Other Questions

Hospital Accommodation

Brian Stanley


43 Deputy Brian Stanley asked the Minister for Health and Children if he has a programme for the reopening of closed public hospital beds and wards; and if he will make a statement on the matter. [13464/11]

In common with other public services, the health services are facing significant financial challenges. The key priority for me in dealing with the serious budget pressures on the health services is to minimise the effect on services for patients to the greatest degree possible.

The Government has a radical programme for reform of the health service. It is no accident that this reform programme is headed ‘Fairness' in the programme for Government. I want to shift the debate away from beds to the actual number of patients treated. I want to focus on access to services based on need and on those services being provided in the best place, be that a big or small hospital, the community, a GP's surgery or in the patient's own home. I want to see a health system providing a service quickly, efficiently and safely.

Activity in acute hospitals has been increasing year on year. A modest increase is planned for 2011 despite the budget cuts. The most important thing is to drive out costs by relentlessly challenging practices which affect efficiency. We must increase the proportion of day case work, reduce the average length of stay and perform surgery on the patient's day of admission to the greatest extent possible. One hospital which I will not name has a day of admission surgery rate of 39% when the international standard is 75%. That has huge cost implications. In fact, physicians and surgeons in the hospital concerned have negotiated a change. I believe in fairness in that regard too; that if people do not understand and realise where they are going wrong we can hardly expect them to fix it. One of the problems that has affected the health service in recent years is that we find areas where excellent services are performed in a more clever, better way but that does not seem to get transposed across the system. That is something we intend to address. There is clear evidence of major variations in performance under various headings across the system. That means we are not getting the best value for patients and the taxpayer from the beds we have.

Additional information not given on the floor of the House.

I am determined to see these inefficiencies addressed. The special delivery unit, SDU, which I will set up will be a robust driver of improved performance which holds providers to account. It will also be a source of expert support for providers which helps them achieve better results quickly.

The purpose of the SDU is to unblock access to acute services and to do that by dramatically improving patient flows. That will free up capacity in the public health system to get more patients treated more quickly and-or to enable resources to be reallocated out of acute hospitals and into primary and community services.

The Minister referred to shifting the focus away from beds and for improvements to be transposed across the system. I wonder how that applies to him? As spokesperson for Fine Gael on health issues in recent years, the Minister correctly laid the emphasis on the importance of restoring bed numbers. His answer now suggests that he has taken a completely different position, one that echoes his predecessor. Let there be no mistake about it; this is a very important matter. I welcome the fact that the Minister now accepts the Trolley Watch figures of the INMO. I commend him for it. Does he accept therefore the figures it has presented on the inappropriate placement of people over the first quarter of 2011, some 25,000 patients, in trolleys and chairs over the first three months of this year — yet another sad record in comparison with the previous five years? Does he also accept that the INMO has indicated that some 1,600 acute public hospital beds have been taken out of the system in recent years? The situation with which we are currently contending is that 1,600 beds have been removed. I have to ask——

I call on the Minister to reply. I am sorry, Deputy.

I will conclude with this question, a Leas-Cheann Comhairle. The Minister indicated that he would establish a special delivery unit in his Department to help reduce hospital waiting lists. Has that been established and will the Minister clarify exactly his intention on bed numbers because thevolte-face he has demonstrated today is incredible?

I am not sure which of the myriad questions Deputy Ó Caoláin has asked, to answer. There is no about-turn orvolte-face, as the Deputy suggested. There is a concern and realisation that what is important is service to patients and that patients get that service. There is also a realisation, with the excellent work being done by the clinical programme managers, that there are many ways to improve the service and increase the through-put through hospitals by having patients discharged sooner. That can be achieved without opening more beds. What I always said is that there should be no more money for the HSE until I found the black hole and that we do not need more beds until we get proper use out of the beds we have. Then we will see whether we need more beds. That remains the situation. It is the service to patients that is important, not the number of beds in a hospital, although, if properly and efficiently used that obviously has a determining effect.

Deputy Ó Caoláin asked about the special delivery unit. It is part of the 100 days programme to have it established. We still have several days to go and we will have something to say about that in the coming week. A serious effort will be made to look at the underlying problems in the health service that give rise to the situation in which we find ourselves. Even with our shrinking budget it should be possible to deliver the service and care that people so richly deserve and have paid for, but with due respect, with €1.5 billion gone from the budget in the past year and a half that will prove extremely difficult but not impossible.

We are utterly determined to make it happen but we are realists and pragmatists. We cannot do it overnight or within a week but in the next few months we will ensure that we never see the likes of what we saw last winter in our hospitals. That will not be made easier by the fact that the budgetary allowance for the fair deal nursing home support scheme has proven to be a totally inadequate and poorly constructed plan by the outgoing Government that has resulted in people being worried and concerned. I assure them that approvals will continue as funding becomes available. Funding will become available, perhaps not at the same rate as it was previously but it will continue.

In some of the examination to date I have discovered that people have been transferred straight from hospital to long-term care in many of the HSE-provided facilities and also in the beds that are contracted by the HSE without being afforded the opportunity to first avail of a home care package and then to be assessed. I put it to the House to consider whether it is wise to assess patients when they are acutely ill in hospital on their long-term ability to survive at home. Perhaps it would be more wise to have a system of convalescence, a place where people could go to continue their recovery and then be assessed as to their suitability for long-term care or whether they would be able to stay at home with support.

I have a brief question.

The Deputy should be very brief as we are running out of time.

Undoubtedly, several patients would wish to remain at home but the Minister cannot make a blanket statement suggesting that one would not make that assessment when in acute hospital settings.

I do not have to go back over the record to cite what the Minister said week on week, month on month and year on year since taking up the role of spokesperson on health. Is he now of a mind not to reopen any of the 1,600 closed public hospital beds? Is his answer now that he has abandoned that position that he championed repeatedly in the House? If the Minister is intent on revisiting some of the 1,600 bed closures, does he not agree that a programme of reopening to whatever degree is what would be required and that should now be planned for? Will the Minister be clear and specific to the House on his intention and that he has not abandoned the proposition which he knows is an integral part of addressing the crisis within the health system?

Part of any plan for a winter crisis is the ability to open beds that have been closed, if that is necessary. Rather than focusing on beds we should focus on service, the treatment of patients and the service they require. I have not entirely abandoned the possibility of re-opening beds.

Based on existing data, at the weekend of 3 April, some 961 beds — 927 inpatient beds and 34 day beds — were closed. The highest figure to date for 2011 was 1,098 beds closed on 9 January and the lowest number was 868 on 23 January. The situation is in flux. I am concerned, as is the Deputy, that people who need long-term care can avail of it. However, I am equally concerned that people who should not be going into long-term care and who would prefer to stay at home get the appropriate supports and are not condemned to unnecessary institutional care.

Fair Deal Scheme

Aengus Ó Snodaigh


44 Deputy Aengus Ó Snodaigh asked the Minister for Health and Children the action he proposes to take regarding the funding of the fair deal scheme; and if he will make a statement on the matter. [13457/11]

Mary Lou McDonald


46 Deputy Mary Lou McDonald asked the Minister for Health and Children the scope of his inquiry into spending in the Health Service Executive relating older persons and the fair deal scheme; and if he will make a statement on the matter. [13461/11]

I propose to take Question Nos. 44 and 46 together.

As the Deputies will be aware, the Minister for Health and Children has recently been made aware of a serious shortfall in the fair deal budget for this year. The budget is coming under pressure from, among other things, increases in overall costs and increases in net demand for long-term care. Furthermore, the HSE has advised that the long-term residential care subhead is also funding services other than those covered by the nursing homes support scheme. I understand these other services, which include therapies and medications, are being provided to people in nursing homes.

The decision to suspend approvals under the nursing homes support scheme was made by the HSE on Friday, 13 May 2011 and a letter issued to each regional director of operations for further distribution to all hospitals in their areas. A copy of this letter was sent to the Department of Health and Children on Tuesday, 17 May. The Minister for Health and Children was advised that day and a meeting with the HSE took place that evening.

A full examination of the funding situation is under way, conducted jointly by the Department of Health and the HSE. This examination is to be completed by Friday, 3 June 2011. The Minister has sought further information about the level of funding provided for, and the cost drivers impacting on, the long-term residential care subhead. The main priority at this stage is to establish what steps might be taken to allow more people to benefit from the scheme. In the meantime, applications for financial support under the scheme will continue to be accepted and processed. However, decisions to grant approval will be subject to the availability of funding.

We addressed this issue in some measure earlier, so I will concentrate on just some of the different areas. The Minister indicated on 20 May that approval of applications "would resume" and said that funding would be reallocated for this purpose. We now face a situation where the entire approvals process has been suspended. Are we to wait until the end of the review, 3 June, or have any other steps been taken to identify additional funding supports for the fair deal scheme? Has everything been sent to limbo for the moment or are we proactively looking at where additional funding can be realised? Will we only start to look at this post the publication of the review?

The Minister claimed that €100 million of the funding allocated for the fair deal scheme was used for other purposes by the HSE, although the HSE would say the funding was spent legitimately on services for older people. There may be truth in both arguments. However, with regard to the Minister's position, does he accept that €100 million that was allocated for the fair deal scheme has been spent in other areas, such as drugs, therapies etc., and that this money must be restored to the fair deal scheme?

It is a pity the Minister must have a surrogate voice here to respond to questions. He has stated there are anomalies not only relating to the funding of the scheme, but also to admissions policy and assessment procedures. Will he elaborate on that? He appears to suggest that some older people have been wrongly assessed and, perhaps, wrongly admitted into nursing homes. We need clarity on his statement.

I do not think the Minister made that assertion at all, but I am sure he will speak for himself later. The report on the review is due on Friday. Therefore, it is pointless to start discussing where the money will come from, whether it should be returned to the scheme or how much will be needed in the future until we see the review. This is not an issue that will disappear overnight. It is a long-term issue that will not just be about this year, but about next year and the year after. The issues need to be reviewed and we need to find out exactly what happened and what the financial and other needs are for the future.

The Minister has admitted that €100 million was spent on areas other than the subhead for which it was intended, but it was spent in nursing homes. Other subheads could have paid for those therapies and medications. This is the subject of the review, which will try to establish where the money was spent and how we will rectify the issue.

I accept the Minister is in a difficult position. If I understand correctly, the Minister is saying that the money was spent from the wrong subhead, but it was spent in areas where it was needed and now we have the problem of trying to identify the money elsewhere, but that it may well be needed in the area from which it will be taken. This is the bind we are in. Some of the Minister's earlier comments suggest he agrees with me that even initially the fair deal scheme was not ideal, based as it was on property prices and putting liens on people's houses. Does he agree that is what makes the terrible bind in which we find ourselves? This is all happening against the background of the IMF-EU deal and the austerity programme.

I know it is not entirely up to the Minister, but should we not say that if we seek other funding, it cannot come from robbing other vital health services? It must come from elsewhere and that requires a Government willing to impose taxes on the wealthy and get money from those who can afford it in order to fund the vital health services without which ordinary people will suffer and face a continuing crisis in the health service.

We all accept that this issue concerns a vulnerable group of people and we want the best possible solution. We need to find out where the money went. The review of the fair deal scheme was promised under the programme for Government and even if this problem had not arisen, the scheme would have been reviewed. The issue is accountability. If the subhead provides the money is to be spent on "X", it cannot be spent on "Y". The lack of accountability and transparency is evident and that is what the review will clarify.

With all respect to the Minister and Minister of State, the responses they have given create a deeper crisis of confidence in the fair deal scheme for the future, because of the lack of certainty. The questions posed and responses received are hugely problematic for many people. How quickly after the receipt of the review report on Friday will the Minister be in a position to make a clear statement of intent on the future of the fair deal scheme? How quickly will he be in a position to say that we are back to processing to approval stage and that beds will be reopened and access will be provided for people who need long-term nursing home care? Will the Minister respond as quickly as possible after Friday?

It is not possible to answer the Deputy's question as none of us has a crystal ball. We will have clarity after Friday and we intend to deal with the issues early next week. We do not know what is in the review and, therefore, cannot say that we will process and approve provision next week. Above all, we reassure people in receipt of care under the fair deal scheme that there is no threat to their service. When talking about this vulnerable group of people, we must be clear, precise and honest.

Mental Health Services

Dara Calleary


45 Deputy Dara Calleary asked the Minister for Health and Children if he will provide an update on the implementation of the mental health strategy. [13422/11]

A Vision for Change contains 200 recommendations to be implemented over a seven to ten-year timeframe. Progress to date includes: the closure of a number of the old psychiatric institutions with ongoing work on the closure of the remaining institutions; a 17% decline in the number of patients resident in psychiatric facilities since 2006; fewer admissions and involuntary admissions; a year-on-year reduction since 2001 in the number of patients readmitted to hospital pointing to an improvement in community-based services; significant improvements in child and adolescent services with more multidisciplinary teams in place throughout the country and an increase in the number of inpatient beds; significant engagement with service users; and improvements in the forensic service.

An independent monitoring group was established to monitor and assess progress on the implementation of the recommendations set out in the report. I look forward to the group's annual report for 2010 which I expect to receive within the next few weeks. This will give an independent update on the current status of implementation and will give us the opportunity to take stock of where we are and identify areas in need of further improvement.

The reform of our mental health services is a priority for the Government. I assure the Deputy that I am fully committed to improving our mental health services, and to driving the implementation of A Vision for Change and the transition from an institutional to a community-based model of care. I am working with officials in my Department as well as the HSE with a view to delivering progress on the reform process in this area as early as possible.

Has the Minister of State established how many adult and children mental health teams the HSE has established? Obviously it is an issue on which we would like to get some clarity. An implementation group for A Vision for Change was established to ensure there was ongoing monitoring of the implementation of the 200 recommendations. In addition the Office for Disability and Mental Health was established in 2008. Does the Minister of State intend to allow that office to continue so as to ensure a strong emphasis on mental health and disability?

There are approximately 61 multidisciplinary teams which will include child and adolescent services. I am not certain that they are fully functioning. That is something we will need to investigate. While many are fully staffed, not all of them are. We are most concerned about children. Two new purpose-built 20-bed child and adolescent units at Bessborough in Cork and Merlin Park in Galway have been completed. I have visited both of these exceptional facilities. Acute admissions at St. Brendan's in Grangegorman have now ceased. Enabling works are under way on the development of a 54-bed replacement long-stay facility as part of the Grangegorman redevelopment project. We are making progress. Progress in some areas is easier than in others. The community-based services are important, as are multidisciplinary teams, and the child and adolescent service. There are other areas where there is major resistance to closing old institutions. I do not believe there is one person in this establishment who feels that those institutions should continue as they are.

I welcome the Minister of State's commitment to continue to close the old psychiatric hospitals and to provide community-based facilities. Given the statement of the Minister for Health and Children, Deputy Reilly, that he does not agree with the number of primary care teams the HSE claimed it had established, would it not be appropriate to look at whether these adult and child community mental health teams are operational, as they cross over with the primary care teams?

The commitment to mental health in the programme for Government is very clear. When an institution is being closed it is closed on an incremental basis. Only in the event of all the community services being in place will that institution close entirely. It is appropriate that people in certain areas — we all know where they are — have that assurance. That will be the practice under this Government. All community services will be in place before institutions are closed.

Written Answers follow Adjournment Debate.