Health Services Expenditure

Questions (500)

Bernard Durkan

Question:

500. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he continues to pursue best practice, efficiency and value for money in the delivery of various aspects of the health service; the extent to which a particular aspect of the service has come to his attention in the matter of current expenditure overruns; and if he will make a statement on the matter. [28238/19]

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Written answers (Question to Health)

The HSE National Service Plan (NSP) is an important accountability instrument in use by the Department in determining how the HSE is performing against its targets as it captures in a clear and quantified way the range of health and social care services to be provided by the HSE for the allocation it has received. It establishes links between funding, staffing and services and it incorporates activity measures, outcome-based performance indicators and deliverables in key service areas, which are matched with targets and timescales.

The Department provides oversight of the performance of the HSE in relation to the delivery of the services set out in the NSP. The mechanism for this oversight includes the ongoing monthly performance management process in place between the Management Board in the Department and the HSE Leadership (now the HSE Executive Management Team) where the HSE reports monthly to the Department on the performance of the health system against the agreed targets set out in the NSP.

As part of the monthly performance cycle, the HSE provides an update on the application of its Performance and Accountability Framework. This includes the submission of an Escalation report which provides detail on services which are in escalation for the month in question and the actions being carried out to mitigate these. Services in escalation are those which are experiencing significant performance issues.

The latest escalation report is for April 2019 and currently the HSE are reporting 7 areas (6 in acute hospitals and 1 in social care) which have been escalated to the National Performance Oversight Group. Improvement plans and support measures are in place to monitor the ongoing performance of the different areas in escalation.

The HSE’s latest income and expenditure position at 30 April 2019 shows a revenue deficit of €116.2m which represents 2.3% of the available budget. The main drivers of the deficit are acute hospitals, PCRS and demand led schemes, disability services, and the treatment abroad scheme. Current gross expenditure on the Health Vote, year to date, is 8.8% higher than the same period in 2018. This percentage varies on a monthly basis during the year depending on spending under various headings but is, nonetheless, a matter of concern.

Significant savings are profiled later in the year in line with the targets set out in the National Service Plan. However, on present trends, taking account of the pressure in certain areas, the HSE would have a deficit at the end of 2019. This is a matter of concern for the Government. My Department is working with the HSE to gain further clarity on the projected year end position and working to mitigate the deficit in so far as is possible, in co-operation with the Department of Public Expenditure and Reform.

Health Services

Questions (501)

Bernard Durkan

Question:

501. Deputy Bernard J. Durkan asked the Minister for Health the degree to which various budgetary projections and targets have been missed in the services provided; the corrective measures taken or pending to address such issues; and if he will make a statement on the matter. [28239/19]

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Written answers (Question to Health)

The HSE’s latest income and expenditure position at 30 April 2019 shows a revenue deficit of €116.2m which represents 2.3% of the available budget. The main drivers of the deficit are acute hospitals, PCRS and demand led schemes, disability services, and the treatment abroad scheme. Current gross expenditure on the Health Vote, year to date, is 8.8% higher than the same period in 2018. This percentage varies on a monthly basis during the year depending on spending under various headings but is, nonetheless, a matter of concern.

Significant savings are profiled later in the year in line with the targets set out in the National Service Plan. However, on present trends, taking account of the pressure in certain areas, the HSE would have a deficit at the end of 2019. This is a matter of concern for the Government. My Department is working with the HSE to gain further clarity on the projected year end position and working to mitigate the deficit in so far as is possible, in co-operation with the Department of Public Expenditure and Reform.

I have emphasised to the Executive the need to address health spending urgently by means of the following measures;

- Steps to ensure compliance with the staffing limits for 2019. The Executive has put in place controls around recruitment, pending receipt of finalised financial plans to manage the staffing levels back to affordable numbers;

- A reporting and monitoring structure around agreed savings targets in the National Service Plan, with responsible managers providing a monthly report from Quarter 1;

- A mid-year review of the Health Service Executives performance on savings and staffing limits, with further interventions as necessary.

The National Service Plan requires the HSE to protect and promote the health and well-being of the population, having regard to the resources available to it, and making the most efficient and effective use of those resources. Implementation of the Service Plan is ongoing, and my Department understands that the position of the HSE is that protection of front-line service delivery is its priority. I have emphasised the need for the Executive to meet its service targets in line with the National Service Plan.

Health Services

Questions (502)

Bernard Durkan

Question:

502. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the delivery of health services here in terms of value for money compares with the most competitive overseas; and if he will make a statement on the matter. [28240/19]

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Written answers (Question to Health)

Comparing health expenditure across countries is not straightforward, and there are a variety of ways of measuring health spend e.g. as a proportion of Gross Domestic Product (GDP), modified GNI* (a national indicator that excludes the globalisation effects that disproportionately affect the measurement of the size of the economy), or per capita; or the public versus private spend.

The System of Health Accounts (SHA) was devised by the Organisation for Economic Co-operation and Development (OECD) and has been adopted for joint reporting of health care expenditure by the OECD, Eurostat and the World Health Organisation. It provides a basis for uniform reporting by countries with a wide range of different models of organising their national health systems. Since the inception of the SHA methodology in 2013, Irish current expenditure has increased each year and this aligns with other OECD countries reflecting changes in demographics, macroeconomic growth and technological change.

The latest figures for Ireland according to the SHA methodology were included in the CSO statistical release, 20 June 2019. Overall there was a 5% increase in health expenditure in Ireland between 2016 and 2017. Ireland’s current health expenditure was €21.1 billion in 2017, which represents 7.2% of GDP or 11.7% of GNI* (Modified Gross National Income).

If modified GNI* us used, Ireland is above the OCED average and if GDP is used Ireland is below the OECD average.

From the most recent report, the majority of health expenditure (73%) was funded by government, with the balance funded by private sources including health insurance (14%) and household out-of-pocket expenditure (12%).

Even within a country, accurately measuring healthcare expenditure can be challenging due to uncertainty over what constitutes expenditure on health. A key feature of the SHA methodology is that it focuses solely on expenditure for health purposes which excludes expenditure on social care, and the implication of this is not insignificant for countries including Ireland where health and social care is delivered by the same providers. The Department has commissioned the Economic and Social Research Institute to examine this issue to assist the Department in a more forensic and more meaningful comparable examination of health expenditure and value for money.

The HSE National Service Plan (NSP) is an important accountability instrument in use by the Department in determining how the HSE is performing against its targets as it captures in a clear and quantified way the range of health and social care services to be provided by the HSE for the allocation it has received. It establishes links between funding, staffing and services and it incorporates activity measures, outcome-based performance indicators and deliverables in key service areas, which are matched with targets and timescales. In line with this, the NSP incorporates a value improvement programme with agreed savings to be achieved in 2019.

The Department provides oversight of the performance of the HSE in relation to the delivery of the services set out in the NSP, including the ongoing monthly performance management of the health system against the agreed activity and savings targets.

Hospital Waiting Lists Data

Questions (503)

Bernard Durkan

Question:

503. Deputy Bernard J. Durkan asked the Minister for Health the hospitals or locations nationally most affected by longer than advisable waiting lists; the degree to which the cause of such waiting lists has been identified with a view to resolution; and if he will make a statement on the matter. [28241/19]

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Written answers (Question to Health)

I am conscious that waiting times are often unacceptably long and of the burden that this places on patients and their families. In this regard, the Government is committed to improving waiting times for hospital appointments and procedures.

Last year saw considerable improvement in the number of patients waiting for procedures. As a result of increased activity and the ongoing collaboration between the HSE and the National Treatment Purchase Fund (NTPF), the number of patients waiting for an Inpatient or Day case procedure fell to 70,204 in December 2018, from a peak of 86,100 in July 2017. This represents a reduction of over 18% in the overall number of patients waiting for a procedure. The number of patients waiting more than 3 months fell by more than 17,700, or 31% in the same period from July 2017 to the end of December 2018.

Budget 2019 announced that the Government had further increased investment in tackling waiting lists, with funding to the NTPF increasing from €55 million in 2018 to €75 million in 2019. The joint Department of Health, HSE, and NTPF Scheduled Care Access Plan 2019 was published in March.

In terms of locations with highest numbers on waiting lists, the latest NTPF figures show that there are 15,947 patients on Saolta University Healthcare Group IPDC waiting list. This represents a 15% (-2,801) decrease when compared to the same period last year. The NTPF figures also show that there are 14,282 patients on the Ireland East Hospital Group IPDC Waiting List. This shows an 11% (1,727) decrease when compared to the same period last year.

The latest NTPF figures show that there are 114,609 patients on the South/South West Hospital Group Outpatient Waiting List. The NTPF figures also show that there are 109,543 on the Ireland East Hospital Group Outpatient Waiting List.

The NTPF advise that over recent months they have placed a particular focus on engaging with hospital groups and individual hospitals to identify outpatient waiting list proposals.

The Sláintecare Action Plan 2019 which was published by my Department, includes a specific workstream on Access and Waiting Lists. Sláintecare emphasises the need to invest in increased capacity while also shifting the balance of care from hospitals to community services for better health outcomes and a more sustainable health service. In addition, many of the other service reforms and enhancements included in Slaintecare will support timely access to care for patients in the coming years.

In line with Sláintecare objectives, my Department is working with the HSE and the NTPF, to develop medium-long term improvement initiatives for patient access to hospital procedures.

Health Services Expenditure

Questions (504)

Bernard Durkan

Question:

504. Deputy Bernard J. Durkan asked the Minister for Health the branch or branches of the health services that have failed to work within budget in the past ten years; and if he will make a statement on the matter. [28242/19]

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Written answers (Question to Health)

In any given year, the Government has a finite amount of money for allocation in the Budget and has many competing priorities. During the fiscal crisis, as with most areas of public spending, significant reductions in health funding were experienced. Including 2014, the budget provided for health was less than that provided in the previous years, with significant targeted savings through pay reductions and efficiency.

From 2015 onwards, funding began to be increased on a gradual basis to meet existing costs within the system. In recognition of the difficulties facing the system, in 2016 a further €500m was approved for health in the REV, this sum remaining in the base for 2017. This allowed for services for older people to be maintained at the previous years’ levels, met shortfalls in the State Claims Agency (SCA) and in PCRS, and provided for a Winter Initiative.

Additional funding was provided for health from 2017 onwards, including supplementary estimates, to cover pay and pension costs, and the SCA. Overall, since 2017, increased funding has been allocated to these and other demand-led areas, and for service-led developments. During the period 2014 to 2018, therefore, supplementary funding was provided for the areas outlined above, and to meet demographic and demand-led requirements in acute hospitals, disability emergency placement and regulation, home supports, local demand led schemes and other areas.

The HSE National Service Plan (NSP) sets out annually the services to be provided by the Executive and the budget provided for that purpose across all health programme areas. The NSP is finalised following an extensive process of engagement between the HSE and my Department. The annual health budget is set within the parameters set out by the Government in its approach to planning for the annual budget. The improving economy has enabled the health service to achieve much needed budget increases in the last three years.

It is clear that there are areas where further improvements are required and my Department continues to work closely with the HSE to optimise service provision within the constraints of available funding. In this regard, the Department provides oversight of the performance of the HSE in relation to the delivery of services set out in the NSP, including ongoing monthly performance management against agreed targets set out in the NSP. In 2019, significant savings are profiled to be achieved in line with these targets. On present trends, taking account of the pressure in certain areas, the HSE would have a deficit at the end of 2019. This is a matter of concern for the Government and my Department is working closely with the HSE to gain further clarity on the position and to mitigate the deficit is so far as is possible, in co-operation with the Department of Public Expenditure and Reform.

HSE Governance

Questions (505)

Bernard Durkan

Question:

505. Deputy Bernard J. Durkan asked the Minister for Health his views on whether the restructured HSE is likely to improve the efficiency and delivery of the health services nationally; and if he will make a statement on the matter. [28243/19]

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Written answers (Question to Health)

The report of the cross-party Oireachtas Committee on the Future of Healthcare, Sláintecare, identifies four core building blocks that underpin a well-functioning health system. The first of these building blocks is a clear governance and accountability framework. In that respect, I was pleased to meet the new HSE Board last week prior to their inaugural meeting, who will assist in improving oversight and governance of our health service

In addition to this, the Sláintecare Implementation Strategy commits to the development of regional care organisations that will enable the delivery of integrated care at a local level. As a first step in this process, it is necessary to align the CHOs and Hospital Groups geographically. My Department undertook a public consultation on this matter in 2018 and has engaged in significant internal analysis on the optimal size and number of future regional areas. I hope to bring proposals on geographical alignment to Government very shortly.

The development of regional care organisations is a critical enabler of the Sláintecare reform programme. These organisations will be designed to facilitate the efficient and effective delivery of services as outlined in the Sláintecare programme, which focuses on how and where services are delivered to provide a more integrated and person-centred service and on improving financial control, governance, accountability, and performance across the health service. This will ultimately allow us to develop a more population-based approach to service planning and care delivery, with the aim,over time, for greater equity in the allocation of resources within and across regions.

Health Screening Programmes

Questions (506)

Bernard Durkan

Question:

506. Deputy Bernard J. Durkan asked the Minister for Health the extent to which school medical examinations continue to identify particular health issues in children that subsequently become instrumental in dealing with the issue through an earlier response; and if he will make a statement on the matter. [28244/19]

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Written answers (Question to Health)

As this is a service matter it has been referred to the HSE for attention and direct reply to the Deputy.

Home Care Packages Data

Questions (507)

Bernard Durkan

Question:

507. Deputy Bernard J. Durkan asked the Minister for Health the number of personnel engaged in the delivery of home care packages either directly through the HSE or through selected agencies; the extent to which the number has fluctuated in each of the past four years to date; and if he will make a statement on the matter. [28245/19]

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Written answers (Question to Health)

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

General Practitioner Data

Question No. 509 answered with Question No. 439.

Questions (508)

Bernard Durkan

Question:

508. Deputy Bernard J. Durkan asked the Minister for Health the number of general practitioners practicing throughout County Kildare; the extent to which each practice is sufficiently supported to meet growing demands; and if he will make a statement on the matter. [28246/19]

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Written answers (Question to Health)

As this question relates to a service matter, I have arranged for it to be referred to the Health Service Executive for direct reply to the Deputy.

Question No. 509 answered with Question No. 439.

Speech and Language Therapy

Questions (510)

Bernard Durkan

Question:

510. Deputy Bernard J. Durkan asked the Minister for Health the extent to which speech and language therapy and mental health support exists for children in all areas nationally; if particular shortfalls have been identified and are being addressed; and if he will make a statement on the matter. [28248/19]

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Written answers (Question to Health)

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Medical Card Data

Questions (511)

Bernard Durkan

Question:

511. Deputy Bernard J. Durkan asked the Minister for Health the number of full medical cardholders in each of the years 2011 to 2018 and to date in 2019; and if he will make a statement on the matter. [28249/19]

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Written answers (Question to Health)

As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly.

Mental Health Services Data

Questions (512)

Bernard Durkan

Question:

512. Deputy Bernard J. Durkan asked the Minister for Health the number of incidents of self-harm in respect of children under the age of 15 reported in each of the past five years to date; the extent to which it was found possible to provide the necessary help and support to address the issue; and if he will make a statement on the matter. [28250/19]

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Written answers (Question to Health)

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Hospital Staff

Questions (513)

Bernard Durkan

Question:

513. Deputy Bernard J. Durkan asked the Minister for Health the extent to which efforts continue to be made to retain doctors and nurses here; and if he will make a statement on the matter. [28251/19]

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Written answers (Question to Health)

The public health service in Ireland operates in a global market for medical specialists which is experiencing a world-wide shortage. Notwithstanding this fact, progress continues to be made in attracting and retaining consultants and in addressing improvements in the training, working environment and career pathways for Non Consultant Hospital Doctors in Ireland to encourage the supply of future consultant candidates.

The issue of new entrant pay is being addressed in general terms under the terms of the Public Service Stability Agreement 2018-2020. The issue has also been examined by the Public Sector Pay Commission in relation to consultants. Given its analysis, the Commission proposed that the parties to the Public Service Stability Agreement jointly consider what further measures could be taken over time to address the pay differential. The proposal of the Commission does need to be addressed. The next step is to engage with the representative organisations of consultants. However, brokering an affordable solution will be a significant challenge, in particular within the context of budgetary pressures and broader public sector policy.

It should also be noted that while pay has an impact in recruitment and retention of consultants, a number of other factors are also important, including, inter alia, opportunities for career development, training opportunities and location. The Commission stated it was strongly supportive of the full implementation of the recommendations of the Strategic Review of Medical Training and Career Structures, the 'MacCraith' recommendations, on the basis they have the potential to resolve many of the issues raised with the Commission relating to recruitment and retention. My Department continues to monitor progress on implementation of these recommendations.

Concerning Nurses, the recent nursing agreement and the new Enhanced Practice Nurse/Midwife contract will see the financial position of nurses and midwives improve and should help to both recruit and retain nurses in the public health service. In relation to pay, the new Enhanced Practice Nurse and Midwife contract will deliver salary improvements for those that migrate to this new role range from between 2% - 11%. The Enhanced Nurse / Midwife Practice salary scale ranges between €35,806 to €47,201. The agreement will see improvements to a range of allowances, their extension to additional nurses and midwives, and a new allowance for those in medical surgical wards up to the maximum full year cost of €10m. It also includes a commitment to increase the number of Advanced Nurse Practitioners to a minimum of 2% of the nursing workforce. The HSE are currently working on a plan to deliver the implementation of the agreement.

Health Services Staff

Questions (514)

Bernard Durkan

Question:

514. Deputy Bernard J. Durkan asked the Minister for Health the extent to which adequate staff at all levels remain available to the HSE to ensure delivery of health services in a fast, effective and efficient manner; and if he will make a statement on the matter. [28252/19]

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Written answers (Question to Health)

I have asked the HSE to respond directly to the Deputy on this matter.

Medicinal Products Availability

Questions (515)

Bernard Durkan

Question:

515. Deputy Bernard J. Durkan asked the Minister for Health the procedures in place to encourage manufacturers of medicines to make their product available for sale to the health service at a manageable cost with particular reference to top of the range new products with an expensive price tag; and if he will make a statement on the matter. [28253/19]

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Written answers (Question to Health)

The HSE has statutory responsibility for medicine pricing and reimbursement decisions under the Health (Pricing and Supply of Medical Goods) Act 2013. The Act specifies criteria for decisions on the reimbursement of medicines. As Minister for Health, I do not have any statutory power or function in relation to the reimbursement of medicines.

If a company wishes to have a medicine reimbursed, it must apply to the HSE to have the product added to the Reimbursement List. It is the sole responsibility of the company to make this application.

HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds, including the advice of the National Centre for Pharmacoeconomics (NCPE).

The NCPE conducts health technology assessments for the HSE and makes recommendations on reimbursement to assist HSE decisions. The NCPE uses a decision framework to systematically assess the cost and clinical effectiveness of the drug as a health intervention at the submitted price.Where the submitted price for a product does not reflect cost effectiveness, the applicant may enter further discussions with the HSE. This can lead to an protracted deliberation process. However, the HSE, because of the significant monies involved, must ensure that the best price is achieved, as these commitments are often multi-million euro investments on an ongoing basis.

Question No. 516 answered with Question No. 82.

Common Agricultural Policy Negotiations

Questions (517)

Charlie McConalogue

Question:

517. Deputy Charlie McConalogue asked the Minister for Agriculture, Food and the Marine the reason an organisation (details supplied) was not invited to be a part of the CAP consultative committee; and if he will make a statement on the matter. [27466/19]

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Written answers (Question to Agriculture)

I established the CAP Consultative Committee to facilitate on-going consultation with key stakeholders in relation to the reform of the Common Agricultural Policy (CAP) for the period post-2020.

The Committee is drawn from stakeholders who have extensive and direct experience of CAP issues as well as organisations that submitted responses to the 2018 public consultation on the “Future of Farming and Food”.

I am satisfied that this approach has facilitated a very broad representation covering all sectors within Irish agriculture as well as interested environmental parties, and that there is no need to further extend the composition of the Committee.

Targeted Agricultural Modernisation Scheme

Questions (518)

Charlie McConalogue

Question:

518. Deputy Charlie McConalogue asked the Minister for Agriculture, Food and the Marine the status of an appeal by a person (details supplied); and if he will make a statement on the matter. [27486/19]

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Written answers (Question to Agriculture)

The person named submitted an application under the LESS Scheme of TAMS II. Following submission of the paperwork required to finalise the payment claim, a number of issues arose and, as a result, no payment issued. These issues related to the fact that the equipment purchased was previously included on a TAMS application submitted by another person and it was also found, at the time of the submission of the claim, that the LESS equipment did not have a direct use on the holding concerned.

The person named, in accordance with standard procedure, was provided with the opportunity to request a review of the decision and this review is currently being carried out.

GLAS Data

Questions (519, 520, 521, 522)

Mattie McGrath

Question:

519. Deputy Mattie McGrath asked the Minister for Agriculture, Food and the Marine the amount paid to farmers under the green low-carbon, agri-environment scheme, GLAS, for low-emission slurry spreading by farm agricultural contractors at the rate of €1.20 per cubic metre spread since the start of the GLAS programme; and if he will make a statement on the matter. [27641/19]

View answer

Mattie McGrath

Question:

520. Deputy Mattie McGrath asked the Minister for Agriculture, Food and the Marine the amount paid to farmers under the green low-carbon, agri-environment scheme, GLAS, for low-emission slurry spreading by farm agricultural contractors by month at the rate of €1.20 per cubic metre spread since the start of the GLAS programme; and if he will make a statement on the matter. [27642/19]

View answer

Mattie McGrath

Question:

521. Deputy Mattie McGrath asked the Minister for Agriculture, Food and the Marine the maximum payment to farmers for low-emission slurry spreading by farm agricultural contractors at the rate of €1.20 per cubic metre spread since the start of the GLAS programme; and if he will make a statement on the matter. [27643/19]

View answer

Mattie McGrath

Question:

522. Deputy Mattie McGrath asked the Minister for Agriculture, Food and the Marine if a register of farm agricultural contractors is maintained that provides the low-emission slurry spreading service to green low-carbon, agri-environment scheme, GLAS, participants; if so, the criteria used in establishing the credentials of a low-emission slurry spreading farm agricultural contractor, such as VAT registration; and if he will make a statement on the matter. [27644/19]

View answer

Written answers (Question to Agriculture)

I propose to take Questions Nos. 519, 520, 521 and 522 together.

The Department does not keep a register of contractors who provide this service to individual GLAS applicants and it is open to the farmer as to whether to carry out the action themselves or employ a contractor to do so. GLAS participants who have selected the Low Emission Slurry Spreading action as part of their 5-year GLAS contract are required to provide documentary evidence to confirm the spreading method used and volumes spread on the holding on an annual basis. For example, a calculation of slurry produced, imported and spread and/or a receipt from the contractor where a contractor has been used to supply the service.

For a farmer to qualify for payment, a minimum of 50 cubic metres of slurry must be spread on the holding each year of the 5-year GLAS contract. All slurry must be spread in compliance with Statutory Instrument 31 of 2014 (the Nitrates Regulation). The amount paid to each applicant will vary depending on the amount of slurry spread.

The table below shows total GLAS payments in respect of the Low Emission Slurry Spreading action per scheme year irrespective of whether this action was carried out by a contractor or by the GLAS participant themselves.

-

2016

2017

2018

Total

€1,117,504.13

€2,093,148.00

€2,209,435.85

Agriculture Scheme Appeals

Questions (523)

Eamon Scanlon

Question:

523. Deputy Eamon Scanlon asked the Minister for Agriculture, Food and the Marine the status of an agricultural appeal by a person (details supplied); when a decision will be made on same; and if he will make a statement on the matter. [27652/19]

View answer

Written answers (Question to Agriculture)

The Agriculture Appeals Office operates independently of my Department. I have been advised that the records of the Agriculture Appeals Office indicate that an appeal was received from the person named in May 2018 in respect of the Basic Payment Scheme and was assigned to an Appeals Officer. The oral hearing of the appeal was held on 24 October 2018.

When all of the facts of the case have been fully assessed, including legal aspects, a comprehensive decision letter will be issued by the Appeals Officer.

I am advised that every effort is being made to finalise the decision as quickly as possible.