Question No. 39 answered with Question No. 6.

Health Services Staff

Questions (40)

Caoimhghín Ó Caoláin

Question:

40. Deputy Caoimhghín Ó Caoláin asked the Minister for Health in view of the recent study in The Lancet journal, which analysed data across nine countries and 420,000 patients and concluded that patients are more likely to die if nursing staffing levels are low, the action he proposes to take to increase nursing numbers in public hospitals to safe and sustainable levels; and if he will make a statement on the matter. [21289/14]

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Written answers (Question to Health)

Notwithstanding the need to reduce public service numbers, the HSE has the capacity to recruit where it is necessary to do so in order to ensure patient safety and quality care and to support service delivery.

While the focus under the Public Service Agreement and the Haddington Road Agreement (HRA) is on increased productivity and reform, additional nursing support is being made available throughout the system. The increase in nursing hours available under the HRA equates to nearly 1,400 additional nurses. Nearly 500 nurses and midwives have commenced employment in recent months on the graduate scheme, with over 200 others currently going through the recruitment process. It is important also to note the link between nursing qualifications and safety and to recognise that nurse education levels are also linked to patient outcomes. The recent Lancet study showed that a 10% increase in the proportion of nurses holding a nursing degree is associated with a 7% decrease in the risk of death. Ireland has invested significantly in nurse education since the Commission on Nursing in 1998. Approximately €55 million is spent annually on nurses education and around 1,570 nurses enter the undergraduate programme each year.

It has been necessary to reduce the numbers of staff employed in the public health service, including nursing, in order to contain health service costs. However, I recognise that there is a balance to be struck to meet both economic requirements and patient safety requirements. It is imperative that patient safety continues to be maintained in the context of these reductions and achieving this requires that relevant expertise is applied to the decision making process. It is for this reason that I have approved the establishment of a taskforce to develop a framework that will determine the staffing and skill mix requirements for the nursing workforce in a range of major specialities. The focus will be on the development of staffing and skill mix ranges which take account of a number of influencing factors. The taskforce will be chaired by the Chief Nursing Officer.

Nursing Homes Support Scheme Data

Question No. 42 answered with Question No. 6.

Question No. 43 answered with Question No. 11.

Questions (41)

Catherine Murphy

Question:

41. Deputy Catherine Murphy asked the Minister for Health the reason some nursing homes have been able to charge additional fees, outside the costs covered by the fair deal scheme, for very basic items such as mattresses and wound dressings which would reasonably be assumed to be covered by the standard charges; if he has initiated an investigation into this practice; the measures he proposes to address the problem; and if he will make a statement on the matter. [21143/14]

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Written answers (Question to Health)

The Nursing Homes Support Scheme provides financial support towards the cost of long-term residential care services in nursing homes. The Scheme covers the cost of the standard components of residential care which are:

- nursing and personal care appropriate to the level of care needs of the person,

- bed and board,

- basic aids and appliances necessary to assist a person with the activities of daily living, and

- laundry service.

In determining the services covered by the Scheme, it was considered very important that nursing home residents and taxpayers would be protected and would not end up paying for the same services twice. For this reason, goods and services that are already available to individuals under an existing scheme are not covered by the Scheme.

A person's eligibility for other schemes, such as the Medical Card Scheme or the Drugs Payment Scheme, is unaffected by participation in the Nursing Homes Support Scheme or residence in a nursing home. Incontinence wear, where required, is provided free of charge by the HSE to all Nursing Homes Support Scheme residents that possess a Medical Card. Individuals availing of the Scheme should not be charged any additional fee over and above the contribution which has been calculated by the HSE, except where they choose to obtain additional services over and above long-term residential care services.

Part 8 of the Health Act 2007 (Care and Welfare of Residents in Designated Centres for Older People) Regulations 2009, stipulates that the registered provider of the nursing home must agree a contract with each resident within one month of their admission. This contract must include details of the services to be provided to that resident and the fees to be charged. Residents should not be charged fees which are not set out in the contract. The HSE is not party to such contracts which are concluded between each resident and their nursing home.

The Nursing Homes Support Scheme is currently the subject of a review. The terms of reference of this review are as follows:-

Taking account of Government policy, demographic trends and the fiscal situation

1. To examine the on-going sustainability of the Nursing Homes Support Scheme;

2. To examine the overall cost of long-term residential care in public and private nursing homes and the effectiveness of the current methods of negotiating/setting prices;

3. Having regard to 1 and 2 above, to consider the balance of funding between long-term residential care and community based services;

4. To consider the extension of the scheme to community based services and to other sectors (Disability and Mental Health);

5. To make recommendations for the future operation and management of the Scheme.

Work on the Review is ongoing. It is expected that the Review will be completed in the coming months and the Report will then be made publicly available.

Question No. 42 answered with Question No. 6.
Question No. 43 answered with Question No. 11.

Medical Card Eligibility

Question No. 45 answered with Question No. 6.

Questions (44)

Dara Calleary

Question:

44. Deputy Dara Calleary asked the Minister for Health if, in view of the 30,000 fall in discretionary medical cards since 2011, he plans to introduce a third tier medical card; and if he will make a statement on the matter. [21259/14]

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Written answers (Question to Health)

While the number of medical cards issued where discretion was involved has fallen in recent years this is not as a result of a change in policy or a deliberate targeting of discretionary cards. Rather, it is attributable, in the main, to the fact that many people, who previously were marginally over the qualifying means thresholds, have subsequently been granted medical cards because they now fall under those means thresholds. Of the discretionary cards in circulation in 2011, less than one-tenth have been found to be ineligible for a medical card on review.

Minister Reilly and I are conscious of the difficulties faced by the relatively small number of people who have been found to be ineligible. At his request the HSE is currently examining how individuals, who are not entitled to a medical card, could still receive services that meet their needs. This examination relates to all of the services and supports provided by the HSE and with regard to as much flexibility as is available and at a local level. In addition, additional information will be provided and local information points will be established at major health centres around the country, where members of the public can obtain comprehensive information and support in accessing their full range of supports and entitlements from the Health Services. The objective is to maximise the supports available for patients and families.

Appropriate notice is also being considered as part of this review for existing medical card holders who may no longer be eligible on renewal - but where serious medical conditions or profound disability continues to exist in the household.

The clear intention is to maximise the supports that can be provided in each case to the fullest extent possible. The HSE is seeking to find the best way to achieve this in order to ensure families will receive the support they need.

Question No. 45 answered with Question No. 6.

Health Services

Questions (46)

Mick Wallace

Question:

46. Deputy Mick Wallace asked the Minister for Health in the case of a person (details supplied), if the Health Service Executive will respect the person's right to life when their medical condition deteriorates to a point where they are unable to breathe independently and will require invasive ventilation; and if he will make a statement on the matter. [21282/14]

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Written answers (Question to Health)

The HSE is responsible for the administration of the primary care schemes, therefore, I have referred this matter to the HSE for attention and direct reply to the Deputy.