Vol. 417 No. 7
1 Mr. R. Bruton asked the Minister for Health if he will outline the estimated annual costs, based on international comparisons, of care for a person with full blown AIDS, and the cost of care for a person with HIV; the way in which this compares with the Irish budgetary allocations to the care of persons with AIDS-HIV; and if he will make a statement on the matter.
As my predecessor indicated in replies to previous questions on this subject, it has not been possible to isolate the costs of caring for and managing persons with AIDS or HIV from general health expenditure due to the range and level of services which have to be provided to each individual patient. During the course of his or her illness an infected person passes through a spectrum of illness, each with varying degrees of severity and each requiring different types and varying levels of care and management. For example, services would be required by persons with HIV and AIDS in the following areas: primary care level; outpatient clinics; hospital services; community care services, such as public health nurses and home helps; tertiary and hospice care; voluntary agencies such as CAIRDE, the AIDS Alliances, Body Positive and the Irish Haemophilia Society; literature and documentation produced by the voluntary and statutory sectors and financial assistance from a variety of sources, both public and private.
The difficulty in estimating costs is complicated further by the evolving epidemiology of the disease where early-intervention therapies have been introduced recently for the care and management of persons with HIV and this has added a dimension to the situation which was not present before. In addition, the cost of managing categories of patients would differ, depending on the category in question. The public and private sources of funding which enable services to be delivered by both the statutory and voluntary sectors also render the estimated costs extremely difficult. Despite these difficulties, however, my Department are endeavouring to draw up approximate cost indicators for AIDS-HIV patients. This will have to be done in the context of work of the National AIDS Strategy Committee.
I am chairperson of this committee, reflecting my intention that AIDS will be dealt with by me as a priority. Up to now, a total of 252 cases of AIDS have been reported to my Department. Of the patients concerned, a total of 101 have died. In addition nearly 1,200 tests for HIV have been confirmed as positive and it can be expected that there are more persons than this with the infection in Ireland. As there is no cure for AIDS at present, these people with HIV will regrettably develop full AIDS and will require ongoing care and management at primary, secondary and tertiary levels as they progress through their infection.
It is vital therefore that we develop a fully integrated framework to deal with AIDS and HIV and, towards this end, the national strategy committee will be bringing forward recommendations on the components of such a framework in the very near future. These measures will be funded and will enable us to respond efficiently and effectively to the evolving situation.
I am sure the Minister is aware that in the UK each health authority are given a budget of £30,000 per year to provide care for persons with AIDS. Would he not agree that to allow a general practitioner about £20 to provide a primary care service to an AIDS patient, under the GMS scheme, is grossly inadequate? Would the Minister not agree also that a situation where he is announcing once again the appointment of a second urinary specialist — a move first mooted in 1985 and announced by all his predecessors — is a very unsatisfactory response? Is the Minister aware that St. James's Hospital have announced that they are at capacity in this regard and would he agree that there is a strain on the services available?
I agree with the Deputy concerning the fee for primary care treatment of AIDS patients. This matter will be considered by the GMS review group. I do not know how many announcements were made concerning the appointment of a consultant in infectious disease for the treatment of AIDS patients on the northside but I am informing the Deputy now that such an appointment will be made and that if it is not made within the next six to 12 months I will resign.
(Carlow-Kilkenny): Do not make threats like that.
They could let you down.
That is on the record. St. James's Hospital are getting extra funds to deal with these cases. While the hospital are experiencing difficulties at present they will be able to cope once there is a consultant on the northside. They are now having to deal with many patients from outside their catchment area.
