Vol. 597 No. 4
6 Mr. Coveney asked the Tánaiste and Minister for Health and Children if she has plans to change the criteria for supplementary subvention as provided by health boards to bring it more into line with current nursing home costs; and if she will make a statement on the matter. [4215/05]
20 Mr. McGinley asked the Tánaiste and Minister for Health and Children if she has plans to increase the maximum rate of supplementary subvention that is awarded to patients going into nursing homes; and if she will make a statement on the matter. [4216/05]
90 Mr. Murphy asked the Tánaiste and Minister for Health and Children if she has plans to increase subvention rates for nursing home care; and if she will make a statement on the matter. [4214/05]
I propose to take QuestionsNos. 6, 20 and 90 together.
As the Deputy will be aware, responsibility for the administration of the Nursing Home (Subvention) Regulations 1993 rests with the Health Service Executive. There are currently three rates of subvention payable under the regulations, that is, €114.30, €152.40 and €190.50 for the three levels of dependency which are medium, high and maximum.
Under Article 10.6 of the Nursing Homes (Subvention) Regulations 1993, the executive may pay more than the maximum rate of subvention in a case, for example, where personal funds are exhausted. The application of these provisions in an individual case is a matter for the executive in the context of meeting increasing demands for subvention subject to the provisions of the Health Act 2004. The average rate of subvention paid by the executive generally exceeds the current approved maximum rate of subvention.
The nursing home subvention scheme is being reviewed by my Department and I do not intend to increase rates of subvention pending the outcome of the review.
Will the Minister of State confirm that no consideration has been given to existing patients under the Tánaiste's ten point plan outlined in respect of the accident and emergency crisis? Will he also agree that the average cost of nursing homes has doubled in the past four years? Will he agree that the current rate of subvention payments he outlined are derisory for the patients involved? Does he consider it acceptable that patients have to practically beg the health service to get an enhanced subvention? Will he agree that these patients are at the mercy of CEOs in the health service? How does he feel about the fact that 60%, or the majority, of nursing home patients pay between €400 and €500 per week to nursing homes?
Will the Minister of State clarify his remark to the effect that when patients no longer have any more means the health service can give higher rates? I am dealing with two cases where patients sold their family homes a few years ago. They wrote to the health service advising that their funds are now exhausted. In these cases it is not the position that these patients have their family homes; they have sold them. They have been given little or no assistance by the health service involved. Their position is not in agreement with what the Minister of State said. Will he comment on those important questions?
We provided €5 million when the subvention scheme was introduced in 1993. Last year we spent over €114 million on it and this year it is expected that we will spend approximately €120 million on the scheme.
When the scheme was introduced it was never intended that it would cover the full costs of nursing home care; it was intended to provide some assistance. I accept what the Deputy said about the amount of assistance being provided, that the top-up payments families must pay are increasing and that puts pressure on a number of families.
We are reviewing the scheme. The Department of Social and Family Affairs is also involved in this. We had a meeting on this matter earlier this week and it is being treated as a priority. We have appointed a group of senior officials to oversee this work and bring proposals to Government in mid-2005.
The Minister of State said nothing about the patients who have gone broke and have no funding. These supplementary payments have not increased since 2001, even though I pointed out all the other developments that have happened since that time. We have been waiting for a policy on the long-term care of the elderly for four years. Under the circumstances and with what is happening in acute hospitals and in the community, we must move faster to resolve these problems and not let them reach crisis point.
If the Deputy knows of individual cases of particular hardship, he can provide us with the details and we will examine them. The funding of long-term care is a problem and we are treating it as a priority. We hope to introduce proposals on it later this year.
I also know of cases where people have been pauperised. They are dependent on the enhanced subvention and find that the cost of nursing home care is increasing to the point where they can no longer pay the bill. Will the Minister of State look at the number of discretionary payments being made over and above the limits? I suspect the numbers are very small. I am in contest with the East Coast Area Health Board about a case and it has been a less than edifying experience.
People suffering from Alzheimer's disease require high maintenance care in the late stages of the condition and the cost of nursing home care can be extremely high, far greater than the enhanced subvention. Will provision be made for people who have those high costs?
There was recognition in the legislation that people living in long-term community welfare homes are entitled to retain a small portion of their pension. There is no such protection for people in a private nursing homes and often they must give up all of their pension, leaving them with no money. These people might not have relatives who can provide them with the small amount of money they need for ongoing expenses or their partners may be on the old age pension and barely able to look after themselves. Will that be examined when the policy is being developed?
Currently, more than 7,000 people are in receipt of a subvention. The subvention scheme is under review and, under the Nursing Homes Subvention Regulations 1993, the executive may pay more than the maximum rate of subvention in a case where there is severe difficulty. It is not our intention to cause hardship and, where it exists, we would like to intervene and assist.
The Minister of State talks about hardship but the reality is that with a 12-year waiting list to get into a public nursing home in greater Dublin, many children find they have no alternative but to put their parents into a private nursing home. Does the Minister of State accept that an elderly person on a pension of €160 a week with a supplement of €80 a week cannot meet the balance, even with an enhanced subvention? Will the Minister of State make this a priority? We have been talking about reviews for a long time, particularly in greater Dublin where prices are exorbitant. We must deal with this by the middle of the year.
It is a Government priority. When the scheme was initially introduced in 1993, there was provision of €5 million.
The Minister of State cannot compare that to the current costs.
It gives some indication. This year we will spend €120 million. The scheme is not perfect and changes should be made. I regularly meet the difficulties raised by Deputies today. That is why we are reviewing the scheme — to introduce greater equity. The Mercer report examined the funding of long-term care and, following a meeting earlier this month, we appointed a number of senior officials to oversee this work. They will bring forward proposals to Government in the middle of this year. We realise the seriousness of the issue and we intend to act on it.
Does the Minister of State accept that an old person should have to sell his or her home to secure accommodation in a nursing home?
His or her home could mean anything.
The family home.
It depends on the family home. If I saw someone living in a property worth €1 million, I would not have any difficulty in that person paying for his or her care. It would be different for someone living in a small cottage with no means. They are different situations and it is hard for me to answer a question put in such general terms.
I am aware of a case of an elderly lady who lived in a small terraced house, a former council home, valued at €150,000, which is not a lot of money in today's terms. Her family live in other parts of the country and outside the country and that home was where they came when they visited. The mother, who was in a nursing home, could not get a subvention and her children had to sell the home and dispose of their mother's effects while she was still alive. For them the trauma was like dealing with their mother's death before she had died. From their coming home until the time of her funeral, there was nowhere to wake her or gather to share their memories of her. Is the Minister of State open to a more caring and humane approach in such cases?
Just as Opposition Deputies hear of these problems in their clinics, Government Deputies are told the same stories. We realise that such situations are extremely sensitive and must be dealt with in a sensitive manner. When assessing a person's means at present, if a property is valued at over €75,000, it is taken into consideration. That is a very small amount and very few properties would be excluded. We are aware the scheme needs to be changed. That is why it is being reviewed and we will show a caring approach in making the necessary changes to the scheme.
7 Mr. Deenihan asked the Tánaiste and Minister for Health and Children if she had discussions with the Health Service Executive to consider changing the date of the changeover of NCHDs to a time that is less likely to put patients at risk; and if she will make a statement on the matter. [4261/05]
105 Mr. Stagg asked the Tánaiste and Minister for Health and Children if her attention has been drawn to the concerns expressed by a senior accident and emergency consultant to the HSE at the risks for patients arising from the total change of NCHD staff occurring at 1 January each year and on weekend days; the steps she is taking to address these concerns; and if she will make a statement on the matter. [4239/05]
I propose to take QuestionsNos. 7 and 105 together.
I am informed by the Health Service Executive employer representative division that it has been in discussion with the Irish Medical Organisation over the past number of years in an effort to reach agreement on new changeover dates for non-consultant hospital doctors. To date, the IMO has been unable to confirm agreement to alternative changeover dates.
Securing agreement with the IMO on this critical issue will continue to be a priority for the HSEERD. In this regard, employer representatives will seek to bring finality to this issue as part of wider negotiations with the IMO on a revised contract for NCHDs. It has been agreed that these negotiations will recommence under the auspices of the Labour Relations Commission on 16 March 2005.
It is important we move on that because that time of year, especially 1 January, is an incredibly dangerous time. January sees the maximum number of patients on trolleys. It is also when doctors and nurses experience the greatest chance of being sick themselves. We should move the changeover date to 1 February, as was done in the UK. I hope the Minister succeeds in moving on that fairly quickly because it is very serious.
I agree with the Deputy. In any event 1 January is a bank holiday. It is not an appropriate day to start a new job, either from the employer's or the doctor's point of view. I hope we can reach agreement and that we will not have to act unilaterally on this issue. There is also the issue of July and the rotation situation in the UK. Both dates need to be changed. If we move to 1 February that would move the other to 1 August, which is the same date as in the UK. There may be issues around people applying for both, but the current date of 1 January is unsatisfactory and should be changed.
8 Mr. Ring asked the Tánaiste and Minister for Health and Children the number of persons treated with radiotherapy at a private clinic in Galway; the intended number of patients that will be treated in any one year; and if she will make a statement on the matter. [4258/05]
The Health Act 2004 provided for the Health Service Executive, which was established on 1 January 2005. Under the Act, the executive has the responsibility to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. This includes responsibility for decisions in relation to the referral of patients to a private treatment facility, where appropriate. Factors which are relevant to such a decision include assessment of patient need, existing service availability, indemnity and quality assurance.
The Health Service Executive, western area, has informed my Department that it is working with the Galway clinic to develop protocols or care pathways to deal with patients who require radiotherapy, mainly for emergency and short-term palliative purposes. My Department has been advised that approximately 50 public patients have been referred to the clinic to date.
The western area of the executive is confident that the supra-regional radiation oncology centre at University College Hospital Galway will be fully commissioned and ready to treat patients in March 2005. Last year, approval issued for the appointment of 102 staff for this unit, together with additional ongoing revenue funding of €12 million to cater for this expansion. Approval issued for the appointment of an additional consultant medical oncologist and three consultant radiation oncologists, two of whom have significant sessional commitments to the north-western and mid-western areas. Key staffing is in place, with two consultant radiation oncologists taking up posts in February and March. The HSE western area has been requested to prepare a development control plan to facilitate the expansion from three to six linear accelerators in the medium term. The capital project team is working to develop a brief for this expansion.
As recommended in the report on the development of radiation oncology services in Ireland, the national radiation oncology co-ordinating group has been established. The group comprises clinical, technical, managerial, academic and nursing expertise from different geographic regions. The group's remit encompasses recommending measures to facilitate improved access to existing and planned services, including transport and accommodation. The group will also advise on quality assurance protocols and guidelines for the referral of public patients to private facilities.
A number of local and national issues arise in regard to this question. The Minister stated that so far 50 people have been treated. How many people will be treated in this private clinic next year when the public clinic is up and running? I presume the Minister is aware that the average number of patients receiving radiation within one month of diagnosis in the west is at 3% and this increases to only 19% within two months of diagnosis. It is important to know whether the executive will cut short its contract with the private clinic and treat patients only in the public facility in Galway.
I would also like the Minister to answer some questions on the radiation oncology report, otherwise known as the Hollywood report. Although it took four years for this report to be published, one of the central points in the report was that the Minister supported centralisation of radiotherapy services and did not believe that small units were safe. A small unit is now being used, although it is a private clinic.
Another problem is that the oncologists wrote a separate report. Their submission was never acknowledged, which is surprising. What is the Minister's position now? Is the Hollywood report being set aside and is the view of the oncologists coming to the fore? I have highlighted the issue regarding Galway. This is an extremely contentious issue in the south east and has been for the past three or four years while we awaited publication of the radiation oncology report.
The Minister said that the radiotherapy unit in Galway would open in March. Does that mean patients will be treated in March or will there be a lead-in time? If there is a lead-in time, will the Minister intervene with the HSA to extend treatment services in the private clinic to everybody in the region who needs radiotherapy?
The Minister indicated that 50 patients had been referred under the national treatment purchase fund to the new private clinic in Galway. What stage are we at regarding the introduction of the radiation oncology unit in Galway? Has that yet been established and, if not, when will it happen? Have we got our priorities right? Is that not what is committed to, even in the limited form of the radiation oncology sites, two in Dublin, one in Galway and one in Cork? Many others are required.
The Deputy should be brief. We are running out of time.
The NTPF is surely not the answer in all cases.
To be fair to Deputy Ó Caoláin, he probably did not hear my answer. The Galway facility is in place. I visited it in January. It will treat patients in March. Approximately 102 staff have been trained. The lead-in time has been going on since last summer.
We have a mixed health system in Ireland with approximately half the population in private health care insurance. We need to ensure that private facilities, provided they are up to standard — the State's job should be standard-setting — are used to treat patients where they are available. We must see people as patients, regardless of whether they are insured and whether they have access to finance. It adds to the trauma of cancer patients and their families if they have to travel long distances for radiation treatment.
In a country of 4 million people we cannot have linear accelerators and bunkers everywhere. We need to think in terms of a national network where everything fits together, whether it is provided by the State or by the private sector.
I have the report Deputy Twomey mentioned, I received it ten days ago. It makes recommendations for the future. I want to ensure provision in the regions, including the south east and the north west. Facilities are being provided in Limerick at the moment. I want to make sure that the trauma of the experience of cancer is minimised for as many patients as possible. I understand that international experience is that to provide safe treatment, two linear accelerators are needed at any one facility. In this area it is not just the machinery and the bunker that are important but expertise and radiation oncologists. Once all that is networked together for the country, all the patients will get the benefit of that expertise. Much of it can be done in satellite centres and that is the Government's plan. I will make an announcement regarding these matters shortly.
It seems the Minister is going against the recommendations of the Hollywood report and going with the oncologists' recommendations.
I have not yet finalised my view on the report. I support the view that two centres are needed in Dublin. The report suggests a need for 35 more linear accelerators over the next few years. We need to keep an open mind regarding how we make that happen. In particular, we need it all to work together. In too many areas of health care there are stand-alone facilities which are not being used to their full potential because people are not all working together. In cancer care in particular we need people working together. That is what happens in many parts of the United States of America and elsewhere. I hope we will be able to do that in Ireland. I had a good meeting with a number of people in this area recently and we need to avail of the best expertise in this area. On the issue of the private clinic in Galway, if there is capacity and there is not enough in the public system for patients, we should use that capacity rather than force people to travel to Dublin. That does not make sense from a cost and transport point of view or from the point of view of the patient and his or her family. I want to see the private facilities used.
When the Tánaiste speaks about the hybrid system, private and public care, does she agree the reason more people are turning to private care and private health insurance is that they believe it confers an advantage on them. They believe the health system is so bad——
That does not arise out of this question.
——that the only way they can get that care is by going private.
There is no doubt the mix system has worked well in Ireland. I am a strong supporter of people making investment in the provision of their own health care while they can. We will get more resources in that context. It is a question of ensuring that a person who does not have the possibility of becoming privately insured is not disadvantaged and that the private facilities can be used to his or her benefit as well. We can do both and we can get much more private investment in health care in terms of bed capacity and diagnostics. There are many areas where the private sector can make a contribution to delivering better services for the population.
9 Mr. Gilmore asked the Tánaiste and Minister for Health and Children the reason the increase in the drugs refund threshold, the cost of an overnight stay in a hospital and the cost of a visit to an accident and emergency were implemented from 1 January 2005 when it is still not clear when the new doctor-only cards will be issued; the estimated additional revenue that will accrue from these increased charges; and if she will make a statement on the matter. [4255/05]
On the issue of the January 2005 increases in hospital charges in question, it should be noted that such increases follow on from the announcement in November 2004 of the 2005 health Estimates. The overall health Estimate for 2005, therefore, takes into account the full-year income implications arising from the implementation of the new charges with effect from 1 January 2005. The income goes towards supporting services in public hospitals and is, therefore, part of their budgets.
In regard to the overnight levy, the amount charged was increased by €10 to €55 per night, subject to a maximum of €550 in any 12 consecutive months. The charge for a visit to an accident and emergency department was also increased by €10 to €55. This increase in the accident and emergency charge will facilitate more appropriate attendances at accident and emergency units by reducing an incentive for people to attend accident and emergency units when they might appropriately receive services from general practitioners.
The charges do not apply to a number of categories of person, including those with full eligibility, women receiving services in respect of motherhood, children up to the age of six weeks and children suffering from prescribed long-term diseases. Additionally, the accident and emergency charge does not apply in circumstances where the person has been referred by a medical practitioner or where the attendance results in a hospital admission. It should also be noted that the Health Service Executive has the discretion to waive the charges if it considers that the charges would cause undue hardship.
On the doctor visit card, my Department is considering the nature of the legislative changes required to enable effect to be given to the decision to introduce the new cards. Legislation will be introduced as quickly as possible. I intend to take this legislation to the Government meeting, as I said on the Order of Business this morning, on Tuesday week.
In addition to the foregoing increases, the daily cost of private and semi-private accommodation in public hospitals was also increased by 25%. In the interests of equity, it is Government policy to eliminate gradually the effective subsidy for private stays in public hospital beds and relieve taxpayers of the burden of carrying these costs. Even with this increase, the cost of providing services to private patients in major hospitals remains significantly greater than the income from the private insurance companies in many cases. The increase being implemented is aimed at closing that gap. The combination of the hospital charge increases effective from 1 January 2005 will yield approximately €50 million a year.
As regards the drugs payment scheme, it is the case that prior to its introduction in 1999, the drug cost subsidisation scheme was available to people certified as having a medical condition with a regular and ongoing requirement for prescribed drugs and medicines. Those eligible for this scheme did not have to pay more than £32 in any month on prescribed medication. Under the drug refund scheme, families and individuals who did not qualify for the drug cost subsidisation or medical card schemes paid the full cost of their prescription medicines and, at the end of each quarter, could claim reimbursement from their health board for expenditure over £90 in that calendar quarter.
Additional information not given on the floor of the House.
From 1999, the drugs payment scheme replaced the drug cost subsidisation scheme and the drug refund scheme. Under this scheme, no individual or family paid more than £42 or €53.33 per month for approved prescribed drugs and medicines for use in that month.
The current threshold for the drugs payment scheme is €85 per calendar month. Based on figures supplied by the primary care reimbursement service, formerly the GMS payments board, a €7 increase in the threshold to €85 per month would lead to savings of €8.4 million. Given the need to prioritise health spending to maximise the benefit over a wide range of pressing health expenditure options together with the advantages of the drugs payment scheme over the schemes it replaced, an increase of €7 per calendar month in the threshold is not considered to be excessive.
Written Answers follow Adjournment Debate.
