Simon Coveney
Ceist:83 Mr. Coveney asked the Tánaiste and Minister for Health and Children her plans for home care packages for the elderly; and if she will make a statement on the matter. [35376/05]
Other Questions.
Care of the Elderly.
It is a priority of mine to support people to stay in their homes and communities and move away from the practice of placing people in residential care as a first option. This is the expressed wish of the majority of older people. I would like to see the further development of home care packages for older people.
The Mercer report on the future financing of long-term care in Ireland, which was commissioned by the Department of Social and Family Affairs, examined all issues surrounding the financing of long-term care. Following on the publication of this report, a working group chaired by the Department of the Taoiseach and comprising senior officials from the Departments of Finance, Health and Children and Social and Family Affairs has been established.
The objective of this group is to identify the policy options for a financially sustainable system of long-term care, including improvements in community care and home care packages, taking account of the Mercer report, the views of the consultation that was undertaken on that report and the review of the nursing home subvention scheme by Professor Eamon O'Shea. This group will report to the Tánaiste and to the Minister, Deputy Brennan, before the end of the year. It is expected that the report of the group will be submitted to Government in the near future.
None of my questions was answered. Put simply, who is entitled to this care, when will the scheme commence, how many people will be able to avail of it and in what areas will it operate? I was told I was wrong when I accused the Tánaiste six months ago of cutting 2 million home help hours from the home care budget. I have still not got a clear answer to how what I said was wrong. It appears that we are robbing Peter to pay Paul in regard to home care plans. It is simply a case of taking home help hours from one group of patients, dressing them up as home care packages and giving them to a new group of patients.
Are patients to be responsible for the home care packages or will they be given to a private service provider who will then be in charge of the provision of home care services for patients? I would be delighted if the Minister of State could tell me where the 2 million home help hours went.
We want to make the practice of placing older people in residential care the last option. All the studies clearly show that people are much happier in their own homes and communities among family and friends. Patients also recover more quickly from illness when they are in that environment.
The home help facility has been a wonderful success and has made a great difference to the quality of life of the people who avail of it. A number of home care pilot schemes have been in place and these have worked exceptionally well. In many cases there is not much difference in the cost of residential care compared with a home care package. It is our intention to improve on the provision of home care. The Tánaiste mentioned that we will increase investment in community based services. The home care packages and home help have worked well. We are getting extremely good value for money. It is also what the patients want. We will continue to invest in this area.
I am sorry but my questions have not been answered. For instance, what can we tell somebody seeking to avail of the home care package who comes into my constituency clinic or those of the Minister of State, Deputy Seán Power, Deputy Ó Caoláin or Deputy McManus, and who will be responsible for it?
I cannot give Deputy Twomey an answer on the floor of the House but, as I stated, a number of pilot schemes that have been in operation around the country have worked very well. A team is coming together in this regard. I accept this is a general question but I am not medically qualified and the medical situation of a person will have to be taken into account. We are seeking to expand the home care service and the number of packages that are available throughout the country. On who can avail of the scheme, that is very much dependent on the individual needs of patients, if they are high dependency and what exactly are the difficulties. If they can be looked after in their own home it is our intention that we would do that.
Has attention been given to establishing a team of people who would be available to provide home care services for those who need it? At present, the process is only set in train when a need is identified. With all the requirements, there is a delay of several months — certainly for Garda clearance the delay is at least two months. In the meantime a patient with an immediate need has to wait for this service to be provided. I have argued with the Health Service Executive in my area that a pool of people must be identified who would be available to give emergency support for somebody in need of care or to take up new opportunities, which need not be confined to care in the home but would also support people with disabilities who need assistance outside the home for walks or whatever the case may be. Has attention been given to that approach to speed up the process?
I think Deputy Ó Caoláin will agree it is important that we ensure those people providing help are fit to carry out that important work. I am aware of a company that recently set up here and has recruited a number of staff to provide a home help service. It appears it had no difficulty recruiting staff and that many people were available.
Should the Health Service Executive do that rather than a private company?
We would like to remove some of the bureaucracy that exists. If it is decided that somebody is in need of a home care package we would like the decision to be implemented as quickly as possible.
Variant CJD Incidence.
Trevor Sargent
Ceist:84 Mr. Sargent asked the Tánaiste and Minister for Health and Children the latest figures for new variant CJD in the Republic; and if she will make a statement on the matter. [35443/05]
There have been two confirmed cases of new variant CJD in Ireland to date. The first concerned a woman who had lived in England for 20 years. Given the long incubation period of variant CJD, the probability is that the disease was not contracted in Ireland. The second concerned a 24 year old Dublin male. The probability is that he contracted it before the current very strict controls on the sale of meat in Ireland were brought into force in 1996. A third suspected case arose in June of this year concerning a young man in a Dublin hospital.
I thank the Minister of State for that information. Have we developed a reliable diagnostic test for new variant CJD? This has long been an issue for the World Health Organisation. The Minister of State referred to the incubation period. Do we have reliable projections for the number of people who could develop new variant CJD in this country, either from the consumption of beef in Ireland or the United Kingdom, which appears to be the most likely source?
Have we developed proper care for people who have contracted new variant CJD. From the cases in Belfast I know that the parents of one individual were not satisfied with the care the young person in question received.
The CJD advisory group provides scientific, professional and technical advice on all aspects of CJD and the policy responses that are appropriate in the light of evolving information and the evidence on this topic.
Fortunately, the number of people contracting this disease has been small. The Food Safety Authority of Ireland and the Department of Agriculture and Food are responsible for the control of BSE. The Food Safety Authority stresses that the BSE controls that have been put in place since 1996 are very strict and robust so as to ensure maximum consumer protection. There has been a welcome decline in the incidence of BSE in the Irish cattle population, which demonstrates that the controls introduced in 1996 are working. The vast majority of current cases are in animals born before the introduction of these enhanced controls. We would not anticipate an increase in the incidence of new variant CJD. There is no evidence at present to suggest the number of people contracting CJD will increase.
Do we have a reliable diagnostic test at present?
We are in the process of developing it and it is not yet finalised. I understand it will be shortly.
I am curious to know whether this is within the remit of the Minister of State. Does he have responsibility for this area?
I am replying to the question because of the variant CJD aspect.
Health promotion.
I am curious. Is that the area of responsibility of the Minister of State?
That is why I am dealing with the question.
I was just asking. It is.
Yes.
Does that mean the Minister of State's area of responsibility extends to MRSA? Where does the boundary occur? What area of responsibility does the Minister of State have that includes new variant CJD?
I have responsibility for health promotion within the Department of Health and Children. If the Deputy wants, I will provide her with a breakdown of responsibilities of the Tánaiste and the three Ministers of State at the Department of Health and Children.
I thank the Minister of State.
Health Services.
Ruairí Quinn
Ceist:85 Mr. Quinn asked the Tánaiste and Minister for Health and Children if the position of chiropody services for medical card holders and the possibility of chiropodists charging top-up fees to medical card holders will be clarified; and if she will make a statement on the matter. [35480/05]
There is no statutory obligation on the Health Service Executive to provide chiropody services to General Medical Service patients. However, in practice, arrangements are made to provide these services. Prior to the establishment of the HSE, the nature of arrangements for chiropody and the level of service provided were matters for individual health boards and variation in practice developed over time. Priority is usually given to certain groups of people, including people aged 65 years and over who are medical card holders. In several regions the service is provided by private chiropodists by arrangement with the HSE.
It is inappropriate for private chiropodists who provide services on behalf of the HSE to charge patients a top-up fee, and I have conveyed this view formally to the HSE. My Department recently requested the HSE to initiate a review of the fee arrangements in place for the provision of chiropody services with a view to ensuring that such additional fees would no longer be levied on persons in receipt of this service. I am preparing new legislation on eligibility and entitlement which will clarify patients' entitlements, especially in the GMS.
I thank the Tánaiste for her reply. She has made great play on her commitment to care of the elderly. Does she agree that one of the most basic and important services one can provide to generally healthy older people is a chiropody service? Does she have a response to the fact that the Health Service Executive sought sanction for an increase in the uniform charge to a level rate throughout the country for domiciliary chiropody services to people in nursing services? Why has the Tánaiste not sanctioned this? Is she aware that a second visit by a chiropodist to a nursing home only accrues €7.03, according to an answer given last month to a parliamentary question? Does the Tánaiste intend to increase charges, outlaw these top-up charges and ensure sufficient chiropodists in the scheme to meet the requirements? She may be aware that elderly people have difficulties in accessing a chiropodist within the scheme.
I am concerned about this area, particularly as we move towards providing more community-based services. Even within the hospital system, some of our largest hospitals have too few chiropodists and major issues arise. The fee must be realistic to provide a service. While I am not in favour of patients paying a top-up fee, unless appropriate fees are paid, chiropodists will not provide the service.
Entitlement and eligibility legislation will clarify who is entitled to services of this kind. A separate issue arises regarding those with diabetes and vulnerable groups such as the elderly. If we do not put in place preventative measures and chiropody services, more serious issues will arise which will be not only more severe for the patient but also more costly from the perspective of the health service. This is one of the areas in which major change must occur in the way we provide services at community level in particular.
The Tánaiste did not answer my question. The HSE has requested an increase in fees for chiropodists. I have a list of chiropodists in the scheme and approximately one third of them are unavailable. I presume they are unavailable because they do not make enough money. It is not a case of entitlements legislation. We have been waiting 20 years for that. What is the response to the HSE's request to increase the fee?
I will not respond to that question because we must consider it in the context of the provision of services. One cannot have one without the other, if that does not sound like a cliché. There are large deficits at community level in chiropody services. I will shortly examine the issues which arise regarding fees. Confusion also arises on who is eligible for what and no statutory basis exists for that. All these matters must be dealt with. I am anxious to ensure that vulnerable groups of patients, in particular elderly patients, have regular access to appropriate chiropody services. In so far as the fee influences that, it must be reviewed.
Regardless of who is eligible for the service and other issues the Tánaiste wishes to tidy up, is it illegal to charge a medical card patient a top-up fee if the fee, no matter how small, is already paid by the HSE? Whatever about the patient offering the provider a gratuity payment, is it illegal to seek a payment from any patient provided a service in the GMS?
As I stated in my reply, it is not part of the GMS. That is the issue.
How does the system work?
It evolved on an ad hoc basis and varied from one health board to another. That is one of the issues that needs to be clarified. IMPACT represents the chiropodists and discussions and negotiations will take place between the Health Service Executive, the employer representative group and IMPACT on fee issues.
Departmental Programmes.
Paul Nicholas Gogarty
Ceist:86 Mr. Gogarty asked the Tánaiste and Minister for Health and Children the nature of the advice on alcohol policy provided by Target Health; and if she will make a statement on the matter. [35439/05]
The national alcohol policy, published in September 1996, provides that a dedicated national alcohol surveillance function be established by the Department of Health and Children. This function is performed on a contractual basis by Target Health. The principal duties of this function are to advise the health promotion unit on alcohol policy issues; collate and co-ordinate relevant data on alcohol policy issues, alcohol consumption, alcohol related health problems, indicators of alcohol related harm, alcohol related offences and expenditure on alcohol, including the establishment of a database of information; liaise with statutory and non-statutory organisations, either in association with or on behalf of the Department of Health and Children, to assess the extent to which agencies implement the national alcohol policy; conduct and advise on research projects; brief departmental officials on relevant international developments in the general area of alcohol policies and of strategies to promote moderation in alcohol consumption; advise the Department of international research and evidence of best practice on alcohol policy; and represent the Department on national and international expert groups on alcohol policy.
Will the Minister of State tell the House how much Target Health charges the Department of Health and Children for this? It seems to be quite a comprehensive list. Did Target Health advise the Minister of State to abandon the alcohol products Bill? Surely that was an integral part of the strategy to deal with alcohol abuse? Does the Minister of State agree that having alcohol advertising all the time, particularly at tea-time, influences people to consume more alcohol? It would be sensible to curtail such advertising if we are to deal with this serious health problem. At the very least, the previous Minister stood up to vested interests. Why has this Government capitulated completely to the alcohol industry?
I resent the comment that the Government has capitulated to the drinks industry. We appreciate the problem presented by alcohol here and there is no greater problem facing society than alcohol. We are all familiar with these difficulties and few families are not affected. The Government set up the strategic task force on alcohol that reported a short time ago. I presented that report to Cabinet and got approval to implement the recommendations under the remit of the Department of Health and Children.
The question is on Target Health. How did it reply?
I ask Deputy Gormley to allow me to reply. I have listened to Deputy Gormley and he often makes throwaway remarks with little foundation.
I asked the Minister of State a question.
Advertisers would not waste money placing advertisements on television if they did not work. This principle applies to the drinks industry. The Government was concerned about the number of advertisements that appear in media, concerning drinks and sexy campaigns aimed at young people. The Government approached the drinks industry and discussed the matter with it. The Government is conscious of the difficulty and realised the industry could be part of the solution rather than part of the problem. The Government has reached an agreement on the type of advertisements placed and the timing of these.
Will there be no more sexy campaigns?
The result of this campaign is the same as if legislation were introduced. We have an independent committee to monitor this agreement and if it does not work legislation will be introduced if needed.
I want to know what Target Health advised the Minister of State. That was my question.
Government must make decisions and it is open to advice from a number of areas, including the Opposition. If the Deputy has something constructive to propose rather than criticism, we will listen to him.
We do so all the time. Did Target Health advise the Minister of State to abandon the alcohol products Bill or did it state that this was the best way forward?
Target Health has a number of functions in advising Government, which it does on a regular basis. The Government takes all advice on board before making decisions.
Will the Minister of State answer this very simple question to which I am seeking an answer for the fourth time? Did Target Health advise the Minister to abandon the alcohol products Bill?
The answer is obviously "yes".
Government decided to enter negotiations with the drinks industry on advertising and deal with it in the manner outlined. This will have the same effect as legislation and if it is not working we will resort to legislation. At present the drinks industry and the advertising industry are conscious of the difficulties alcohol creates and are prepared to take measures to deal with this. The Government is pleased to work with them to do so.
The Minister of State is stating the Government paid substantial sums of taxpayers' money to consultants, who advised a certain strategy that was ignored.
Deputy Gormley can choose his words but should not try to put words into my mouth. I did not state what Deputy Gormley suggests. A strategic task force on alcohol made certain recommendations. There are several ways of achieving a result and legislation is not necessarily needed.
I cannot get an answer from the Minister of State.
In this instance we have entered into agreement with the relevant——
Stakeholders. Why not use that word?
——members. Nothing could be further from the truth than to suggest the Government is cosying up to the drinks industry. This was seen last year when the ban on smoking in the workplace was introduced.
Nothing is banned here and the Government is not dealing with this matter.
Written answers follow Adjournment Debate.