Written Answers. - Family Support Services.
Noel Ahern
Ceist:
537
Mr. N. Ahern
asked the
Minister for Health and Children
the situation regarding the retention of secondary benefits, for example, medical cards for persons on community employment schemes; and the process for a person on a community employment scheme who has been informed by the health board that their medical card is being withdrawn.
[13395/02]
In relation to the scheme operated by the Department of Social and Family Affairs, my colleague, Deputy Mary Coughlan, has informed me that participants on community employment schemes may retain their secondary benefits, at the level which obtained prior to participation in the scheme, subject to a weekly gross household income limit of €317.43. The retention of the medical card is not affected by the operation of the limit.
The key secondary benefits under the social welfare system are rent and mortgage interest supplement, fuel allowance and back-to-school clothing and footwear allowance. In the case of rent and mortgage interest supplement, the payment is phased out over a four year period, with 75% of the claimants previous entitlement being paid in the first year on the programme and 50%, 25% and 25% being paid in the subsequent three years.
In relation to retention of medical cards in this area, as part of budget 1996 the then Government announced that "persons who have been unemployed for at least one year shall retain their medical cards after entering employment." Persons on the live register for at least one year, who take up paid insurable employment were deemed to meet the criteria for retaining their medical cards for three years. The provision also covers participants on approved schemes applicable to the long-term unemployed, including back to work allowance, BTWA, community employment, Jobstart, job initiative, partnership and community group initiative and development courses such as workplace and vocational training opportunities scheme, VTOS. The purpose of the budget provision was to remove disincentives to labour force participation by long-term unemployed persons.
The retention of medical card eligibility is approved for a period of three years when a person or the spouse of a person who has been unemployed for a minimum of one year takes up employment. In this context, time spent on the live register, approved schemes or courses for the long-term unemployed is treated as an unemployed period.
In a case such as that outlined by the Deputy in this parliamentary question, the person concerned should contact their local health board so that the case can be addressed in the light of the information provided above.
Gay Mitchell
Ceist:
538
Mr. G. Mitchell
asked the
Minister for Health and Children
the reason it is not possible for a person (details supplied) in Dublin 15 to continue treatment at Tallaght Hospital due to the fact that this person is over the age of 18; and if he will make a statement on the matter.
[13408/02]
Responsibility for the provision of hospital services to residents of Dublin, Kildare and Wicklow rests with the Eastern Regional Health Authority. My Department has, therefore, asked the regional chief executive of the authority to investigate the position in relation to this case and to reply to the Deputy directly.
John Bruton
Ceist:
539
Mr. J. Bruton
asked the
Minister for Health and Children
his plans for targeting health inequalities in accordance with the commitment given to this in the programme for Government.
[13444/02]
A wide range of plans is in train to target health inequalities in accordance with the commitment in this regard in the programme for Government. These plans build on the substantial investment in social inclusion issues made over the period 1997-2002. Plans going forward are set in the context of the national health strategy: Quality and Fairness – A Health System for You, which has been identified in the programme for Government as the blueprint for the future direction and development of the health services. One of the key underpinning principles in the strategy is equity. The strategy was developed following an extensive consultation process including that carried out with vulnerable groups as part of the process of developing health targets for the national anti-poverty strategy. These latter have been taken on board as an integral part of the national health strategy. Some examples of plans for targeting health inequalities are outlined below.
The health strategy provides a framework for the reform of the acute hospital system and for improved access for public patients. It includes a plan covering the action required to address the issue of waiting lists and particularly waiting times. The target set out in the strategy is that by the end of 2004 no public patient will wait longer than three months for treatment.
To achieve this target the current waiting list initiative, which directs additional resources to health agencies to enable them to carry out waiting list procedures, will continue to operate. In addition a new dedicated treatment purchase fund has been set up for the purpose of purchasing treatment for public patients from private hospitals in Ireland and from international providers. A sum of €30 million has been provided in 2002 for this fund. This considerable investment is in addition to the existing waiting list initiative funding of €43.8 million in 2002.
The single most important limiting factor for admission to hospital is bed availability. In this context a comprehensive review of bed capacity needs has been conducted in both the acute and non-acute sectors. I recently announced the commissioning of an additional 709 acute beds in public hospitals at a cost of €65 million. This is the first phase of the provision of an additional 3,000 acute beds over the period to 2011, as announced in the health strategy.
The national health strategy contains a commitment to establish a national hospitals agency to plan the configuration of hospital services. Work is under way in this regard.
I am concerned to ensure not only that vulnerable groups have access to care in acute hospitals, and elsewhere in the health system, within a reasonable time but also that the care they receive is of the highest quality. To that end the Irish Health System Accreditation Agency, an independent statutory body, has been established and the accreditation scheme will initially operate in eight major acute teaching hospitals. The first hospital survey under the scheme is planned for mid-2002. The total investment in the scheme to date stands at €4.127 million.
Government has approved the establishment of a national task force on medical staffing. The task force will, among other issues, consider the proposed development of a consultant delivered public hospital service, which would guarantee availability of a senior hospital doctor at all times, for which resource and cost implications need to be quantified.
The Government is committed to the continued development of a hospital service which will provide patients with the best possible care from well trained and fully qualified health professionals, using treatments based on best practice and evidence-based medicines at whatever time and in whatever circumstances they are admitted to hospital.
The extension of the 24 hour general practitioner co-operative initiative, as mentioned in the health strategy and the programme for Government continues and will be in all regions by the end of 2003.
The programme for Government contains a commitment to the development of a network of primary care centres where general practitioners, public health nurses, physiotherapists and other health professionals will work together to improve the care available to all groups. This commitment is in line with the primary care strategy, Primary Care: A New Direction, which I launched in conjunction with the national health strategy. A task force and budget has been put in place to take this development forward in 2002. Stakeholder involvement including the community and voluntary pillar is being secured through a broadly based steering group and it is intended to have a number of initial implementation projects commenced in 2002.
The development of the primary care system will provide: A greatly strengthened primary care system which will play a more central role as the first and ongoing point of contact for people with the health-care system;an integrated, interdisciplinary, high-quality, team-based and user-friendly set of services for the public; enhanced capacity for primary care to complement the existing diagnosis and treatment focus in the areas of prevention, early intervention, rehabilitation and personal social services.
A key objective will be to ensure that services meet the special needs of particular groups or communities and are directed at reducing health inequalities.
The key health target chosen by Government in its review of the national anti-poverty strategy is to reduce the gap in premature mortality between the highest and lowest socio-economic groups by at least 10% for circulatory diseases, cancer and injuries and poisoning by 2007. A wide range of actions across the whole spectrum of health services and in other sectors is required to achieve this. The Department is committed to the further development of a NAPS health implementation framework to ensure a coherent and integrated approach to the achievement of the NAPS health targets.
The cardiovascular health strategy – Building Healthier Hearts – noted that the lower socio economic groups are disproportionately affected from heart disease. In this context two targets have been set for 2010: The medium term objective is to bring Irish levels of premature deaths from cardiovascular disease in line with the EU average at a minimum; and the longer term goal is to reduce Irish rates to those of the best performers in the EU.
Funding of €45 million has been allocated to the implementation of the strategy to date across a range of services including, health promotion, primary care, pre hospital, hospital and cardiac rehabilitation. In relation to future plans one of the implementing structures, the advisory forum, has recommended a prioritisation to the implementation of the 211 recommendations. I am committed to implementing the strategy in a coherent manner in line with this prioritisation, within available resources.
The national cancer strategy, Cancer Services in Ireland: A National Strategy, was published in 1996. Since that time, over €103 million has been invested in the development of cancer services. In recognition of the need to further develop cancer services, the national health strategy has identified the need for the preparation by the end of this year of a revised implementation plan for the national cancer strategy. This plan is being prepared by my Department in conjunction with the National Cancer Forum and will set out the key areas to be targeted for the development of cancer services over the next seven years.
In relation to children the Government is committed to moving forward on the basis of implementing the national children's strategy.
We will continue to implement the Children First guidelines for the prevention, identification, reporting, assessment, treatment and management of child abuse in all its forms. Children First are national over-arching guidelines and are being implemented as a priority in all health boards. Significant additional resources have been made available to health boards over the past three years to progress implementation and a national advisory group on the implementation of Children First advises health boards on implementation matters. A dedicated resource team from the Health Board Executive, HeBE, is also assisting the regional health boards in the implementation process and the social services inspectorate is monitoring implementation. A full independent evaluation of Children First will also be initiated in 2003.
The programme for Government pledges to establish the office of the children's ombudsman and to have the office fully operational during 2002. The legislation to establish the office was signed by the President on 2 May. Work is ongoing at present to recruit the ombudsman and to staff the office.
Family Support and other community-based early intervention services including Springboard will be expanded under a new programme of investment. My Department is committed to undertaking a review of family support services, which it is intended will commence in 2002.
The youth homelessness strategy provides a strategic framework for youth homelessness to be tackled on a national basis. The Eastern Regional Health Authority and the health boards have submitted draft implementation plans based on the objectives of the youth homelessness strategy. The National Children's Office has lead responsibility for driving and co-ordinating the actions necessary to ensure the successful implementation of the strategy.
Capital investment of approximately €38.092 million, including €4.63 million in 2002, is being made available by Government through the health boards to put in place additional high support and special care places to provide for a small group of children who need more intensive intervention than mainstream residential or foster care services. The number of high support and special care places has increased from 17 in 1996 to a current total of 94 with an additional 41 high support-special care places due to be introduced on a phased basis from mid-2002.
The Children Act, 2001, was passed by the Oireachtas in June 2001. My colleague, the Minister for Justice, Equality and Law Reform has the main responsibility for the Act. A plan to implement the Act on a phased basis was put forward by the then Minister of State with responsibility for children and was approved by the Cabi net Committee on Children at its meeting in March 2002. Work on the regulations to bring into effect the sections of the Act relating to non-offending children is in progress.
The programme for Government sets out a number of specific initiatives to improve the health and well being of drug misusers. These include the efficient operation of regional drugs task forces, the expansion of treatment and rehabilitation programmes, and the monitoring of specific prevention, supply reduction and treatment targets. These initiatives will be progressed within the context of the National Drugs Strategy 2001-2008, which provides a focused plan for the improvement of the health and well being of drug misusers.
In relation to services for older people, the programme for Government contains a commitment to introduce a home subvention scheme to maximise support to those needing full time care in the community. As outlined in the recently published health strategy, the expenditure review of the nursing home subvention scheme has shown that current funding arrangements do not effectively support home care. The Government intends reforming the operation of existing schemes in order to introduce an integrated care subvention scheme which maximises support for home care.
One of the groups which experiences significantly worse health status than the general population is the Traveller community and one of the NAPS health targets is to reduce that difference and earlier this year I launched, Traveller Health – A National Strategy 2002-2005. This strategy provides a clear statement of policy which focuses on the underlying problems associated with the poor health status of the Traveller community and sets out a realistic and practical plan for specific improvements in that status.
Significant additional funding amounting to €312 million has been invested in recent years to enhance the level of support services available to people with an intellectual disability and those with autism. The Government is committed to continuing this programme of investment to meet identified needs in this population group. There is specific objective in the health strategy to complete the transfer of persons with an intellectual disability from psychiatric hospitals as soon as possible and not later than 2006. Additional funding was provided for an extra 500 rehabilitative training places across all health board areas in 2002.
Between 1997 and 2002, funding of over €179 million has been provided for the maintenance and development of services for people with physical and sensory disabilities, to enable them to live as independently as possible within the community either on their own or with their families.
The Mental Health Act, 2001, was enacted in July 2001 and will significantly improve safeguards for persons with a mentally disorder who are involuntarily admitted for psychiatric care and treatment. The Act will bring Irish law in this area into conformity with the European Convention for the Protection of Human Rights and Fundamental Freedoms. The Act provides for the establishment of an independent agency to be known as the Mental Health Commission whose primary function will be to promote and foster high standards and good practices in the delivery of mental health services and to ensure that the interests of detained persons are protected.
The health strategy, Quality and Fairness – A Health System for You, includes a commitment to prepare a national policy framework for the further modernisation of the mental health services, updating the 1984 policy document, Planning for the Future. It also includes a commitment to intensify the existing suicide prevention programmes over the coming years. The Government is fully committed to ensuring that further investment takes place in this area, building on the achievements to date.
The national health strategy recognises that if health status and particularly the health status of vulnerable groups is to be improved then initiatives in the health sector must be supported by health promoting policies in a range of other sectors whose activities impact on health. In this context health impact assessment will be introduced, led within my Department by a population health division. Statements of strategy and business plans of all relevant Government departments will incorporate an explicit commitment to sustaining and improving health status. A national environmental and health action plan will be prepared.
Relevant, accurate and timely information is essential in identifying and addressing health inequalities. A national health information strategy is currently being finalised. Key developments will be the establishment of a health information and quality agency and a national population health observatory. Enhanced health service and population health data will greatly improve our ability to measure areas of inequality, to adopt targeted strategies and to evaluate the effectiveness of interventions. An important aspect of this work will the provision of appropriately disaggregated data to improve service planning, provision and monitoring for vulnerable groups in line with the commitment to this in the review of the national anti-poverty strategy, NAPS. It is also relevant to mention that the Department continues to support the areas of reserach and monitoring with, for example, the commissioning of the second nationally representative lifestyle survey in 2002. Such surveys provide valuable data on the link between poverty and health and help formulate and inform policy development to reduce health inequalities.
The national health information strategy will provide an essential framework for the subsequent development of a national information and communications technology, ICT, plan for the health services. This will be carried out under the auspices of the health boards executive and will constitute a health services wide, ICT, response to the health and primary care strategies. It will provide a cohesive and cost effective framework for fully exploiting the potential of ICT and support a broadening of access to expert care. It will also integrate closely with the overall eGovernment initiatives. The introduction of the electronic healthcare record and a health information portal will be part of this.
I am confident that the plans I have outlined above together with other measures detailed in the national health strategy provide a coherent basis for targeting health inequalities in accordance with the commitment given to this in the programme for Government.
