Dáil Éireann díospóireacht -
Wednesday, 9 Oct 2002

Vol. 554 No. 5

Written Answers. - Nursing Home Subventions.

Breeda Moynihan-Cronin

Ceist:

1184 Ms B. Moynihan-Cronin asked the Minister for Health and Children if funding will be made available to the Southern Health Board for the provision of enhanced nursing home subvention; if his attention has been drawn to the waiting list and the hardship being experienced by applicants awaiting decisions; if his attention has further been drawn to the fact that the Southern Health Board is now only dealing with applicants who applied in June 2001; and if he will make a statement on the matter. [17077/02]

Minister for Health and Children (Mr. Martin):

As the Deputy is aware, sections 22.3 and 22.4 of the Nursing Home (Subvention) Regulations, 1993, allow health boards the discretion to contract beds in private nursing homes and to pay more than the maximum rates of subvention in such cases. However, the application of these provisions is a matter for each health board in the context of meeting the requirements of the subvention scheme within the board's revenue allocation as notified annually in the letters of determination. This is in keeping with the provisions of the Health (Amendment) (No 3) Act, 1996.

In 1997 the funding available for the scheme was £27 million, in 2001 the sum was £52 million and in 2002 the funding available is €91.4 million. In recognition of the issues involved, this Department made significant additional resources of over £1.2 million, €1.5 million, available to the Southern Health Board at the end of 2001. Furthermore, the board received an additional €4.24 million this year, including a sum of €2.641 million to respond to extra pressures on the scheme.

The Southern Health Board has received a significantly increased number of claims from patients for enhanced payments in accordance with Articles 22.3 and 22.4. It is a matter for the board to determine the extent to which it can meet such claims consistent with its requirement to live within its overall revenue allocation and taking account of the fact that such enhanced payments are discretionary. However, in the interest of avoiding hardship to individual patients, my Department has been in regular contact with the board in an effort to find a solution which would take cognisance of the considerations outlined above. This solution involves the payment of enhanced subventions on a significant scale. It is the Department's intention to remain in contact with all health boards throughout the year on this and other issues.

Breeda Moynihan-Cronin

Ceist:

1185 Ms B. Moynihan-Cronin asked the Minister for Health and Children when a decision will be made by the Southern Health Board on an application for enhanced nursing home subvention for a person (details supplied) in County Kerry; and if he will make a statement on the matter. [17078/02]

Minister for Health and Children (Mr. Martin):

Responsibility for the administration of the nursing home subvention scheme in Kerry is a matter for the Southern Health Board. My Department has, therefore, asked the chief executive officer of the board to investigate the matter raised by the Deputy and reply direct to her.

Breeda Moynihan-Cronin

Ceist:

1186 Ms B. Moynihan-Cronin asked the Minister for Health and Children when a decision will be made by the Southern Health Board on an application for enhanced nursing home subvention for a person (details supplied) in County Kerry; and if he will make a statement on the matter. [17079/02]

Minister for Health and Children (Mr. Martin):

Responsibility for the administration of the nursing home subvention scheme in Kerry is a matter for the Southern Health Board. My Department has, therefore, asked the chief executive officer of the board to investigate the matter raised by the Deputy and reply direct to her.

Question No. 1187 answered with Question No. 1168.

Olivia Mitchell

Ceist:

1188 Ms O. Mitchell asked the Minister for Health and Children in view of the Government's decision to give free medical cards to all persons over 70 years of age regardless of their income, the original estimate of the numbers that would qualify for medical cards as a consequence of the decision; the original estimate of the cost of the scheme; the actual number who have qualified in 2002; the cost of implementing the decision under all headings from July 2001 to 30 June 2002; and if he will make a statement on the matter. [17081/02]

Minister for Health and Children (Mr. Martin):

The Government decision to extend automatic medical card eligibility to all persons aged 70 and over with effect from 1 July 2000 was announced on budget day in December 2000. The measure was subsequently unanimously approved by this House. It was originally estimated that 39,000 persons would benefit from the initiative. This was based on the CSO estimate of persons aged 70 and over in the State less the number in that age category already registered as medical cardholders.

However, it subsequently came to light that the health board/GMS databases of medical cardholders in the over 70s age category were inaccurate. Following a targeted review by health boards of medical card lists for the over 70s, in excess of 15,100 duplicate entries and entries for deceased persons have so far been removed from those lists. My Department has now requested the chief executive officers of the health boards to arrange for an immediate full review of the entire GMS list for their functional areas, to be completed by the end of the year. They have also been requested to put in place an effective proactive management system so as to ensure that the lists are accurate in the future.

During the period 1 July to 31 December 2001, a total of 68,084 additional persons aged 70 and over, including 1,446 such persons in nursing homes, had been registered as medical cardholders under the initiative. By the end of June 2002, a further 7,123 persons, including 1,024 residents of nursing homes, had been registered. In considering these figures, it is important to bear in mind that they include persons who attained the age of 70 years since 1 July 2001.

My Department did not prepare an estimate of the cost of the initiative, but supplied such data as was readily available to it in early December 2000 to the Department of Finance in order to assist that Department in determining the likely cost in 2001. It was recognised at the time that implementation of the initiative would require the agreement of both the Irish Medical Organisation (IMO) and the Irish Pharmaceutical Union (IPU). Following difficult and protracted negotiations between my Department and the IMO, a deal estimated to cost €19 million annually was agreed in late June 2001, on the basis that there would be 39,000 newly eligible persons in total. My Department is still engaged in negotiations with the IPU in relation to the implementation of the initiative by community pharmacy contractors. For this reason, the actual cost of the initiative in respect of the period 1 July 2001 to 30 June 2002 has yet to be finalised. However, the cost in 2002 of implementing the initiative is currently estimated at €83 million gross, and €55 million net when account is taken of consequential savings on the community drugs schemes estimated at €28 million. The following is a breakdown of the estimated gross cost:

Revised Costings for 2002Over 70s scheme	Doctors	Pharmacists	Total
	(€m)	(€m)	(€m)
Pharmacy Lump Sum and Enhanced Fees	–	17.78	17.78
Pharmacy Ingredient Cost	–	22.00	22.00
Doctors Capitation re New Over 70s	33.00	–	33.00
Other	10.15	–	10.15
Total	43.15	39.78	82.93