Billy Kelleher
Question:12. Deputy Billy Kelleher asked the Minister for Health the measures he will take to improve the ambulance service; and if he will make a statement on the matter. [27050/14]
View answerAmbulance Service Provision
Questions (12)
Written answers
This Government is committed to improving our ambulance service and ambulance response times. The National Ambulance Service (NAS) is continuing the modernisation of its services, to ensure emergency pre-hospital care is delivered in an appropriate and timely manner. In that regard, additional funding of €3.6 million and 43 staff have been provided in the National Service Plan 2014. Including Dublin Fire Brigade emergency ambulances, our total fleet is now 534 vehicles, 77 more than four years ago, and I understand that a number of emergency ambulances will be upgraded this year.
A significant reform programme is underway, to provide a clinically driven, nationally co-ordinated system, supported by improved technology. Ongoing performance improvement projects include:
- the single national control system, to be completed in 2015
- the Intermediate Care Service, which transports patients between facilities, and allows emergency vehicles to focus on emergency responses
- on-duty rostering and the development of a national rostering system
- the Emergency Aeromedical Support Service - 652 missions were completed to the end of May 2014, about one third involving time-critical transfers of STEMI heart attack patients to primary PCI units.
- the NAS has developed turnaround guidelines, which provide a standardised national approach to clinical handovers of patients from ambulances to Emergency Departments. Data on handovers is now being collected, which allows for more effective management of patient handovers and ambulance turnaround times.
I would also like to draw the Deputy’s attention to three separate reviews of ambulance services. HIQA is examining the governance arrangements for pre-hospital emergency services; the HSE and Dublin City Council have commissioned a joint review of Dublin services to determine the optimal and most cost-effective model of ambulance services delivery for the city; and the NAS is undergoing a comprehensive capacity review, to determine what level of staff, vehicles, skills and distribution, is required to deliver a safe and effective service now and into the future. These reviews will inform the development of a modern, clinically driven system, properly resourced, for appropriate and timely services to the benefit of patients.
Hospital Staff Recruitment
Questions (13)
Denis Naughten
Question:13. Deputy Denis Naughten asked the Minister for Health the steps he is taking to deal with the shortage of non-consultant hospital doctors; and if he will make a statement on the matter. [26884/14]
View answerWritten answers
The next NCHD rotation occurs on 14th July. The HSE has advised that it is too early to be definitive on the level of vacancies that will arise, noting however that the number of posts that have not been filled is similar to previous years. However, vacancies are more concentrated in smaller hospitals. There are some hospitals to which it has historically been difficult to attract applicants, in particular smaller hospitals that have onerous rosters. The planned establishment of hospital groups should help to address this issue, as this will allow doctors to be appointed as group resources - instead of to just one hospital.
It should be noted that there are some specialties, in which there are international shortages. The filling of these posts represents a significant challenge given that there is a competitive international market for NCHDs and also for consultants. Where posts are vacant and suitable candidates cannot be sourced, locums are retained or alternative arrangements are made to ensure the continued delivery of the service. However, the intention is to move to a position where reliance on agency to fill posts is minimised and permanent staff are appointed.
Last July I set up a group under the chairmanship of Professor Brian MacCraith to carry out a strategic review of medical training and career structures. Under its terms of reference the Group will make recommendations aimed at improving the retention of medical graduates in the public health system and planning for future service needs. It provided an Interim Report in December 2013 focusing on training. In April 2014 the Group submitted its second report to me and this dealt with medical career structures and pathways following completion of specialist training. The final report of the Group will deal with workforce planning and this is due to be submitted by the end of June 2014. The work of the Group is fundamental to ensuring that we have attractive propositions for consultants and doctors in training, NCHDs, in the years ahead.
Medical Card Data
Questions (14)
Brendan Smith
Question:14. Deputy Brendan Smith asked the Minister for Health the number of discretionary medical cards the Health Service Executive now projects for 2014; the number of new discretionary medical cards that were issued for the first time from 1 January 2014 to 16 June 2014; the number of new discretionary medical cards that issued in 2013; and if he will make a statement on the matter. [27054/14]
View answerWritten answers
The HSE does not set targets for different grounds of awarding medical cards. Medical cards are awarded on a number of grounds, which are set out in the HSE National Assessment Guidelines:
- the means of a person/family;
- person/family solely dependent on social welfare income;
- person returning to work after long term unemployment;
- person qualifying under EU legislation.
All medical cards are subject to a periodic review of eligibility to determine continuing eligibility. The change in the number of existing cards will be dependent on individuals' personal circumstances and the extent of ineligibility detected. As a consequence, it is difficult to estimate the number of medical cards that may be awarded on a discretionary basis. I have been advised by the HSE that 5,478 new cards were issued where discretion was involved in the period January to April 2014, and that 23,000 new cards were issued in 2013 where discretion was involved.
Accident and Emergency Services Provision
Questions (15)
Timmy Dooley
Question:15. Deputy Timmy Dooley asked the Minister for Health his response to recent reports regarding emergency departments; and if he will make a statement on the matter. [27073/14]
View answerWritten answers
The most recently published report referring to Emergency Departments is the HIQA report on University of Limerick Hospital Group. University of Limerick Hospital Group is the first hospital group to be assessed against the National Standards for Safer Better Healthcare. This is an independent assessment of services against explicit standards and it is important that the findings, both good and bad, are made clear. This will improve the quality and safety of the services for the patients who use them.
While the report makes it clear that significant challenges remain, particularly with unscheduled care, it also identifies that significant progress has been made in relation to corporate and clinical governance, and in the reorganisation of services within the Group. It is acknowledged that there are ongoing pressures on the ULH ED. However, an extensive capital project is underway with a budget of 20 million to build a new ED which will open in 2016. In the interim, the HSE has put in place a number of initiatives to address current limitations for patients and staff in the ED facility. These include:
- a separate paediatric emergency area which is now fully open and provides a child friendly, separate area for children who require an emergency response;
- a newly opened €35 million critical care unit, which represents a major step forward in the development of acute hospital services across the region;
- a 17 bedded short stay unit, which opened on 25 April and is being managed by the acute medicine physicians. The unit admits patients who are short stay and can be discharged within 48 hours of admission.
The work of the ED is supported by the Acute Medical and Surgical Assessment Units, which take direct referrals from GPs and referrals from the Emergency Department. There are also three Local Injury Units and Medical Assessment Units in the Region, in Ennis, Nenagh and St. John’s Hospital, and further information campaigns are being undertaken locally to promote the use of these units. The HSE National Director of Acute Hospitals will continue to support the ULH team. The Special Delivery Unit will provide the expertise required to provide both interim and long term sustainable solutions to deal with bed capacity, excessive trolley waits and overcrowding in the ED.
Accident and Emergency Department Waiting Times
Questions (16)
Michael Moynihan
Question:16. Deputy Michael Moynihan asked the Minister for Health if he is satisfied with the turnaround time for ambulances at accident and emergency departments; and if he will make a statement on the matter. [27059/14]
View answerWritten answers
The National Ambulance Service (NAS) is committed to ensuring that patients are handed over to emergency departments in a professional and timely manner, with the safety and dignity of the patient being paramount. However, at times of high demand in the emergency system, there is potential for delays in the transfer of patient care from ambulances to EDs. This can delay the release of ambulances from EDs, and reduce their availability for emergency calls.
To address this issue, the NAS has developed a hospital turnaround framework. The framework provides, for the first time, a standard national approach to patient handovers at EDs. This enables all parties to understand their part in the timely releasing of emergency ambulances, so that the ambulances are available to respond to emergency calls. The framework, developed in association with the National Emergency Medicine Programme, clarifies the clinical handover process, outlining clear responsibilities and standards. It also sets out an escalation process, to alert NAS and wider health management to increases in emergency demand and activity, where this might delay patient transfers and the release of ambulances back into service.
Hospital turnaround data is now being collected nationally and is included, for the first time, in the April HSE Performance Assurance Report. This data will allow the HSE and my Department to assess performance in the handover of critically ill patients nationally, as well as at individual hospital level, and to target areas for improvement. I understand that, in April, the NAS brought over 16,000 patients to hospital and that the average turnaround time, from arrival to availability for another call, was 29 minutes 57 seconds.
Hospital Staff
Questions (17)
Ciara Conway
Question:17. Deputy Ciara Conway asked the Minister for Health if his attention has been drawn to the current situation in Waterford University Hospital whereby there will be no consultant dermatologist for the summer months and where a backlog of 3000 letters to patients exists; if his attention has been drawn to the fact that patients will not even be able to get on a waiting list for the next few months; his views that this is a crisis and emergency measures need to be put in place immediately; and if he will make a statement on the matter. [27042/14]
View answerWritten answers
I have been assured that both the HSE and the South/South West Hospitals Group are committed to ensuring the continuation of dermatology services for people in the South East whilst temporary staffing/recruitment difficulties in University Hospital Waterford are being addressed. The Deputy will be aware that the HSE has the capacity to recruit consultants and other front-line staff where there is an established service need, despite the need to reduce the numbers employed across the health service in order to meet fiscal and budgetary targets.
Every effort is being made to fill the two consultant dermatologist posts which have recently become vacant in University Hospital Waterford, following a retirement and maternity leave. Both of these posts, along with a third permanent consultant dermatologist post, have been advertised. I very much regret that, in the current circumstances, routine non-urgent referrals are on hold. However, arrangements have been put in place to ensure that urgent referrals are dealt with at South Infirmary Victoria University Hospital in Cork city.
In light of the difficulties experienced by some hospitals in filling certain consultant posts, I established a working group, chaired by Professor Brian MacCraith, to carry out a strategic review of medical training and career structure. The review is aimed at improving graduate retention in the public health system and planning for future service needs. To date, that working group has issued two reports; the first report, submitted in December 2013, focused on improving the training experience for trainees. The second report, submitted at the end of April, reviewed career structures and pathways following completion of specialist training. The final report is due to be submitted by the end of this month.
Universal Health Insurance Provision
Questions (18)
Éamon Ó Cuív
Question:18. Deputy Éamon Ó Cuív asked the Minister for Health the progress made to date in introducing universal health insurance; and if he will make a statement on the matter. [26887/14]
View answerWritten answers
The Government has embarked on a major reform programme for the health system, the aim of which is to deliver a single-tier health service, supported by universal health insurance (UHI), where there is fair access to services based on need, not on ability to pay. Under UHI, everyone will have a choice of health insurer and access to a standard package of health services. In addition, a system of financial protection will ensure affordability by paying or subsidising UHI premiums for those who qualify.
The White Paper on Universal Health Insurance was published on 2nd April and is available on my Department's website at www.health.gov.ie. It provides substantial detail on the UHI model for Ireland, the process for determining the future health basket, including the standard package of services covered under UHI, funding mechanisms and the key stages of the journey to UHI. Since publication of the White Paper, work on the following key areas to advance UHI has been underway:
- A wide-ranging public consultation on the overall policy set out in the White Paper commenced on 2nd April and remained open for submissions from the public and other stakeholders until 28th May. 134 submissions have been received and these will be subject to an independent thematic analysis. It is anticipated that the report on the thematic analysis will be completed by the end of September.
- Ongoing preparatory work to establish an Expert Commission which will consult widely and make recommendations in relation to the scope and composition of the future health basket is being carried out. It is my intention to bring proposals to Government in relation to this proposed body in the near future.
- The Joint Oireachtas Committee on Health and Children has been invited to develop a Values Framework which will help inform the work of the Expert Commission in making recommendations on the services for inclusion in the future health basket. Officials from my Department have held discussions with the Committee and it is hoped that it will be in a position to commence hearings with stakeholders in the coming months.
- On the issue of the cost of UHI, I have initiated a major costing exercise to estimate the likely cost of UHI both for the State and individuals and households. This a complex exercise which requires expert analytical support and input from a number of State agencies. I expect to have initial results from this exercise early in 2015.
- My Department has commenced a baseline examination of the current financial support systems in the health sector. This will be followed by policy proposals on the financial subsidy system for UHI.
My aim is to have all necessary preparatory work for UHI in place by early 2016 with a view to full implementation of UHI by 2019.
Long-Term Illness Scheme Coverage
Questions (19)
Thomas Pringle
Question:19. Deputy Thomas Pringle asked the Minister for Health if he will clarify the term mental handicap as a listed medical condition under the long-term illness scheme; the specific illnesses this term encapsulates; his plans to revise this outdated terminology; and if he will make a statement on the matter. [27045/14]
View answerWritten answers
The Long Term Illness (LTI) Scheme was established under Section 59(3) of the Health Act, 1970 (as amended). Regulations were made in 1971, 1973 and 1975 specifying the conditions covered by the LTI Scheme. The conditions covered by the LTI Scheme are as follows: Acute Leukaemia; Mental handicap; Cerebral Palsy; Mental Illness (in a person under 16); Cystic Fibrosis; Multiple Sclerosis; Diabetes Insipidus; Muscular Dystrophies; Diabetes Mellitus; Parkinsonism; Epilepsy; Phenylketonuria; Haemophilia; Spina Bifida; Hydrocephalus; and conditions arising from the use of Thalidomide. There are no plans to extend the list of conditions covered by the LTI Scheme.
The term mental handicap, as used in the Regulations, encapsulates such conditions as Down's Syndrome and Global Development Delay etc. The Consultant or GP who signs the patient's application for a LTI book outlines which condition is relevant for the patient. My Department is currently reviewing the operation of the LTI Scheme. It is expected that this review will be completed later this year. However, there are no plans to review the Scheme along the lines of the work of the expert panel established by the Health Service Executive to review eligibility for medical cards.
European Health Insurance Card
Questions (20)
Catherine Murphy
Question:20. Deputy Catherine Murphy asked the Minister for Health if his attention has been drawn to any cases where Irish citizens who require medical attention in other EU countries have had their wish to have medical expenses covered under the European health insurance card turned down in breach of their entitlements under the scheme; if he understands that there is no enforcement mechanism in place either bilaterally or at EU level to ensure enforcement of the EHIC regulations; that Irish citizens are in some cases being forced to pay significant medical bills where they should be covered; if he plans to raise this matter with his EU colleagues at the next Council of Ministers meeting; and if he will make a statement on the matter. [26908/14]
View answerWritten answers
The European Health Insurance Card (EHIC), introduced in 2004, certifies that the holder has the right to receive emergency healthcare during a temporary stay in any EU country as well as Switzerland, Liechtenstein, Norway and Iceland. This right is guaranteed to all persons who are covered by the public healthcare system of these countries. The European Health Insurance Card holder has the right to receive necessary treatment in the host Member State's public healthcare system on the same terms and at the same cost as nationals of the state concerned. Member States are entitled to seek reimbursement of the cost of the provision of these services to individuals from the Member State which is "competent" for the client concerned, i.e. the Member State which issued the EHIC.
Where citizens require healthcare, but do not have an European Health Insurance Card, or don't have it with them, they can also request a Provisional Replacement Certificate (PRC) from the relevant health body in their home Member State and this can usually be faxed or e-mailed to them. The PRC will show that they are entitled to benefit in the host country from the right to necessary healthcare given by EU law and can be used in the same way as a European Health Insurance Card. The aim is always to prevent citizens having to return home before the end of the planned duration of stay. It is also important to note that an Irish EHIC holder charged for a public health service in another State can claim a refund on return through their local HSE office.
The Deputy has enquired if I am aware of cases where Irish citizens who requested healthcare were turned down in breach of their entitlements under the scheme. Neither I, nor the Health Service Executive (HSE), have received any complaints and have no knowledge of any such refusals. I am however aware that the Commission has investigated some complaints from other Member States regarding treatment for temporary visitors to Spain.
It is not correct for the Deputy to say that there is no enforcement mechanism to ensure compliance with Regulations governing health care as the Commission has the power to initiate “infringement procedures” which could ultimately end up in the European Court of Justice.
Hospital Facilities
Questions (21)
Caoimhghín Ó Caoláin
Question:21. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the action he will take to address the situation where at present only three out of seven operating theatres in Cappagh Hospital are being utilised, resulting in unacceptable delays for patients requiring vital surgery; and if he will make a statement on the matter. [27039/14]
View answerWritten answers
As the Deputy is aware, Cappagh Hospital, as with all other hospitals, must comply with its statutory obligations and remain within its allocated budget. The hospital must sustain a level of activity within current financial allocation. The current deficit at the hospital to the end of May is €820,000 with a residual deficit of €390,000 against an allocation of €23,487,000.
There has been a significant increase (46%) in the number of referrals to Cappagh. This level of increase is not observed in other sites and causal factors are being evaluated to ensure that patients are offered timely access to appropriate services. In terms of access, urgent patients continue to be prioritised and Cappagh Hospital has advised that due to strict chronological booking policies, all patients attending the hospital are being offered dates for surgery based on their waiting time to surgery with due regard to clinical categorisation.
At present, notwithstanding the increase in referrals, the hospital has less patients waiting over 8 months compared with 2013. The HSE is in active engagement with Cappagh Hospital to examine and agree options for optimising the available theatre resources and to ensure patients have timely access.
Mental Health Act Review
Questions (22)
Colm Keaveney
Question:22. Deputy Colm Keaveney asked the Minister for Health further to the ongoing delay in the publication of the expert group’s review of the Mental Health Act 2001, the impact of that delay on addressing the continuing human rights issues within the mental health system; and if he will make a statement on the matter. [27036/14]
View answerWritten answers
The Expert Group set up to review the Mental Health Act 2001 first met in September 2012 and was originally due to report in 2013. When it began its work, I made it clear to the members of the Expert Group that they should take an open and expansive approach, and consider all issues which they might feel were relevant and necessary for a thorough review, having regard to the Review's terms of reference. The interim review of the Act, published in June 2012, was therefore a starting point for a much more detailed analysis of the issues.
In line with this approach, the Group requested additional time to consider the implications for mental health legislation of the Assisted (Decision Making) Capacity Bill, which was published in July 2013 and an extension of its timeframe was accordingly agreed to. The Deputy will also be aware that the Review takes account of the fact that the Mental Health Act 2001 predates the publication of the Convention on the Rights of Persons with Disabilities in 2007. The Convention provides for a rights-based approach to disability and certain of its Articles have implications for our mental health legislation. In this context, the need to achieve a balance between individual human rights and the requirements for public safety has given rise to detailed discussion and analysis by the Expert Group.
The Mental Health Act 2001 was introduced on a phased basis and was fully enacted by 2006. It would not be usual to have a formal comprehensive review of legislation that has only been fully operational for less than a decade. The 2001 Act was fully consistent with prevailing approaches to rights at that time and continues to underpin a modern approach to regulation of mental health services in Ireland. I am satisfied that the extended timeframe which was necessary for the current review is not impacting on human rights issues issues within the mental health system. I expect to receive the Expert Group's final report by the third quarter of 2014.
HSE National Service Plan
Questions (23)
Michael McGrath
Question:23. Deputy Michael McGrath asked the Minister for Health if the Health Service Executive will deliver its national service plan within the budget assigned in 2014; and if he will make a statement on the matter. [27056/14]
View answerWritten answers
There has been significant focus recently on the challenging resource constraints within which the HSE is operating. While the budgetary targets this year are particularly constrained, it is important to recognise that similar financial and resource constraints have applied in each of the last number of years in preparing the HSE National Service Plan as a direct consequence of the emergency financial situation the Irish State has had to address since 2008. The cumulative impact of this unprecedented period of financial and resource restraint has resulted in reductions in the health service budget of the order of €3.3 billion (over 20%) with numbers employed reduced by over 14,000 in this period. On a comparative basis the OECD Report, Health at a Glance 2013, shows that recent reductions in public health expenditure per capita in Ireland are the highest experienced in any OECD country with the exception of Greece.
These challenges come at a time when the demand for health services is increasing each year which, in turn, is driving costs upwards. However, despite these resource reductions and increasing service demands the HSE, in its annual National Service Plan, has managed to support growing demand for its services arising from such factors as population growth, increased levels of chronic disease, increased demand for prescription drugs, and new cost intensive medical technologies and treatments. The HSE is to be commended for meeting these increased demands on its services. That said, 2014 is proving to be a particularly challenging year for the health services. Cumulative net expenditure to end April is €138 million lower than the same period last year, but given the extent and the phasing of the targeted budget reductions, the cumulative deficit of €107.5 million, is higher than last year’s €24.7 million. The Vote for the HSE is reporting a net deficit of €158m at the end of May.
As the Deputy will be aware, the expenditure ceiling for the HSE is decided by Government, amongst other things, against a backdrop of national budgetary objectives and the prevailing macro-economic conditions. Very difficult decisions were taken by Government in the context of this year's overall budgetary arithmetic. Certain savings targets required of the HSE at the time of the Budget and the finalisation and approval of this year's Service Plan were considered so challenging that it was agreed that a separate validation exercise to assess their achievability would be undertaken by the Departments of Health, Public Expenditure and Reform and An Taoiseach. Whilst work continues in relation to the maximisation of the savings achievable under the Haddington Road Agreement, the initial savings targets under medical card probity were reduced by €110m in the context of the REV. Along with pay savings targets, and taking account of the reliance on agency workers which is further compounded by the European Working Time Directive, it is clear that the challenges facing the HSE in 2014 were extraordinary from the outset.
There is ongoing and intensive engagement each month between officials of my Department, D/PER and the HSE in the context of regular monitoring of expenditure. The HSE is pro-actively engaged in internal efforts to maximise savings and cost containment plans and to ensure that additional measures are identified and safely implemented to mitigate any projected deficits which are within HSE direct control, while engaging on an ongoing basis with my Department. I would also like to assure the Deputy that the National Director for Acute Hospitals has written to all hospital groups / hospitals setting out clear key messages around the need to reduce costs safely and to submit additional cost containment plans. Additionally, a full round of high level performance assurance meetings has been completed and another round is starting. The Director General has met the Board Chairs, CEO’s and Clinical Directors of the 10 hospital groups/hospitals with the greatest financial challenges to ensure the messaging is explicit right up to board level in terms of the hierarchy of performance management priorities - i.e. service safety and quality first, financial management next and then all other priorities come behind these including elective access for non-clinically urgent cases.
Work is ongoing between the HSE and my Department on finalising projections to year end based on data for the first four months of 2014, in tandem with assessment of performance in the same period and risk to year end within its cost containment plans. It would be premature for me to comment further at this stage, pending the outcome of this work, but as the HSE has indicated, the scale of the risk and challenge in achieving financial breakeven by year end remains extremely significant as predicted in the 2014 NSP.
Health Insurance Regulation
Questions (24)
Michael McGrath
Question:24. Deputy Michael McGrath asked the Minister for Health his assessment of the VHI’s annual results for 2013; and if he will make a statement on the matter. [27055/14]
View answerWritten answers
On Tuesday 17 June this year I welcomed the announcement by the VHI of its annual results for the year 2013 and I am pleased to note the positive financial results of €65m profit after tax. This is an improvement of €10.7m over the corresponding period last year (when reported profits were €54.3m) and represents a marked improvement on the figures for 2011 (€7.4m). This is a positive indication of the future sustainability of the Irish private health insurance market.
I would draw the Deputy's attention to the significant progress made since the Government Decision of 3 December 2013 to achieve authorisation of VHI by the Central Bank of Ireland (CBI). In particular, I welcome the fact that VHI has negotiated a further reinsurance deal with Berkshire Hathaway for a four-year period 2014-2017. VHI believes it can achieve the solvency levels required for authorisation without the need for capital from the Exchequer and a consequent State aid process with the EU Commission. The improved profit level reported recently for 2013, the new reinsurance deal and a reported fall in claims costs of 2.1% for 2013, will strengthen the VHI case for authorisation by the CBI.
Health Insurance Prices
Questions (25)
Seán Ó Fearghaíl
Question:25. Deputy Seán Ó Fearghaíl asked the Minister for Health his plans to make private health insurance more affordable; and if he will make a statement on the matter. [27068/14]
View answerWritten answers
I have consistently urged the private health insurers to do everything possible to keep down the cost of private health insurance. I am determined to address costs in this sector in the interest of consumers and I have made it clear to insurers that I believe significant savings can still be made, the effect of which can be to minimise the need for increases in premiums.
As part of the Consultative Forum on Health Insurance, I appointed Mr. Pat McLoughlin as Independent Chair to work with insurance companies and the Department to identify effective cost management strategies to help ensure the long-term sustainability of the private health insurance market. Mr. McLoughlin’s Costs Review Phase I report was published on 26 December 2013. Work on the implementation of key recommendations in the Phase 1 report is progressing well. Phase II of Mr. McLoughlin's report will deal further with the factors driving costs in private health insurance and is expected to be finalised and published shortly.
Many consumers can make large savings on their health insurance premiums by shopping around for the health insurance plan that best suits their needs. For those who have been insured on the same plan for a number of years, it is important to review the level of cover to ensure that their needs are being met, without being over-insured. Consumers have a legal right to switch between or within insurers to get better value and to reduce their premium costs. The Health Insurance Authority (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.
Ambulance Service Provision
Questions (26)
Brendan Smith
Question:26. Deputy Brendan Smith asked the Minister for Health the way he will address the ongoing concern regarding the quality of the ambulance service; and if he will make a statement on the matter. [27053/14]
View answerWritten answers
This Government is committed to improving the quality of our ambulance service and ambulance response times. The National Ambulance Service (NAS) is continuing the modernisation of its services, to ensure emergency pre-hospital care is delivered in an appropriate and timely manner. In that regard, additional funding of €3.6 million and 43 staff have been provided in the National Service Plan 2014.
As the Deputy may be aware, there are three reviews of the NAS currently underway. The NAS has commissioned a national capacity review, to determine the level and use of resources required for a safe and effective service. This independent review is being undertaken by the UK Association of Ambulance Chief Executives, an organisation with considerable international experience in operational and strategic reviews of this kind.
In the context of the development of the single national control and dispatch system, a review of the Dublin Fire Brigade (DFB) emergency ambulance service is also underway. This review was commissioned by the Dublin City Manager and the HSE’s Chief Operating Officer, and is considering all aspects of DFB ambulance operations, including the capacity and capability of current ambulance services. The review will inform consideration of the best model for the provision of emergency medical services in the greater Dublin area.
HIQA is undertaking a scheduled review of the NAS, examining the governance arrangements for pre-hospital emergency care services, to ensure the timely assessment, diagnosis, initial management and transport of acutely ill patients to appropriate healthcare facilities.
The three reviews are being conducted in parallel, in a concerted effort to examine our pre-hospital emergency care services throughout the country, with a view to identifying the best way to enable them to meet the challenges of the future. I am confident that the recommendations will guide us in the provision of a modern, forward looking service, capable of delivering the best possible outcomes for the public.
Ambulance Service Provision
Questions (27)
Patrick O'Donovan
Question:27. Deputy Patrick O'Donovan asked the Minister for Health if his Department has carried out a review of practices in the ambulance service where ambulances are reportedly being delayed leaving accident and emergency units due to a reported lack of patient trolleys; and if he will make a statement on the matter. [26891/14]
View answerWritten answers
The National Ambulance Service (NAS) is committed to ensuring that patients are handed over to emergency department staff in a professional and timely manner, with the safety and dignity of the patient being paramount. However, at times of high demand in the emergency system, there is potential for delays in the transfer of patient care from ambulances to EDs. This can delay the release of ambulances from EDs, and reduce their availability for emergency calls.
To address this issue, the NAS has developed a hospital turnaround framework. The framework provides, for the first time, a standard national approach to patient handovers at EDs. This enables all parties to understand their part in the timely release of emergency ambulances, so that the ambulances are available to respond to emergency calls. The framework, developed in association with the National Emergency Medicine Programme, clarifies the clinical handover process, outlining clear responsibilities and standards. Target times are 20 minutes for clinical handover and 30 minutes for turnaround. The framework also sets out an escalation process, to alert NAS and wider health management to increases in emergency demand and activity, where this might delay patient transfers and the release of ambulances back into service.
Hospital turnaround data is now being collected nationally and is included, for the first time, in the April HSE Performance Assurance Report. This data will allow the HSE and my Department to assess performance in the handover of critically ill patients nationally, as well as at individual hospital level, and to target areas for improvement. I understand that, in April, the NAS brought over 16,000 patients to hospital and that the average turnaround time, from arrival to availability for another call, was 29 minutes 57 seconds.
Long-Term Illness Scheme Coverage
Questions (28)
Thomas Pringle
Question:28. Deputy Thomas Pringle asked the Minister for Health his plans to review the operation of the long-term illness scheme; if he will outline the details of this process and when he expects it to be completed; and if he will make a statement on the matter. [27044/14]
View answerWritten answers
The Long Term Illness (LTI) Scheme was established under Section 59(3) of the Health Act, 1970 (as amended). Regulations were made in 1971, 1973 and 1975 specifying the conditions covered by the LTI Scheme. There are no plans to extend the list of conditions covered under the Scheme.
My Department is currently reviewing the overall policy concerning the LTI Scheme. It is expected this review will be completed later this year. However, there are no plans to review the Scheme along the lines of the work of the expert panel established by the Health Service Executive to review eligibility for medical cards.
Under the Drug Payment Scheme, no individual or family pays more than €144 per calendar month towards the cost of approved prescribed medicines. The scheme significantly reduces the cost burden for families and individuals incurring ongoing expenditure on medicines.
In addition, people who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be entitled to a medical card. In the assessment process, the HSE can take into account medical costs incurred by an individual or a family. Those who are not eligible for a medical card may still be able to avail of a GP visit card, which covers the cost of GP consultations.
Hospital Waiting Lists
Questions (29)
Éamon Ó Cuív
Question:29. Deputy Éamon Ó Cuív asked the Minister for Health the progress made in three years in reducing waiting lists for orthopaedic operations; and if he will make a statement on the matter. [26886/14]
View answerWritten answers
In relation to the specific query raised by the Deputy, as this is a service matter it has been referred to the HSE for direct reply.
HSE Expenditure
Questions (30)
Niall Collins
Question:30. Deputy Niall Collins asked the Minister for Health if the Health Service Executive will stay within its financial envelope in 2014; and if he will make a statement on the matter. [27066/14]
View answerWritten answers
There has been significant focus recently on the challenging resource constraints within which the HSE is operating. While the budgetary targets this year are particularly constrained, it is important to recognise that similar financial and resource constraints have applied in each of the last number of years as a direct consequence of the emergency financial situation the Irish State has had to address since 2008. The cumulative impact of this unprecedented period of financial and resource restraint has resulted in reductions in the health service budget of the order of €3.3 billion (over 20%) with numbers employed reduced by over 14,000 in this period. On a comparative basis the OECD Report, Health at a Glance 2013, shows that recent reductions in public health expenditure per capita in Ireland are the highest experienced in any OECD country with the exception of Greece.
These challenges come at a time when the demand for health services is increasing each year which, in turn, is driving costs upwards. However, despite these resource reductions and increasing service demands the HSE has managed to support growing demand for its services arising from such factors as population growth, increased levels of chronic disease, increased demand for prescription drugs, and new cost intensive medical technologies and treatments. The HSE is to be commended for meeting these increased demands on its services. That said, 2014 is proving to be a particularly challenging year for the health services. Cumulative net expenditure to end March is €114 million lower than the same period last year, but given the extent and the phasing of the targeted budget reductions, the cumulative deficit of €80 million, is higher than last year’s €27 million. The Vote for the HSE is reporting a net deficit of €158m at the end of May.
As the Deputy will be aware, the expenditure ceiling for the HSE is decided by Government, amongst other things, against a backdrop of national budgetary objectives and the prevailing macro-economic conditions. Very difficult decisions were taken by Government in the context of the overall budgetary arithmetic. Certain savings targets required of the HSE at the time of the Budget were considered so challenging that it was agreed that a separate validation exercise to assess their achievability would be undertaken by the Departments of Health, Public Expenditure and Reform and An Taoiseach. Whilst work continues in relation to the maximisation of the savings achievable under the Haddington Road Agreement, the initial savings targets under medical card probity were reduced by €110m in the context of the REV. Along with pay savings targets, and taking account of the reliance on agency workers which is further compounded by the European Working Time Directive, it is clear that the challenges facing the HSE in 2014 were extraordinary from the outset.
There is ongoing and intensive engagement each month between officials of my Department, DPER and the HSE in the context of regular monitoring of expenditure. The HSE is pro-actively engaged in internal efforts to maximise savings and cost containment plans and to ensure that additional measures are identified and safely implemented to mitigate any projected deficits which are within HSE direct control, while engaging on an ongoing basis with my Department. I would also like to assure the Deputy that the National Director for Acute Hospitals has written to all hospital groups/hospitals setting out clear key messages around the need to reduce costs safely and to submit additional cost containment plans. Additionally, a full round of high level performance assurance meetings has been completed and another round is starting. The Director General has met the Board Chairs, CEO’s and Clinical Directors of the 10 hospital groups / hospitals with the greatest financial challenges to ensure the messaging is explicit right up to board level in terms of the hierarchy of performance management priorities - i.e. service safety and quality first, financial management next and then all other priorities come behind these including elective access for non-clinically urgent cases.
Work is ongoing between the HSE and my Department on finalising projections to year end based on data for the first four months of 2014, in tandem with assessment of performance in the same period and risk to year end within its cost containment plans. It would be premature for me to comment further at this stage, pending the outcome of this work, but as the HSE has indicated, the scale of the risk and challenge in achieving financial breakeven by year end remains extremely significant as predicted in the NSP 2014.