Vol. 679 No. 1
34 Deputy James Reilly asked the Minister for Health and Children her views on the situation in hospital accident and emergency departments in view of the fact that almost 400 patients are lying on trolleys throughout March 2009; her plans to address this problem or if she is resigned to seeing patients continue to lay on trolleys; and if she will make a statement on the matter. [13410/09]
The average number of people waiting admission to hospital during the month of March was 137 people. It is my intention to continue to reduce waiting times for all patients presenting as emergencies to our hospitals. The HSE has set a lower waiting time target of six hours for all patients. The aim is that all patients, irrespective of whether they are admitted, will be assessed, treated and discharged or admitted within six hours of arrival. Up to now, the focus has been on waiting times for those awaiting admission to hospital.
The Healthstat data published by the HSE last week measures a number of elements of hospital activity which directly affect emergency departments. One of the Healthstat measures the number of patients who are given a discharge plan from the hospital. The target for this is that 60% of all patients should have such a plan and a discharge date. This will allow for increased efficiency and certainty regarding bed usage in hospitals. The most recent bed utilisation study, taken in June 2008, indicates that, of the patients surveyed, 48% had evidence of discharge planning, while only 16% had a documented date of discharge.
Another element of hospital efficiency on which I expect to see improvements is the number of elective patients who are admitted to hospital on the day of their procedure. The international target for this is 75%. The current national average in Ireland is approximately 30%. The majority of our hospitals need to make significant improvements on this front. The acute hospital bed capacity review of 2007 indicated that up to 140,000 beds a year could be freed up if Ireland was to reach best practice standard in this regard.
The HSE's service plan commits to reducing inappropriate admissions, reducing average length of stay and shifting activity from in-patient to day case procedures. I am confident that these measures will ensure more efficient use of available capacity and facilitate further improvements in the delivery of services in the emergency departments.
The Minister stated the average number of people waiting admission was one hundred and something. I do not know where she gets her figures. The INO figures indicate that some 340 people are on trolleys today while on 27 March some 305 people were on trolleys. On 24 March, some 387 people were on trolleys while the figure on 20 March was 304 people. The figure does not dip below 300. Therefore, five years after the Minister's ten-point plan, we still have a mess with regard to patients on trolleys. It does not matter how one dresses up the figures or how we dispute them in the House because the reality, irrespective of whether we like, is that people are lying on trolleys in accident and emergency units for two and three days at a time. No amount of gloss can change that.
We hear today of plans to address this issue rather than of actual results. In 2006, the authorities in Northern Ireland set up a system to deal with the matter. In March 2008, one year ago, 92% of patients were seen within four hours of arrival. We are still counting waiting times and the number of people on trolleys from the time a decision to admit is made rather than from the time of arrival at the hospital. The two measures are entirely different.
Why, after five years, does the crisis continue? Why are the numbers still so high? Even using the Minister's own numbers, one cannot say there has been any real decrease since the time she said the problem should be treated as a national emergency. Where has all the money gone? Why have we not done what we said we should do, that is, address the bed capacity issue with regard to beds occupied by those whose acute phase of treatment is over and who have nowhere to go in the community?
I agree with the last point the Deputy made. The Fair Deal, which will be implemented later this year when legislation is enacted, will play a very important role in facilitating patients, particularly older ones moving from the acute setting to long-term care, because we will have a fair system of funding for all persons.
We are measuring time of arrival now. We are considering this measure and not just the time of the decision to admit a patient. This involves a six-hour timeframe. There has been a reduction of 20%. Measuring patient statistics at 8 a.m. is not appropriate, as the Deputy knows. The measurement that is taken by the HSE is at 2 p.m. every day and, according to this, there has been a 20% improvement. This continues to be the case.
Issues do arise within the hospital system. There have been serious infection issues in Beaumont Hospital, St. Vincent's Hospital and others. During the months of February and March, these issues have affected some of the targets we have set. Notwithstanding that, there has been an enormous improvement with regard to the number of people waiting to be seen in emergency departments, certainly in recent years. We are beginning to see a drop off in the number attending emergency departments because individuals are instead going to primary care facilities, which practice I know the Deputy supports.
How can the Minister possibly hope to improve circumstances when she plans to cut another 600 beds from the system this year after having cut 500 last year?
The emphasis must be on how we use the beds. As I stated, we should have a national standard whereby 75% of those admitted for surgery would be admitted on the day of surgery. This does not happen. We do not have discharge plans for the vast majority of our patients.
The new HealthStat system, which will drive the performance of our hospitals, will be enormously beneficial in helping hospitals to do better with their existing stock of beds. I refer in particular to moving to more day-case activity, which is in line with the service plan that has been submitted to me by the HSE.
The Minister had the information for two years.
35 Deputy Jan O’Sullivan asked the Minister for Health and Children if she has received proposals from the Health Service Executive for the cuts it proposes to make to achieve the savings in its budget required of it by the Government in 2009; the action she will take to protect patients from the effects of these cuts; the estimated number of bed closures envisaged in these proposals and the timeframe; and if she will make a statement on the matter. [13183/09]
The HSE is facing significant financial pressures. These are due to a range of factors, including the implications for the HSE of the broader economic circumstances of the country. There have been intensive ongoing discussions between the executive and my Department regarding the executive's emerging financial position. Based on figures for the end of January and the end of February, the best estimate of the shortfall in HSE funding for the year was in the order of €480 million, including a shortfall of €100 million in health contributions. Subsequent to this overall assessment, the Department of Finance has notified an increase in its revised figure for the shortfall in health contributions from €100 million to €160 million. This figure is being kept under review in the context of the overall economic circumstances.
All projected overruns are influenced by the difficult circumstances we are in and subject to the limitations of forecasts. I wrote to the chairman of the HSE earlier this month and emphasised that it was crucial that the HSE manage the costs in its control. I indicated that under the circumstances, the HSE should focus on the measures required to be implemented to deliver on the service plan as outlined to me. As I have indicated to this House, the challenge to the HSE to break even within its financial allocation, while still protecting services, will present major difficulties. The board had previously agreed measures amounting to some €133 million and was asked to further examine how it could achieve another €72 million in savings.
I have indicated to the board that issues such as the income loss in health contributions, extra costs associated with the long-stay repayments scheme or the extra costs arising from increased medical card numbers will have to be considered by the Government in the context of the supplementary budget, which will introduced to the House next Tuesday.
The board of the HSE met yesterday to further consider its financial position. I understand a revised service plan will be submitted to me within the next five days. It will include proposals to save the further €72 million. I will consider the proposals contained in the revised service plan when it is submitted for my approval in accordance with the Health Act 2004.
I thank the Minister for her reply. I understand she has not yet received the revised plan. When she does, will she establish a bottom line as regards the services she will protect? What will occur if she does not agree with the plan? Will she be in a position to reject it or will she make alternative proposals if she feels it is too harsh on health services?
Is it true that the cuts will include cuts to the home help service and cuts in respect of acute hospital beds, as reported in a newspaper today? If true, will the Minister approve the cuts? It is clearly policy that people should be catered for in the community or their own homes, where possible, and it is clear that cuts to the home help service will affect that. What is the Minister's bottom line with regard to health cuts and the protection of the patient?
Did the Minister state, in respect of the levy, there will be a shortfall of €160 million rather than €100 million? Where will the €60 million be found? We were only aware of a shortfall of €100 million the last time we received answers.
I do not know whether the Minister wants to refer to the cystic fibrosis issue given that it will be discussed on the Adjournment tonight. It is the cause of serious concern. I realise the problem relates to 2010 but money pertaining to 2009 is obviously involved.
That issue is referred to in the next question. I call the Minister.
In deference to Deputy Reilly, who tabled a question on cystic fibrosis, I will reserve my comments on it until we take that question.
The sum of €160 million arises because of the emerging economic circumstances in March, according to the Department of Finance. I said at the committee last week that the shortfall was €160 million rather than €100 million. Furthermore, I stated in my reply to Deputy O'Sullivan's question that, in the context of the budget next week, the Government is considering the shortfall. It has a considerable impact on the HSE because it affects appropriations-in-aid and the consequent increase given the level of unemployment and the number of medical cards.
Even accepting all that, the HSE clearly has a budgetary challenge. The HSE spends approximately €1.2 billion each year on what I would call some archaic work practices. I refer to junior doctors getting paid for their lunch and to live out of the hospital. These are practices that would never be negotiated in current circumstances. The priority for dealing with the financial constraints must be in the context of that envelope of very rigid work practices whereby we cannot deploy people from where they may not be needed to where they are needed.
When the HSE submits its service plan to me, I will want to ensure it is dealing with issues such as travel and subsistence, work practice issues and legal issues. The HSE spends an enormous sum each year on legal issues. Since we are reducing professional fees to doctors, dentists and pharmacists by approximately 8%, I hope the HSE will be in a position to do the same in regard to legal fees. My priority will be to ensure we minimise, if possible, the impact of the financial constraints on services to patients, either within the hospital or the community, and that we maximise the potential to live within budget on the basis of some of the sources to which I referred.
Will the Minister answer my question on whether she has a bottom line on what she would consider to be going too far in terms of affecting patient care?
The bottom line is that the use of the money allocated to the HSE which, in gross terms, amounts to approximately €15 billion on the current side, must be maximised in the interest of patients. Therefore, any restrictions must hit hard in areas such as travel and subsistence, work practices, overtime issues, redeployment and legal costs.
It will be very hard to get those kinds of cuts in those areas.
I have the power to reject the proposals submitted and suggest alternatives.
36 Deputy James Reilly asked the Minister for Health and Children the reason only eight of the additional 14 fast-tracked cystic fibrosis beds promised to be put in place by the end of summer 2008 have been delivered; the further reason that the remaining beds have not been delivered; and if she will make a statement on the matter. [13411/09]
Since 2006, some 19 additional staff have been recruited in St. Vincent's Hospital to work with cystic fibrosis patients. The physical infrastructure has also been enhanced through the refurbishment last year of accommodation to provide eight single en suite rooms for the exclusive use of people with cystic fibrosis.
It had been intended to free up a further six beds at the hospital for the use of cystic fibrosis patients. This has not yet happened due to serious infection control concerns in the care of the elderly unit in the hospital which required immediate essential refurbishment work. In order to do this, patients from the care of the elderly unit had to be moved to the area which had been planned for the additional six beds. This work has been completed and the elderly unit has reopened.
In order to provide six additional single en suite rooms for cystic fibrosis patients, the current configuration of the ward will have to be changed from five three-bedded rooms and one six-bedded room to six single rooms. The current complement of 21 beds would be reduced to six and the hospital would therefore lose 15 beds which are available to it. The additional 15 beds are necessary at the moment to accommodate patients requiring admission from the emergency department.
Phase 2 of the development at St. Vincent's is being designed to provide a new clinical building which will include 120 replacement beds. The new facility will include appropriate isolation facilities and accommodation for cystic fibrosis patients. Design work and preparation of tender documents is continuing in respect of the development.
A number of other significant capital developments are being progressed for cystic fibrosis patients throughout the country, including in Beaumont Hospital. An additional 48 staff, including consultant, nursing and allied health professionals, have been appointed across the hospital system in recent years to enhance the services provided to cystic fibrosis patients. I intend to continue these improvements, including the development of outreach services to facilitate the treatment of patients outside the hospital setting where appropriate.
I thank the Minister for her response. There is one chink of light for the many people in this country who suffer with cystic fibrosis, the people who love them and those who try to treat them, and this is that the Minister has the power to change the HSE's suggestions and plans.
Since this issue came to the airwaves last year, two of the brave young women who were on "Liveline" with Joe Duffy have passed away. We know this unit was costed at €40 million. We know from the Minister's own testimony at the Oireachtas Joint Committee on Health and Children that building costs have decreased by 25% so we are now looking at a cost of a mere €30 million. We know that in the current climate builders, if pushed and pressed, will take deferred payment to keep their employees at work. I must put it to the Minister that failure to address this issue and progress this development will impact on all other facilities for cystic fibrosis in the country.
We can defer payments but these young Irish citizens die ten years sooner than their cousins 40 miles up the road. They cannot defer their demise if this facility is not built for them. I plead with the Minister to use her good offices to examine what the HSE has planned and where the cutbacks are planned and make this an absolute priority. Some of the people who would be outspoken about this issue this week and next week may not be with us next year if she does not make that decision.
It is a priority but, to be fair to the HSE, if it does not have the money it cannot do it. Virtually all of the HSE's capital plan is contractual. Yesterday, I stated that I know the hospital has an alternative proposal on how this could be funded in the immediate period and we need to explore options in an innovative and imaginative way to bring this facility into place as quickly as possible. I agree it is important and certainly it is a priority for me and for the Government to make this happen.
Given how long it takes for matters to be explored, will the Minister explore in a very urgent fashion the possibility of putting in place a pre-modular unit to have at least some beds and isolation facilities available for these very needy young people? This could be done in a matter of weeks while an alternative way to provide the 120-bedded unit is being explored.
That was explored last summer and the hospital's very strong preference, because of space issues, was to do it all together. We committed to doing this, which is why we reorganised within the hospital. Certainly, all options will be explored. As the Deputy may be aware, the care of the elderly facility at St. Vincent's leaves much to be desired. The facilities there for very old stroke victim patients are not what people are entitled to expect. If we can provide the 120-bedded facility in an innovative way with the hospital's support, and this is a voluntary hospital which is not owned by the State, then we should be prepared to do so. I am exploring this in the context of next Tuesday's budget.
The Minister promised 30 beds for cystic fibrosis patients.
The children and young adults in this country suffering from cystic fibrosis require these facilities in the most urgent possible sense. Unless a commitment is given that can be kept to build the 120-bedded unit, then another facility should be provided which can meet their needs.
The problems in St. Vincent's do not stop with the elderly. A haematology unit there has stopped admitting people who have neutropenia, a low white cell count, which is a complication of illness, because of two episodes of vancomysen resistant e.coli. The inpatient unit has one toilet so the problem goes deeper.
I am pleading on behalf of children and young adults with cystic fibrosis. We have lost some already and we will lose more. As a society, we cannot stand over the fact that people here in the so-called Celtic tiger economy die ten years younger than their cousins in Northern Ireland.
The matter of life expectancy is not confirmed by the registry. However, this is not the issue. The issue is having appropriate facilities for these patients and I am committed to making this happen.
37 Deputy James Reilly asked the Minister for Health and Children if she will roll out the national retinopathy screening programme in view of the fact that retinopathy screening for people with diabetes is highly cost effective in terms of the long-term health gain and money saved through prevention and in view of the recent publication of the Health Service Executive report recommending the programme; if not, the reason for same; and if she will make a statement on the matter. [13412/09]
As the Deputy is aware, this issue was the subject of a full debate in the House on 26 February 2009. As I indicated then, the HSE plans to roll out a diabetic retinopathy screening programme on a phased basis by HSE area. It is proposed to commence in the HSE west region, as a population-based screening programme had previously been established in the former North-Western Health Board. Funding of €750,000 is being allocated to implement this first phase of the screening service. This will allow the service to be offered to approximately 30,000 people with diabetes, registered with the programme, between west Limerick and north Donegal. It is estimated that this programme will commence in the third quarter of 2009. Once the first phase has been established, the programme will be rolled out on a phased basis, having regard to overall resource availability and other competing priorities.
For the record, we did not have a debate on this issue. We had statements on it which is quite a different matter. Will the Minister bear in mind that approximately 5% to 10% of people with diabetes have sight-threatening retinopathy? This requires treatment and if they do not receive it, some 14,000 to 16,000 will end up with sight-threatening retinopathy by the end of next year. The cost of providing a comprehensive retinopathy programme is approximately €1.9 million with ongoing costs of €2.5 million per year. The cost to the State of the care of 100 people who are sight impaired runs to €2.4 million. For the price of looking after 100 blind people, we can prevent thousands of cases of blindness. If there was ever a case of penny wise pound foolish, this is it.
I recounted the story at the Oireachtas Joint Committee on Health and Children, and I will repeat it here, of a gentleman who went blind waiting for an outpatient's appointment. He went to England and had partial sight restored to his left eye. He has returned here and on at least three occasions prior to a six month appointment he was told it had been put back for another six months. This man is extremely angry for his own sake and for the sake of the many other people he knows who suffer the same consequences. It is a small amount of money for what is a form of prevention. Tough decisions will always have to be made, but we must invest in prevention to save money tomorrow. For every euro we spend on prevention, between €12 and €20 will be saved on treatment, and this €1.9 million needs to be made available.
Funding of €750,000 is available in 2009 for the purpose, but the estimated total cost of the scheme nationally will be €4 million. The key message is that despite the difficult financial situation, this is being rolled out in the HSE western region. We picked that area because a population based screening programme was located there previously. We are putting in place all of the various pieces we need to put in place for 2009, including governance and committee structures and the processes involved. There also has been recruitment of staff for the IT side of the scheme. It is a good news story as it is getting priority under the current financial situation and the roll out is happening on a phased basis.
The Minister of State is well aware that this money was available in 2008 and 2007, when we were not in such straitened times, yet it was not spent. While we welcome the fact that it is being rolled out in the west, what about the rest of the country? What about the rest of those with diabetes who may lose their eyesight due to a failure to detect their retinopathy, which is an eminently treatable condition?
There is no doubt we are facing resource constraints and that is why it was not rolled out in 2008. We can certainly say this is a positive development as it is happening in 2009 in the west, where 30,000 people will be screened. Thereafter, depending on the availability of overall resources, this will be the first phase of the national roll out.
So there will be no relief for the remaining 110,000 people with diabetes.
38 Deputy Alan Shatter asked the Minister for Health and Children if she has been furnished with the Health Service Executive review of adequacy of child and family services for the year ending 31 December 2007; when she expects to receive the Health Service Executive review of adequacy of child and family services for the year ending 31 December 2008; her views on the failure of the HSE to publish such reports promptly following the conclusion of each year; her views on whether the HSE is in breach of its statutory obligations with regard to its delay in publishing the review of adequacy of child and family services 2007; and if she will make a statement on the matter. [13184/09]
It had been expected that the review of the adequacy of child and family services report for 2007 would be completed and published before the end of 2008. However, following discussions between my office and the HSE in late 2008, it was agreed to give priority instead to the preparation of a social work and family support services survey. The finalisation of this comprehensive survey necessarily involved the same cohort of HSE officials working on the validation of the interim data set for 2007 to support the section 8 report. I am advised, however, that the section 8 report for 2007 will be published within the next two weeks and that future reports will be produced in a timely fashion. In this regard, I do not consider there has been any breach by the HSE of its statutory obligations. In regular meetings with HSE child welfare protection managers, I have been impressed by their commitment to addressing the many issues surrounding the provision of timely, accurate and consistent management information.
A draft version of the social work and family support services survey document has been already presented to me by the HSE. It provides a good indication of the breadth of information which will follow in the final version, which is expected to be ready before the summer. In addition to an array of statistical data, including data on current caseloads and family support services, the document also contains a considerable amount of valuable contextual commentary which will support better management and service reform. Informed by the social work and family support services survey, I intend to discuss with the HSE how the section 8 report can be enhanced in future years, and how the information now becoming available can be used in HSE performance reports submitted to the Department.
Is the Minister of State telling the House that as a result of his intervention, the HSE has failed by the end of March 2009 to publish its report on the workings of the child protection services for the year ending 31 December 2007? Is he in a position to tell the House how many children were taken into care in 2007? Such information would be contained in this report if it were published. Is the Minister of State in a position to tell the House how many children, either at the end of 2007 or at the end of 2008, were reported to be at risk but whose family circumstances had not been comprehensively investigated and whose case had not been expressly referred to a social worker? Can he explain to the House how, in the absence of up-to-date statistics and background information on the workings of the child protection services, it is possible to assess the efficiency of those services, the extent to which they truly provide children with the protection they require or to determine what new initiatives may be required to improve those services?
I am working very closely with the HSE and I am satisfied we have made very considerable progress on the issues the Deputy identifies as shortcomings in the child welfare and protection service. The information should be at hand in two weeks, and I am absolutely confident that we will have it to hand before Easter. The survey to which I referred will give us the further context mentioned by the Deputy, so that we will not be just presented with raw data and will be able to check these figures against matters such as the demographics of an area and the level of deprivation in an area. We can then develop strategies based on those figures, rather than leave them to collect dust on a shelf. They will provide the basis for the preparation of a proper strategy. I am confident we have made considerable progress in this area.
The Minister of State has failed to answer the questions I asked. Will he confirm that he does not know on 31 March 2009 how many children were taken into care at the end of December 2007? Will he confirm that he does not know how many children reported to be at risk have not had their cases investigated? If the report for 2007 has not been published, even though it is required by the Child Care Act 1991 to be published with a degree of promptness, when will the report for 2008 be published?
I am told there are hundreds of cases involving reports of children at risk across the country, within 32 child care regions under the supervision of the HSE, whose files are sitting on shelves and are unallocated to social workers for proper family investigation. Does the Minister of State know this? Does he agree that since the formation of the HSE, it has been incapable of collating up-to-date information on the workings of the child protection service, for which it has statutory responsibility?
Will the Minister of State with responsibility for children confirm that he has no idea about the current position regarding the efficiency or otherwise of the workings of our child protection system? He has no up-to-date information on which he can rely.
In the main body of my answer, I explained to the Deputy that I have been furnished with the draft social work and family support services survey, and the Deputy will be given that report as soon as it is finalised and validated. This report presents up-to-date information and context for the first time. It was not available to policymakers before.
Does he have the children's figures I requested?
I have the interim data for 2006, which are what this survey is based on.
The 2006 figures were published last October.
The HSE will publish the 2007 figures within two weeks. Thereafter, we will endeavour to ensure the 2008 figures are published in a timely fashion. The reform of social work, child welfare and protection is my priority. This always has been the case since I was appointed to this job. I cannot stress enough the progress we have made in partnership with the HSE in the last year. I am very satisfied with what the organisation has done.
What did the Minister of State's predecessor do?
It has set up a task force to work on the standardisation of business processes. That will be reported in May and will provide us with the capability to ensure we have a much better X-ray of child welfare and protection on a contemporaneous basis in the future.
In other words, the Minister of State does not have a clue what is going on. That is a substantially inadequate reply.
