Thursday, 19 Dec 2013

Written Answers Nos. 315-329

Legislative Process RIA

Questions (315)

Lucinda Creighton

Question:

315. Deputy Lucinda Creighton asked the Minister for Children and Youth Affairs the total number of Bills that have been published by the Department since she was appointed Minister; the number and Title of those Bills that included a regulatory impact assessment in advance of publication; the regulatory impact assessments published; the total number of promised Bills for publication; if she will list the Bills that will include a regulatory impact assessment; the regulatory impact assessments that will be published before the publication of a Bill; and if she will make a statement on the matter. [55123/13]

Written answers

Minister for Children and Youth Affairs

My Department was established on the 2nd June 2011 and since then I have published the Thirty-First Amendment of the Constitution (Children) Bill 2012, the Child and Family Agency Bill 2013 and the Child Care (Amendment) Bill 2013.

A Regulatory Impact Assessment (RIA) was not published in advance of publication of any of these. A RIA for the Child and Family Agency Bill 2013 was published on 4th July 2013. No RIA was conducted in respect of the other two published bills. I have also obtained Government approval for the publication of the Adoption (Amendment) Bill 2013 and a RIA has not been conducted in respect of this Bill.

My legislative commitments are set out in the Government Legislative Programme which is published by the Department of An Taoiseach and also on my Department's website. These include the Children First Bill, Children (Amendment) Bill, Adoption (Information and Tracing) Bill and the Adoption (Amendment) Bill.

In general, it is the practice in my Department not to publish a RIA until the Bill is drafted and published.

Departmental Bodies

Questions (316)

Lucinda Creighton

Question:

316. Deputy Lucinda Creighton asked the Minister for Children and Youth Affairs the total number of Irish quasi-autonomous NGOs that the Department created or which fall under the Department’s responsibility and were in existence when she became Minister and continue to exist; and if she will make a statement on the matter. [55139/13]

Written answers

Minister for Children and Youth Affairs

There are four agencies which are funded by the Exchequer through my Department's Vote. These are the Adoption Authority of Ireland, the Family Support Agency, the National Educational Welfare Board and the Ombudsman for Children’s Office. With effect from 1 January 2012, I also took responsibility for the Children Detention Schools as provided for in Part 10 of the Children Act 2001. All the aforementioned were in existence when I became Minister.

The Deputy may be aware of the recent completion of all parliamentary stages in respect of the Child and Family Agency Bill 2013, which has been signed into law by the President. This important piece of legislation provides for the subsuming of functions from three separate agencies; namely the HSE's Children and Family Services, and also the Family Support Agency and the National Educational Welfare Board. The Child and Family Agency will bring together some 4,000 staff and a budget of over €500 million. The Family Support Agency and the National Educational Welfare Board will both be dissolved on Agency Establishment Day.

It is my intention that the Child and Family Agency will assume statutory responsibility for services for children and families in early 2014. The Agency will formally come under the remit of my Department. Until the Agency is established the recently-appointed board of the Family Support Agency will, in addition to its existing functions, continue to provide oversight and direction to the ongoing organisational preparations for establishment.

Departmental Bodies

Questions (317)

Lucinda Creighton

Question:

317. Deputy Lucinda Creighton asked the Minister for Children and Youth Affairs the total number of chairpersons of State boards, agencies and regulators that fall under the Department’s responsibility who were chairpersons when she became Minister and continue to be chairpersons; and if she will make a statement on the matter. [55155/13]

Written answers

Minister for Children and Youth Affairs

There are four agencies which are funded by the Exchequer through my Department's Vote. These are the Adoption Authority of Ireland, the Family Support Agency, the National Educational Welfare Board and the Ombudsman for Children’s Office. With effect from 1 January 2012, I also took responsibility for the Children Detention Schools as provided for in Part 10 of the Children Act 2001.

The Chairperson of the Adoption Authority of Ireland, Mr. Geoffrey Shannon, is the only chairperson who was in post on my becoming Minister, and he remains in post at this time.

Medical Card Eligibility

Questions (318)

Catherine Murphy

Question:

318. Deputy Catherine Murphy asked the Minister for Health if he considers there to be a potential unfairness in his recent move to set the over 70s medical card allowance for a couple at less than double that of a single person over 70; if such a move is contrary to established practice in other areas of taxation where couple allowances and rates are set at double the figure for a single person; and if he will make a statement on the matter. [55070/13]

Written answers

Minister of State at the Department of Health

The adjustment to the over-70s medical cards, to which the Deputy refers, is not a tax related adjustment and does not relate to any allowance or tax credit.

Assessment for eligibility for an over-70s medical card is based on a gross income basis and there are no standard deductions allowable (for example, for income tax). Pensions, earnings, interest from capital and all other sources of income are included in the means test.

The gross income limits for a single person is currently €600 per week and €1,200 per week, in the case of a couple. Under Budget 2014, it was announced that income limits for the over-70s medical card would be set at €500 per week and €900 per week for a single person and a couple, respectively. In setting the limits, the Government recognises that the living costs of an individual living alone are more than half the living costs of a couple living together and that expenditure does not necessarily diminish relative to the number of people in the household. This is reflected, inter alia, through the provision of the Living Alone Increase and differential income limits for medical cards for persons aged under 70 years between individuals and couples. Furthermore, in the assessment for Supplementary Welfare Allowance, a differential applies whereby the rate for a dependent qualified adult is not half the personal rate of the applicant.

In that context, the over-70s income limit for a single person has been reduced proportionately less than the income limit for a couple.

Disease Management

Questions (319)

Billy Kelleher

Question:

319. Deputy Billy Kelleher asked the Minister for Health the chronic disease management programmes that were introduced in 2013; and if he will make a statement on the matter. [54763/13]

Written answers

Minister of State at the Department of Health

The HSE is engaged in an ongoing process to develop chronic disease management programmes across the spectrum of services from prevention to sustaining services, including specific additional investment in diabetes services for the promotion of integrated care.

The National Clinical Programme for Chronic Disease Prevention has been established to ensure all national clinical programmes, including primary care, incorporate relevant prevention activities into their programmes to deal with chronic disease risk factors.

The Programme recognises the importance of developing evidence based care pathways in brief interventions and other behaviour change methodologies for use with patients with key risk factors, e.g. smoking, diet, physical activity and alcohol. All health care professionals within and across the clinical programmes will have appropriate education and training to deliver these pathways of care.

The development of a National Clinical Programme for Chronic Disease Management will be a priority for the HSE in 2014.

Health Services Staff Data

Questions (320)

Billy Kelleher

Question:

320. Deputy Billy Kelleher asked the Minister for Health the numbers of health care professionals working in primary care as of 1 January 2013; the most up-to-date numbers for them; and if he will make a statement on the matter. [54764/13]

Written answers

Minister for Health

The number of staff (WTE excluding career breaks) working in the primary care area of the public health service, broken down by staff category, at 31 December 2012 and at 31 October 2013 is set out in the following table:

Staff Category	31/12/2012	31/10/2013
General Support Staff	318.41	313.87
Health & Social Care Professionals	1920.16	2004.67
Management & Admin	2788.67	2688.14
Medical & Dental	852.50	865.83
Nursing	1782.16	2228.78
Other Patient & Client Care	1890.35	1786.51
TOTAL	9552.25	9887.80

Health Services Reform

Questions (321)

Billy Kelleher

Question:

321. Deputy Billy Kelleher asked the Minister for Health when the Department’s programme management office was established; and if he will make a statement on the matter. [54766/13]

Written answers

Minister for Health

A governance framework has been put in place for the Health Reform Programme to coordinate implementation in a planned, coherent manner. The governance arrangements, as promised in Future Health, include a Programme Management Office (PMO) and a Health Reform Programme Board, in the Department of Health and a Systems Reform Group in the HSE. The Programme Board is chaired by the Secretary General of the Department of Health, and includes senior managers from the Department and Health Service Executive, as well as an independent external expert in programme management.

The Programme Board first met on 26 March 2013 and is driving and overseeing implementation of the health service reform programme in line with the overall public service reform agenda. Work on establishing the Programme Management Office commenced in February 2013. The PMO is focusing on timing, sequencing and milestones for each project. It is prioritising, monitoring and reporting on the health reform programme as a whole, identifying inter-dependencies between actions and highlighting areas for corrective action. Senior officials with extensive experience and two other staff with relevant expertise work in the Programme Management Office.

Patient Safety Agency Establishment

Questions (322)

Billy Kelleher

Question:

322. Deputy Billy Kelleher asked the Minister for Health when the new patient safety agency will be established on an administrative basis; and if he will make a statement on the matter. [54767/13]

Written answers

Minister for Health

My Department is liaising with the Health Service Executive on the details surrounding the establishment of the Patient Safety Agency to ensure an identifiable and distinct leadership responsibility for patient safety and quality at national level having regard to the need for a robust quality and safety function within the new delivery structures of the Reform Programme.

Discussions are continuing with the HSE on establishing the PSA initially on an administrative basis within the HSE structures in 2014. This will allow the PSA to become an identifiable entity within the HSE and facilitate a smooth transition of certain functions undertaken by the HSE to the PSA.

The establishment of the PSA will be included in the work programme of the HSE in its Service Plan for 2014. The HSE is expected to establish a Board to oversee the PSA and to agree its initial governance and operational arrangements. The post of Chief Executive of the PSA will be advertised in the first half of 2014.

Patient Safety Agency Establishment

Questions (323)

Billy Kelleher

Question:

323. Deputy Billy Kelleher asked the Minister for Health when the patient safety agency's work with the Health Service Executive and the State Claims Agency to develop a risk-based approach to provision of indemnity to services and professionals was completed; and if he will make a statement on the matter. [54768/13]

Written answers

Minister for Health

The Patient Safety Agency (PSA) is not yet in place, but its establishment is a priority and is provided for in the work programme of the HSE in its Service Plan for 2014. Discussions are continuing with the HSE on establishing the PSA initially on an administrative basis within the HSE structures in 2014. This will allow the PSA to become an identifiable entity within the HSE and facilitate a smooth transition of certain functions undertaken by the HSE to the PSA. It is intended that the PSA will ensure an identifiable and distinct leadership responsibility for patient safety and quality at national level, having regard to the need for a robust quality and safety function within the new delivery structures of the Reform Programme. The main priorities for the PSA will be to ensure that patients, their families and carers experience high quality care, as well as ensuring the provision of care which is safe and protects patients from harm. The PSA will seek to ensure that the care provided is effective and based on the best available evidence and is integrated to support the smooth transition of patients across different care settings.

My Department is working with the HSE's Patient Safety Directorate and the State Claims Agency on the use of data which will be generated by the upgraded National Adverse Event Management System (NAEMS). Phase 1 of the upgrade of the system aims to provide enhanced intelligent adverse event entry screens together with enhanced and powerful reporting capabilities in locations covered by the Clinical Indemnity Scheme. The State Claims Agency has established an implementation group including representatives of the voluntary hospitals and the HSE. Training will be provided to those who are involved in the existing STARweb adverse event reporting system, and to relevant managers and clinical leads. It is also planned to introduce the system to the staff that will interface with the new system at "point of occurrence".

Phase 2 of the upgrade involves enabling the functionality on the system to provide end to end adverse event management, root cause analysis and policy audit tools. This will commence roll out in early 2014. The provision of performance benchmarks on clinical and non-clinical risk and claims performance, which will underpin a risk pooling approach to the Clinical Indemnity Scheme, will be developed during 2014. The roll out of the new system will commence with a pilot in a small number of sites, and the system will be expanded to all other sites during 2014.

Cancer Screening Programmes

Questions (324)

Billy Kelleher

Question:

324. Deputy Billy Kelleher asked the Minister for Health the date in 2014 that the age range extension of BreastCheck to include 65 to 69 year old women will commence; and if he will make a statement on the matter. [54769/13]

Written answers

Minister for Health

The BreastCheck Programme provides free mammograms to all women aged 50-64. A priority of the BreastCheck Programme at present is to maximise national uptake in the 50-64 year age cohort. It also aims to extend the upper age range to include the 65-69 age cohort as soon as possible in line with available resources.

HSE Governance

Questions (325)

Billy Kelleher

Question:

325. Deputy Billy Kelleher asked the Minister for Health the findings and recommendations of the review conducted by the Department in conjunction with the Health Service Executive of corporate functions and resources staff and budget of the various corporate, support and shared services as they exist in the HSE; and if he will make a statement on the matter. [54770/13]

Written answers

Minister for Health

The review of corporate functions and resources, staff and budget of the various corporate/support/shared services as they currently exist within the HSE is ongoing. This review must be undertaken in parallel with the establishment of the revised organisational structure and governance arrangements in the HSE, and is due to be completed in 2014.

Departmental Funding

Questions (326)

Billy Kelleher

Question:

326. Deputy Billy Kelleher asked the Minister for Health if funding for the health service will be provided through the Vote from the first quarter of 2014; and if he will make a statement on the matter. [54771/13]

Written answers

Minister for Health

Funding of the health service in 2014 will be through Vote 38 (Health) and Vote 39 (Health Service Executive). The Deputy will be aware that as part of the reconfiguration of health services, the Vote of the HSE will be disestablished and funding for services will be provided through the Vote of the Office of the Minister for Health. The Health Service Executive (Financial Matters) Bill was submitted to Government on Tuesday 17th. The Bill provides for the disestablishment of the Vote of the Health Service Executive from 1st January 2015. The Government has approved publication of the Bill and it will be published shortly.

The transfer of the Vote requires significant preparatory work including strengthening the financial control and planning capacity of my Department and enacting legislation to provide for a new statutory financial governance framework.

Health Insurance Regulation

Questions (327)

Billy Kelleher

Question:

327. Deputy Billy Kelleher asked the Minister for Health when the Department will address the regulatory status of the VHI in line with the European Court of Justice ruling; and if he will make a statement on the matter. [54772/13]

Written answers

Minister for Health

The Government agreed in December 2011 to address the European Court of Justice ruling of September 2011 and to work with the VHI in its application process for authorisation by the Central Bank of Ireland (CBI), subject to further Government consideration of any application for authorisation. Officials from my Department, the VHI and the CBI continue to engage regularly to progress the application. My Department is also in regular contact with the EU Commission in relation to the authorisation and related issues.

Authorisation is a complex and time consuming process and despite good progress, it will not be possible to authorise the VHI before the deadline of 31 December 2013. The Government has decided to request a year's extension from the EU Commission, with a commitment to seek to have VHI authorised by end 2014. VHI has stated that it will seek to raise any capital itself through reinsurance and subordinated loans. VHI's readiness for authorisation and any subsequent capital requirements will be determined by the CBI after its assessment of their application.

Departmental Funding

Questions (328)

Billy Kelleher

Question:

328. Deputy Billy Kelleher asked the Minister for Health the way the Department has developed programme-based budgeting in 2013; and if he will make a statement on the matter. [54773/13]

Written answers

Minister for Health

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. In Vote terms, programme based budgets have already been established for the Primary Care Reimbursement Service and NHSS - Fair Deal. During 2013, due to the imminent establishment of the Child and Family Agency, the determination of a Children and Family Services budget took primacy, given the need to transfer the provision from the Vote of the Health Service Executive to the Vote of the Minister for Children and Youth Affairs.

My Department will continue to work with the HSE and the Department of Public Expenditure and Reform to develop a new Programme Based Budgeting system. However, given the multitude of financial systems in operation in the HSE, this work will be dependant on the development and roll out of an integrated financial management system. Under the direction of the Finance Reform Board, and with my full support and approval, the HSE is now finalising a business case for submission to the Department of Public Expenditure and Reform.

Health Services Reports

Questions (329)

Billy Kelleher

Question:

329. Deputy Billy Kelleher asked the Minister for Health if he will detail in tabular form the recommendations contained in the 2012 reviews of financial management systems in the Irish health service; the progress made in implementing these recommendations; and if he will make a statement on the matter. [54774/13]

Written answers

Minister for Health

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

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). These are set out in the attached table.

As part of the process of further strengthening the financial management of the HSE, additional independent expertise was engaged to evaluate the financial performance management system and a Finance Reform Board has been established comprising the HSE Director General (Chair), senior HSE management and representatives from my Department and the Department of Public Expenditure and Reform.

Proposals regarding the development and roll out of an integrated financial management system have been endorsed by the Board, with my full support and approval, and the HSE is now finalising a business case for submission to the Department of Public Expenditure and Reform.

A REVIEW OF FINANCIAL MANAGEMENT SYSTEMS IN THE IRISH HEALTH SERVICE

Main Recommendations

1. Improving Financial Performance	-
1.1	Review and clarify the National financial accountability arrangements.
1.2	Enhance the core financial management capability of the system, through Building on the capacity and capability in the Department of Health; Developing a clear organisational strategy to prepare the financial system for hospital groups; and Designing a programme to upgrade financial capability.
1.3	Provide immediate clarity to the system for 2012 on what will be funded nationally and what is a local responsibility for resolution.
1.4	Agree financial control target ranges for each region for 2012 consistent with national agreements.
1.5	Develop a strategy as a priority to establish the technical ICT infrastructure and management capacity required to support a single financial information system.
1.6	Develop systems for measuring cost containment, avoidance, and reduction within the non-hospital sector.
1.7	Review the process and transparency of forecasting, with best practice methodologies researched and adopted.
1.8	Develop a supply chain excellence programme to underpin the full establishment of shared procurement services within the health system.
1.9	Accelerate plans to develop a system wide procurement ICT system and shared service.
-	2. Policy Considerations
2.1	Review the process of managing deficits and surpluses urgently and establish a new concordat between the centre, regions and organisations to enshrine the principle that deficits and surpluses will ‘lie where they fall’, with the appropriate consequences for local leaders in terms of autonomy and control.
2.2	Review the allocations process and policy for 2013 – 2015
2.3	Develop a strategy of stabilisation for hospitals
2.4	Develop a suite of metrics to manage the financial and operational performance in community and primary care services.
-	3. Effective Transitioning (Managing the Change)
3.1	The present period of transition is a period of maximum risk and clarity is required urgently on the leadership arrangements that will obtain through the transition period.
3.2	Create a formal accountability framework based on the new incentives and governance arrangements at every level, and re-affirm accountability within the immediate system, through the transition phase into the future system.
3.3	Create a single quality assurance process to ensure savings both now and in future are delivered safely, with full involvement of the clinical community.
3.4	Model the impact of the clinical programmes in a more sophisticated way. This needs to be factored in to the service planning and budget allocation process for 2013 – 2015.