58. Deputy Billy Kelleher asked the Minister for Health the reason, in view of earlier statements he made, he has tripled rather than abolished prescription charges [57056/12]

Written answers

Minister of State at the Department of Health

I propose to take Questions Nos. 24 and 58 together.

Due to the very difficult and challenging economic environment the Government has committed to achieving additional savings in health expenditure during 2013 and 2014 with €781m savings targeted in 2013. The Government is committed to achieving these savings while protecting front line services to the most vulnerable to the greatest extent possible. Reductions in the cost of Primary Care Schemes will contribute €323m towards this overall savings target, and the increase in prescription charges will account for €51 million of this target.

Cancer Screening Programmes

Questions (25)

Éamon Ó Cuív

Question:

25. Deputy Éamon Ó Cuív asked the Minister for Health when the BreastCheck programme will be provided to women aged 65-69 years; and if he will make a statement on the matter. [57079/12]

Written answers

Minister for Health

The BreastCheck Programme provides free mammograms to all women aged 50-64. The Programme for Government includes the extension of BreastCheck to women in the 65-69 age group, in keeping with EU Guidelines on effective screening for breast cancer.

The main priority for the HSE's National Cancer Screening Service (NCSS) at present is to maximise national uptake in the 50-64 year age cohort.The extension of the BreastCheck programme has been listed as a priority in the HSE's 3 year Corporate Plan (2012 -2015).The HSE's National Cancer Control Programme is examining how it can extend the programme to 65-69 year olds. A review of the BreastCheck screening process, commissioned this year by my Department from the Department of Epidemiology and Public Health in UCC and the Centre for Health Policy and Management in Trinity College,has just been submitted to my officials.This review will help to inform how greater efficiencies may be achieved within the Programme in order to extend the age range at the earliest date. The Strategic Framework for Reform of the Health Service estimates that this will be in 2014.

In the meantime women of any age who have concerns about breast cancer should seek the advice of their GP who will, if appropriate, refer them to the symptomatic breast services in one of the eight designated specialist cancer centres.

Medical Card Eligibility

Questions (26)

Seamus Kirk

Question:

26. Deputy Seamus Kirk asked the Minister for Health the postion regarding the supply of medical cards to cancer patients; and if he will make a statement on the matter. [57068/12]

Written answers

Minister of State at the Department of Health

Medical cards are not awarded to any particular group of patients on the basis of a specific medical condition.

Under the provisions of the Health Act 1970, eligibility for health services in Ireland is based primarily on residency and means.There are currently two categories of eligibility for all persons ordinarily resident in Ireland i.e. full eligibility (medical card) and limited eligibility (all others).Full eligibility is determined mainly by reference to income limits, and is granted to persons who, in the opinion of the Health Service Executive, are unable to provide general practitioner, medical and surgical services to themselves and their dependents without undue hardship.There is no automatic entitlement to a medical card for persons who have cancer.

There is a provision for discretion to grant a card in cases of "undue hardship" where the income guidelines are exceeded. The HSE recently set up a clinical panel to assist in the processing of applications for discretionary medical cards where there are difficult personal circumstances.

There is an emergency process for a person who is terminally ill, or in urgent need of medical attention and cannot afford to pay for it, that provides a card within 24 hours while the normal application process is completed. Details of this procedure have been made available to all GPs and Social Workers. Such applications can be initiated through the Local Health office whose manager has access to a dedicated fax and e-mail contact line to the Primary Care Reimbursement Service (PCRS).Once the medical condition is verified by a GP or a consultant, and the required personal details are provided, an emergency card is issued to that person for a six-month period.

Lourdes Hospital Redress Scheme Eligibility

Questions (27)

Clare Daly

Question:

27. Deputy Clare Daly asked the Minister for Health in view of the age profile and growing stress of the women involved, the reason for the delay in delivering on the commitment for redress of the victims of Dr. Michael Neary, and when the promised redress may be expected [56892/12]

Written answers

Minister for Health

This Government has given a commitment in the Programme for Government to seek a mechanism to compensate those women who were excluded on age grounds alone from the Lourdes Hospital Redress Scheme. I understand that approximately 35 women who suffered an unnecessary bilateral oophorectomy were excluded from the Redress Scheme on the basis of age alone. The Scheme of Redress approved by Government in 2007 was a non-statutory, ex-gratia scheme. Awards were determined by an independent Redress Board in 2007 and 2008.

My Department has been engaged in a review to identify the most appropriate mechanism to compensate these women. This review has included taking instructions and legal advice, including advice from the Office of the Attorney General, with a view to bringing proposals to Government for a decision. This process is ongoing, and it is my intention that it will be brought to a satisfactory, legally sound conclusion as quickly as possible.

I would like to assure the Deputy that I am committed to finding a solution to this sensitive issue and I intend bringing proposals to Government for its consideration at the earliest possible opportunity.

Universal Health Insurance Provision

Questions (28)

Seán Crowe

Question:

28. Deputy Seán Crowe asked the Minister for Health if, in relation to the Government's plan ‘future health’ and its statement that social care services will not be covered by universal health insurance, this will mean people having to pay for care services which they are eligible to receive without charge at present; and if he will make a statement on the matter. [57014/12]

Written answers

Minister of State at the Department of Health

Under Universal Health Insurance, everyone will be insured for a standard package of primary and acute hospital services, including acute mental health services. While primary and hospital care will be funded mainly via the UHI system, specialised and social care services, including long term care, will be funded by general taxation.

The future sustainability and model of delivery of social care services will have to be subjected to detailed policy analysis and consultation along the lines of the initiatives outlined in Future Health - A Strategic Framework for Reform of the Health Service 2012 – 2015.

Future Health commits to the development of a social and continuing care system that maximises independence and achieves value for the resources invested. The measures include a reform of the Nursing Home Support Scheme to allow many more people to continue living at home as they would wish. Consideration will also be given to the extension of the Nursing Home Support Scheme model to the disability and mental health sectors. Disability services will be reformed in line with the findings of the recent Value for Money and Policy Review of Disability Services. Future Health also reaffirms our support for the move from the traditional institutional based model of mental health care, towards a patient-centred, flexible community based service. Other important measures identified include the introduction of a standardised framework to commission services from both public and non-public providers; individualised budgeting to bring about a closer alignment between funding and the outcomes of individuals; and a robust regulatory regime to ensure quality and safety.

Home Care Packages

Questions (29)

Dara Calleary

Question:

29. Deputy Dara Calleary asked the Minister for Health the number of persons that lost home help hours following the cuts announced in September; the savings that accrued as a result of these cuts; and if he will make a statement on the matter. [57059/12]

Written answers

Minister of State at the Department of Health

As this is a service matter it has been referred to the Health Service Executive for direct reply.