Wednesday, 13 Nov 2013

Written Answers Nos. 1-22

Prescription Charges

Questions (10)

Joan Collins

Question:

10. Deputy Joan Collins asked the Minister for Health if he will reverse his proposals to increase prescription charges to €2.50 with a cap of €25. [48008/13]

Written answers

Minister of State at the Department of Health

As announced in Budget 2014, it has become necessary to increase the prescription charge due to the very difficult and challenging economic environment which requires the Government to achieve additional savings in health expenditure with €666 million of savings targeted in 2014. The increase in prescription charges will account for €43 million of this target. The Government is committed to achieving these savings while protecting front line services to the most vulnerable to the greatest extent possible.

Medical card holders will be required to pay a €2.50 charge per item for medicines and other prescription items supplied to them by community pharmacists, subject to a cap of €25 per month for each person or family. Prescription charges do not apply to children in the care of the HSE or to methadone supplied to patients participating in the Methadone Treatment Scheme. These new rates will be effective from 1 December 2013.

Questions Nos. 11 and 12 answered orally.

Health Services Expenditure

Questions (13)

Billy Timmins

Question:

13. Deputy Billy Timmins asked the Minister for Health if a workable system for the management of the health services budget is in place, as recommended in the Ogden report. [42414/13]

Written answers

Minister for Health

A Review of Financial Management Systems in the Irish Health Service, commonly known as the Ogden Report, was published in 2012.

The review was commissioned by the Secretary General of the Department of Health. Its overall intention was to review the state of the financial management system in place in the health sector in Ireland at the time in the context of the serious overruns projected to occur in 2012, the continuation of a challenging financial environment for the foreseeable future and the radical reforms envisioned in the Programme for Government.

Recommendations

The report made a number of recommendations to improve the financial management process within the HSE, with particular reference to managing the transition phase that the health sector was undergoing. The recommendations were grouped into 3 distinct areas: Improving Financial Performance; Policy Considerations; and Effective Transitioning (Managing the Change).

New Integrated Financial Management System

The Strategic Framework for Reform of the Health Services “Future Health” identified, as one of the key challenges, the need for an integrated financial management system. The current financial management system in the HSE was largely inherited from the health boards, the Eastern Regional Health Authority and the other bodies which were subsumed into the HSE. It has evolved over many years as the structure of the organisation has changed. However it is acknowledged, that given the new requirements for financial management and comprehensive financial reporting, the current operating model is inadequate for its purpose. The Department of Health is committed to working with the HSE to ensure the development and roll out of a comprehensive financial management system as a matter of priority.

As part of the process of further strengthening the financial management of the Health Service Executive independent expertise was engaged to evaluate the financial performance management system and a Finance Reform Board has been established within the HSE made up of senior management and representatives from the Departments of Health and Public Expenditure and Reform.

Current Position

The Finance Reform Board and my Department have endorsed proposals regarding the development and roll out of an integrated financial management system with my the full support and approval. Proposals for significant new projects must be approved by the Department of Public Expenditure and Reform which requires a robust business case to be made. The HSE is currently finalising a business case for submission to the Department of Public Expenditure and Reform.

Mental Health Services Funding

Questions (14)

Thomas P. Broughan

Question:

14. Deputy Thomas P. Broughan asked the Minister for Health the reasons for the underspend in the mental health services budget this year, which was specifically identified as ring-fenced funding; and the way commitments to increase staffing levels in mental health services can be fulfilled in view of the ongoing constraints in the Health Service Executive’s overall budget. [47945/13]

Written answers

Minister of State at the Department of Health

An additional €35m was allocated in Budget 2013 for the continued development of our mental health services across a range of headings, including the further development of forensic services and community mental health teams for adults, children, older persons and mental health intellectual disability. 477 posts have been approved to implement these measures.

As at 30th September 255 posts (54%) were in the final stages of recruitment, and a further 149 (31%) were at earlier stages indicating that 85% of the posts are in the recruitment process with the balance in the HR approvals process.

There are a number of posts for which there are difficulties in identifying suitable candidates due to factors including availability of qualified candidates and geographic location. The HSE's National Recruitment Service is currently working to ensure that the remaining posts will be filled as soon as possible, from existing panels or through competition in the absence of panels, at the earliest opportunity. Options to enable more local recruitment are also being considered where this will assist in filling specific posts. I have received assurances from the HSE that the recruitment process for these new posts is being given priority within the HSE.

In relation to expenditure against the 2013 allocation of €35 million and associated 477 posts, the HSE is currently validating the position regarding the new posts filled at the end of October and will then be in a position to estimate the spend once that data is available. I will provide this information to the Deputy when it becomes available.

Hospitals Building Programme

Questions (15)

Billy Kelleher

Question:

15. Deputy Billy Kelleher asked the Minister for Health if he will provide an update on the construction of the new children’s hospital; and if he will make a statement on the matter. [48051/13]

Written answers

Minister for Health

The new children's hospital project is a priority for me and for this Government. In October, the Minister for Public Expenditure and Reform announced that up to €250m would be available for the project from the sale of the National Lottery, adding to the €450m Exchequer funding already indented.

The National Paediatric Hospital Development Board is the body responsible for the capital project. Last August, I announced appointments to this Board to replace the transitional Board which had been in place since January this year. These appointments bring architectural, planning, procurement, engineering and construction expertise to the project. Also in August, I announced appointments to the Children's Hospital Group Board which, as client for the project, will play a key role in ensuring the new hospital is optimally designed and completed as swiftly as possible. Earlier this month, Ms Eilísh Hardiman took up post as CEO of the Children's Hospital Group, and will play a central role in driving forward the integration of the three hospitals, and the project as a whole.

Prior to the commencement of construction, key elements of the project include design development, decant works for the site and planning permission. The new Board has reviewed the design team procurement process, which had been initiated in July, and decided on a change of approach based on its collective expertise and taking into account changing market conditions. While this means that the design team will be selected in Spring 2014, rather than by the end of this year as originally planned, the Board is confident there will be no delay to the project overall. Work on the review of urgent care centre configuration is at an advanced stage and I intend to bring proposals in this regard to Government shortly.

Pre-application planning discussions have commenced, a masterplan for the St. James's Hospital campus is being prepared and St. James's Hospital is working closely with the Development Board and the HSE in relation to the decant phase of the project.

Work on developing a detailed timeline is continuing, which will reflect the urgency and priority of the project and also its scale and complexity. However, at this stage, the Board is confident that construction can begin in Spring 2015.

Organ Donation

Questions (16, 19)

Seamus Healy

Question:

16. Deputy Seamus Healy asked the Minister for Health if he will ensure that the €3 million needed to develop donor coordinators in hospitals here will be included in the 2014 health budget; and if he will make a statement on the matter. [48062/13]

Joan Collins

Question:

19. Deputy Joan Collins asked the Minister for Health if he will ensure that the minimum €3 million needed to develop the donor coordinators in our hospitals is allocated in the health estimates for 2014. [48007/13]

Written answers

Minister for Health

I propose to take Questions Nos. 16 and 19 together.

The HSE, through its National Organ Donation and Transplantation Office, in conjunction with my Department, has identified priority areas for action, including the deployment of additional donor coordinators, to enhance the organ donation and transplantation system. These proposals are being considered in the context of the Health Estimate for 2014 and the development of the HSE's National Service Plan 2014.

Primary Care Centres Expenditure

Questions (17)

Catherine Murphy

Question:

17. Deputy Catherine Murphy asked the Minister for Health his views on the sentiments of 45 general practitioners (details supplied) who publicly stated that cuts in primary care spending are leading directly to a reduction in doctors and nurses; if his attention has been drawn to the fact that several GPs are stating that they have invested large sums in their practices with the expectation that primary care services would be at a more advanced stage by this time; his views on whether these trends present a serious risk to patient safety; and if he will make a statement on the matter. [48058/13]

Written answers

Minister of State at the Department of Health

The HSE’s National Service Plan for 2013 sets out the funding allocations for this year by care group programme. It includes provision of €2,562 million in respect of the Primary Care Reimbursement Service and €400 million for Primary Care services. This is an increase of 1.7% and 7.6% respectively on the 2012 figures.

Successful transformation of our health services requires a corresponding transformation of the existing funding model. The first stage in transforming this funding model is to clarify funding streams through the creation of directorates and corresponding programme based budgets. As part of this process, a Primary Care Directorate was established within the HSE in 2013. This directorate will oversee the development and strengthening of primary care.

In 2013, Primary Care funding of €20 million, nationally, is being invested to support the recruitment of prioritised front-line primary care team posts and to enhance the capacity of the primary care sector. 264.5 additional Primary Care posts, including 72 Public Health Nurses and 40.5 Registered General Nurses, have been approved. The filling of these posts is at an advanced stage. From 1st July 2010, the GP trainee intake increased from 120 to 157 training places per year, in line with GP workforce requirements.

Earlier this year, a review was carried under the Financial Emergency Measures in the Public Interest (FEMPI) Act 2009 in relation to the operation, effectiveness and impact of the amounts and rates payable to certain health professionals under the relevant Regulations. Having carefully considered the submissions made during the consultation process, the Minister for Health decided to make an overall reduction of 7.5% in fees and allowances payable to GPs under the GMS and other schemes. Under the FEMPI legislation, the Minister for Health is required to carry out a review of the operation, effectiveness and impact of the amounts and rates fixed under the regulations each year. This will involve a full consultation with stakeholders in 2014.

The development of primary care is central to the Government's objective to deliver a high quality, integrated and cost effective health system. The development of primary care centres, through a combination of public and private investment, will facilitate the delivery of multi-disciplinary primary health care. Considerable progress has been made already in the delivery of primary care centres and 32 centres have opened since May 2011.

Since 2012, primary care infrastructure has been approved and is underway at 15 locations through refurbishment, extension of suitable properties or through new build. Construction is underway at 6 locations and planning permission has been granted at an additional 22 locations under the 'operational lease' mechanism.

The HSE is working with the National Development Finance Agency to progress the PCC Public Private Partnership programme. Planning applications for the PCC sites have been lodged recently or will be shortly.

I am aware that many GPs have invested in their practices. This, coupled with the increased investment in Primary Care by this Government will provide enhanced, safer services for patients.

Medical Card Eligibility

Questions (18)

Seamus Healy

Question:

18. Deputy Seamus Healy asked the Minister for Health if he will reverse the decision to exclude the first €50 per week of travel to work costs, the cost of home improvement loans and child care costs from allowance expenses for assessment for medical cards-general practitioner visit cards; and if he will make a statement on the matter. [48063/13]

Written answers

Minister of State at the Department of Health

As part of the Budget 2013 savings measures, payments on a home improvement loan and a €50 per week allowance for a car were excluded from the standard means test assessment. These changes took effect from April last.

For clarity, the exclusion from travel to work costs relates to removing the weekly amount of €50 allowed to cover standing charges, such as depreciation or other running costs, used when considering travel to work costs as an outgoing where public transport is not available or suitable and a car is required. This means that the HSE will continue to consider the standard mileage costs or public transport costs when assessing eligibility.

Expenses for childcare costs have not been excluded from the means test assessment. There are no proposals to reverse the changes introduced.

Question No. 19 answered with Question No. 16.

General Practitioner Services

Questions (20)

Thomas Pringle

Question:

20. Deputy Thomas Pringle asked the Minister for Health the way he intends to fulfill his pledge to have free general practitioner care for all by 2016; and if he will make a statement on the matter. [48055/13]

Written answers

Minister of State at the Department of Health

The Government is committed to introducing, on a phased basis, a universal GP service within its term of office, as set out in the Programme for Government and the Future Health strategy framework. As announced in the Budget, it has been decided to commence the roll-out of a universal GP service by providing all children aged 5 and under with access to a GP service without fees. This will mean that almost half of the population will have access to GP services without fees. The Government is providing new, additional funding of €37 million to meet the cost of this measure.

The introduction of a universal GP service constitutes a fundamental element in the Government's health reform programme. The current Government is the first in the history of the State to have committed itself to implementing a universal GP service for the entire population. A well functioning health system should provide equal access to healthcare for its patients on the basis of health needs, rather than ability to pay. The principles of universality and equity of access mean that all residents in Ireland should be entitled to access a GP services that is free at the point of use.

The Cabinet Committee on Health and Children has discussed the issues relating to the roll-out of the universal GP service and has agreed that a number of alternative options should be set out with regard to the phased implementation of a universal GP service without fees. As part of this work, consideration is being given to the approaches, timing and financial implications of the phased implementation of this universal primary care health service as a first step towards the introduction of Universal Health Insurance. A range of options are under consideration with a view to bringing developed proposals to Government shortly.

Symphysiotomy Report

Questions (21)

Caoimhghín Ó Caoláin

Question:

21. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the progress he has made since 26 September in ensuring justice and truth for the survivors of symphysiotomy; and if he will make a statement on the matter. [48068/13]

Written answers

Minister for Health

I received the independent report by Professor Oonagh Walsh on Symphysiotomy in Ireland at the end of May 2013. I met the three support groups representing the women concerned in August 2013. At that meeting, I acknowledged that this was a complex issue about which Government had not yet finished its deliberations. A number of those present described their personal experiences and I acknowledged the adverse effects endured by many women and their families as a result of symphysiotomy. In this context I proposed to appoint a judge to meet with the women in order to facilitate decisions on how best to bring closure for them.

My officials are actively considering this issue and I intend bringing preliminary proposals to Government in the coming weeks. I intend to publish the Walsh report when I have received Government approval regarding how best to proceed in relation to this issue.

My priority continues to be to ensure that the women who have had this procedure have their health needs comprehensively and professionally met. In this regard, the HSE provides a range of services to women who may be experiencing any adverse effects as a result of undergoing this procedure. These services include the provision of medical cards, the availability of independent clinical advice and the organisation of individual pathways of care and the arrangement of appropriate follow-up.

HIQA Investigations

Questions (22)

Clare Daly

Question:

22. Deputy Clare Daly asked the Minister for Health if he will order a Health Information and Quality Authority investigation into the circumstances of the care of a person (details supplied) in line with the HIQA investigation into the death of Savita Halappanavar. [48053/13]

Written answers

Minister for Health

I would like in the first instance to offer my sympathies to the family involved in this very unfortunate case.

I have been advised that the circumstances surrounding this patient's death were investigated by the HSE under the National Incident Protocol following which 11 actions were recommended. I have been informed by the HSE that the Rotunda Hospital has now implemented all 11 recommendations.

I am advised by my Department's Chief Medical Officer that it is not necessary nor is it appropriate for me to request the Health Information and Quality Authority (HIQA) to undertake investigations in a case such as this which has been adequately investigated under the HSE's incident management procedures.

It is important to state that maternal and peri-natal health statistics indicate that Ireland continues to be a very safe country for a woman to give birth and our safety record compares favourably with other developed countries.