Priority Questions

Nursing Homes Support Scheme

Billy Kelleher


38 Deputy Billy Kelleher asked the Minister for Health and Children if he will provide further clarity regarding funding for the nursing home support scheme; the reasons behind the review of the scheme; when he was informed that funding had run out for the scheme; when he called for the review to take place; the reason the public was not informed of this review sooner; when he expects the review to be completed; the number of persons waiting for funding to be approved; and if he will explain the effect that this will have on these persons and on hospital waiting lists. [13617/11]

Caoimhghín Ó Caoláin


39 Deputy Caoimhghín Ó Caoláin asked the Minister for Health and Children the action he will take to ensure the immediate resumption of approval of applications under the fair deal scheme; and if he will make a statement on the matter. [13516/11]

I propose to take Questions Nos. 38 and 39 together.

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. These other services, which include therapies and medication, 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 was 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 funding is under way, conducted jointly by the Department of Health and Children and the HSE. This examination is to be completed by Friday, 3 June 2011.

The Minister 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.

I thank the Minister of State for the reply but it leaves me more confused than I was before. I do not mean that disrespectfully. Last week inThe Irish Times, the Minister for Health and Children said “I believe it is only proper that money be brought back from the ancillary services and put back in to the Fair Deal scheme which will allow for the continued processing and approval of people”. When this issue was raised in the Dáil several days ago, the Taoiseach said quite clearly that there would be processing and approval of applications. At the same time we find there is no approval. Does the Minister of State agree that this was badly handled in the context of notification to the public? It happened in a drip-drip manner and there was concern, fear and anxiety generated among people dependent on nursing home care or who had applied for nursing home care. We had fanfare at the announcement of the sacking of the board of the HSE, where cameras and media were tripping over each other. This took place in a drip-drip feed to the public and there was no clarity brought to the issue. There is still no clarity because one Minister is saying approvals are being allowed and today’s statement says we must wait until 3 June for a review to be completed.

Everyone is very concerned about this but the days of spinning a message are long gone. We must be honest and open with people and there is a substantial shortfall in the necessary funding to provide long-term care for elderly and not-so-elderly people. There is no disagreement between myself and the Minister and we are looking at how to best provide for the long-term care of the people for whom we are responsible into the future.

Applications are being accepted and processed. When funding becomes available, approvals will be forthcoming; as of now there is a shortfall in the budget. Items were paid for out of the subhead which should not have been paid for in that way. We are not saying anybody made off with the money, as it was spent in nursing homes on people who needed the services. They should have been paid for out of a different subhead. That position is clear to most people and we must be clear with people from here on. There must be honesty and openness rather than a notion that there can be a spin on bad news.

This is the first time we have had the opportunity to put questions directly to the Minister since news of this issue broke on 18 May and yet it appears, very strangely, that we will not hear answers from him. I have the height of respect for the junior Minister in the Department answering, as she has, although the answers are most disturbing. It would be doubly disturbing for the Minister to sit silent through all of this.

Does the Minister or Minister of State acknowledge that over the period since 18 May — the issue dates from 16 May — many older people and their families have been and still are very concerned about the future of the fair deal scheme? We cannot lay enough emphasis on that. I presume we are all cognisant of all that was exposed in the "Prime Time Investigates" programme last evening, which is a backdrop to this afternoon's exchange. How many older people in acute hospital beds are currently awaiting approval? That number was speculated yesterday to be 477; that is almost 500 older people in hospitals awaiting approval and access to nursing home beds across this State. They are currently and inappropriately in acute hospital beds in hospital sites the length and breadth of the State. How many others are at home under the loving care of families and home care packages? What is the total number of people awaiting approval? When will approvals recommence?

I agree with the Deputy as people are very concerned. It should be made crystal clear that those people in receipt of long-term care face no threat to the service. That is not what we are talking about. I cannot tell the Deputy how many people are at home who may have aspirations involving long-term care or how many people are in beds in hospitals with aspirations of long-term care. I can only deal with the facts as presented.

As of end of March 2011, the level of applications processed is at 78%. The figure sought by the Deputy of figures in process is 4,604. The number of people in receipt of long-term care is approximately 22,000. We are not talking about small numbers or in a vacuum as we have facts. We know that of the 22,000 in receipt of long-term care, there is absolutely no threat to the service. When we get the money to grant approval to those who deserve it, we will issue grants of approval.

In the programme for Government it is stated quite clearly that there will be an increase in funding every year in the provision of nursing home care. We now find money is being taken from ancillary services to fund the fair deal nursing home scheme. Does the Minister of State agree that at this stage it is clear there are insufficient funds for the continuation of new approvals? Is it now time to admit that the programme for Government is dysfunctional and what is required is a Supplementary Estimate?

This is about choices. A couple of weeks ago the Government potentially raised €2 billion with a pension levy but none of that money went to the health system. It is about choice.

It is about choices made by Fianna Fáil.

People have suggested this could go away but it will not; we must confront the problem. Nobody is talking about spinning the matter. We are talking about clarity and truthfulness as there are not sufficient funds for the programme. Funds must be found.

I am not privy to how the figure was compiled but I assume some assistance was given through the HSE but I again point out that almost 500 older people are in acute hospital beds awaiting approval for access to nursing home beds at this time. In other words, there is a serious hold-up in the freeing up of very important acute hospital beds because of this debacle. What steps are being taken by the Department in order to ensure that those people gain access to nursing home beds under the fair deal scheme and that those beds are freed up to cater to the many others who need them?

Will the Minister of State clarify the figure of 4,604 referred to as in processing? Was that of 31 March? Will the Minister of State clarify the detail of the response and would the Minister of State agree that the figure is staggering? If the €100 million is to be redeployed from another source, it will not be adequate to cater for the remainder of 2011. What further funding is being sought now for the fair deal scheme?

There is a clear shortfall in the funding. Maybe the 500 people in acute beds make up part of the 4,604 but that is not clear. All we know is that a certain number are waiting for final approval. Some will not gain final approval because of other circumstances such as not being in need of long-term care and various other issues.

We do not have the money to provide final approval for the applications; it is as simple as that. There is turnover in long-term care and that will always be an issue. People will come out of the system, which is an issue that can be considered. The final examination of where the money went and how we will manage this scheme for the rest of the year will come to us on 3 June.

The figures I provided were for the end of March. We can stand here all day playing games but the issue is way too serious for that. People are very worried about the long-term care of elderly parents, spouses or siblings and the problem is too serious for political games. We are working very hard to ensure the matter is resolved.

We need leadership.

This is clearly a legacy issue.

Accident and Emergency Services

Mick Wallace


40 Deputy Mick Wallace asked the Minister for Health and Children if maintaining the 24 hour accident and emergency service at Wexford General Hospital remains in the long-term plans of the health service; and if he will make a statement on the matter. [13514/11]

The Government's priority in regard to acute hospital services is to ensure a safe and high quality of care for patients which is provided at the most appropriate location. I am committed to ensuring that all care is provided at the lowest level of complexity, is safe, timely and efficient and is available as close to home as possible, consistent with safe practice.

Wexford General Hospital has an important and permanent role to play in the south-east region. It will continue to operate as a vibrant, fully functioning acute hospital. Acute medicine will continue at the hospital with an emphasis on increasing day surgery in line with international trends. The hospital will continue to operate a 24-hour emergency department but, in common with all other hospitals, the scope and composition of the department will be developed having regard to advice of the national clinical programmes, the service standards required by HIQA and the related requirements of acute hospital licensing, legislation for which is in preparation.

As for all acute services, we should look at the future of Wexford General Hospital in the wider context of hospital networks functioning as part of a co-ordinated system. One of the prerequisites for the introduction of universal health insurance is strong and efficient hospital networks which provide the appropriate treatment at the appropriate level of complexity to the patients in their area. These networks will provide the basis from which the independent hospital trusts can be established.

I also believe there must be strong clinical leadership at the head of the development of hospital networks. The clinical programmes developed by the HSE to improve and standardise patient care throughout the system are being led by clinical directors. They will support and direct the development of hospital networks and the safe and effective provision of services. We can ensure a well functioning acute hospital service in the south-east region by using the Government's approach to networks and clinical programmes and the future of Wexford General Hospital is assured within this system.

I am glad to hear that the Minister intends to maintain a 24-hour accident and emergency service, as well as maintain the general upkeep of the hospital. He stated before the election that we cannot afford to downgrade Wexford General Hospital because we do not have capacity elsewhere to take up the load.

He will be aware that the psychiatric hospital in Enniscorthy, St. Senan's, has been closed. Some 25% of the people in the north of County Wexford are using the unit in Newcastle, which I believe is very good, but the remaining 75% have been diverted to Waterford.

A question, please.

The 2010 report of the Inspector of Mental Health Services was critical of the facilities in Waterford but nothing substantial has been done to improve the facility since the report was published. Adding to the existing problems in Waterford, patients from Wexford now use the same facility. The acute mental health service in Waterford Regional Hospital is located in a basement overlooked by a car park and there are no occupational or recreational facilities for patients. In recent weeks, 16 of its 40 beds have been occupied by Wexford patients. Will an acute mental health admission service be established in Wexford General Hospital given that Waterford is clearly not fit for purposes and that requiring patients from Wexford to use the same service is hardly a great idea? Wexford is crying out for an acute mental unit.

Wexford General Hospital is a separate issue to psychiatric services, which are being re-organised in the south east and Wexford in particular. As I noted in my original reply, it is important to site services as close to patients as possible and to this end the development of a community psychiatric service is well advanced. A crisis house will be open 24 hours per day, seven days per week and a psychiatric service will be made available in the community with the back-up of consultant psychiatrists. The local psychiatric teams have been engaged in the design and implementation of this service, which is only proper, and patients will receive a much better service than the one described by the Deputy. That is the way forward.

I defer to the Minister of State, Deputy Kathleen Lynch, who has responsibility for this area but both consumers and providers of the service have indicated their preference for proceeding in the direction of more services and treatments in the community and less stigmatisation.

Deputy Wallace may ask a brief supplementary question.

I agree that it will be great if services in the community are brought up to scratch but at present the people are going nuts in Wexford because they are demoralised about what is available in Waterford. Community facilities offer a way forward provided adequate facilities are put in place.

I share the Deputy's concern. The matter is being expedited and significant advances have been made to the point that services will be in place very shortly. This should be seen as progress rather than regress.

Health Service Executive Board

Billy Kelleher


41 Deputy Billy Kelleher asked the Minister for Health and Children if he will give details of the work of the interim board of the Health Service Executive; if he will give further details of his interactions with the interim board and any adjustments he has made in his Department on foot of the new approach to the board. [13618/11]

The new HSE board held its first meeting this morning. The new, largely executive, board will meet more frequently than its predecessor and I will be briefed about board business on a regular basis by the chairman, Dr. Frank Dolphin, the CEO, Mr. Cathal Magee, and the Secretary General of my Department, Mr. Michael Scanlan. The board will focus on operational excellence and its membership includes a strong element of service delivery. I have asked the board as one of its priority tasks to examine how it will streamline reporting relationships to ensure decisions are implemented quickly and better services can be delivered for patients as a result. Under the old system, decisions made within the HSE were reported up through the system and across to the relevant section of the Department and the Secretary General. That circuitous route has been removed and they all sit at the top table together so decisions can be made and implemented without the need for a tortuous chain of command.

I appointed the board following discussions with the chairman and CEO of the HSE and my Secretary General. I have also asked the CEO and the Secretary General to review the existing senior management roles and responsibilities in both organisations, address any duplication of functions and explore the scope for more conjoined working. This will free up expert individuals who are at present engaged in the duplication of work to undertake important tasks such as examining risk equalisation.

I want to develop strong and coherent governance arrangements for the entire health care system which will continue to operate after the abolition of the existing legal governance structure. This will facilitate the Government's plans to reform the system. In the short term, we plan to establish a special delivery unit to address waiting lists. Over the longer term, our goal is to eliminate the two-tier health service and move to a system of universal health insurance, whereby everyone in this country is treated on the basis of need rather than ability to pay.

Does the Minister agree there is a lack of corporate oversight and governance on the board of the HSE given that officials are now overseeing their own work at board level? That could be a cause of concern, particularly in the HSE.

In regard to proposals to subsume the agency back into the Department, will this result in a large reduction in the number of staff currently employed in the latter?

Now that the election is over, we can park what the Minister has previously said regarding the HSE but in more recent discussions on the numbers of people on hospital trolleys and the delivery of primary care units he clearly stated he did not believe the figures set out by the HSE and did not trust its counts of patients on trolleys or primary care units. They are issues about which many people have concerns.

The Deputy's first contention is that there will be no oversight. The Department has strong representation on the board, which ensures oversight. There are also external auditors, etc. There is not the major concern alluded to by the Deputy from the Government's point of view. It is an interim board, which will not be in place for a number of years but until the new system comes into place.

I said we wanted more integration between the HSE and the Department but I never said we would absorb the HSE into the Department. Ultimately, we are heading for universal health insurance with primary care and hospital care coming under a new body that will be responsible for cure while longer term care will be looked after by a health care agency.

With regard to my statements on the issue of the numbers of patients waiting on trolleys, I was happy to say following discussions with the HSE and the INMO that we would accept their figures but that they must be validated by a HSE official at the time the count takes place in the morning. The Deputy is right that primary care teams do not exist. I have had discussions with the HSE on this and I now have clarity on the issue. HSE officials allude to primary care teams which exist in name but which are not fully functioning. They are seeking to put together the criteria for what constitutes a functioning primary care team, which delivers something to patients, as opposed to a primary care team, under which GPs may have had discussions with other health personnel. I did not say that I did not trust the INMO, I said I did not accept or believe its numbers and I stand over that.

Was money misappropriated in the context of provision of the primary care units? The HSE said it had X number of units up and running. Were funds spent establishing units that do not exist?

I note the Deputy's fondness for the use of the word "misappropriation". Last week, he used it during the debate on the fair deal issue, which my colleague addressed. Nobody said moneys were misappropriated. I said clearly in that instance that money that should have been under different subheads were taken from subhead 12, which covers the fair deal scheme.

That is a misappropriation of funds.

No, "inappropriate" as opposed to "misappropriation". There is a big difference between both and there is a big difference in law if we were to debate this outside the House.

The Deputy asked about primary care centres and teams. I am not aware of any such issue but I will check it out and revert to him.

National Drugs Strategy

Maureen O'Sullivan


42 Deputy Maureen O’Sullivan asked the Minister for Health and Children his views on the fact that the drugs issue, affecting many individual and families in every town and village across the country, will get the necessary support and attention; his plans for greater collaboration and integration for addiction and mental health programmes; and his plans for the drugs advisory group and the oversight forum on drugs in implementing the national drugs strategy. [13616/11]

The Government decided to transfer the functions of the Department of Community, Equality and Gaeltacht Affairs relating to the NDS to the Department of Health and Children with effect from 1 May 2011. I have been asked by the Minister to take the lead role in this area.

The Government is committed to addressing problem drug use in a comprehensive way and this is made clear in the programme for Government. Our overall strategic objective is to tackle the harm caused to individuals and society by the misuse of drugs through a concerted focus on the five pillars of supply reduction, prevention, treatment, rehabilitation and research. The actions set out in the National Drugs Strategy 2009-2016 facilitate a planned and monitored approach to achieving the overall strategic aims.

The NDS is a cross cutting area of public policy and service delivery and it is based on a co-ordinated approach across many Departments and agencies in conjunction with the community and voluntary sectors. The institutional arrangements to support cross agency working, advise on operational and policy matters, assess progress across the strategy and address any operational difficulties include the drugs advisory group and the oversight forum on drugs. I intend that the work of these bodies will continue, as has been the case up to now. The national advisory committee on drugs also plays a key role and there are no plans to alter its functions.

In excess of €33 million has been allocated to the drugs initiative this year and the majority of expenditure is allocated to local and regional drugs task forces. They have allocated funding to projects and initiatives based on priorities identified in their respective areas. This allocation is only part of a much larger expenditure programme on drugs services by the other bodies involved in tackling drug misuse, not least of which is my Department.

I am familiar with the ongoing issues relating to the drugs problem in communities and the initiatives that have been taken to address them. The difficulties facing our society as a consequence of problem drug use are significant and addressing all the factors involved will not be an easy task but I am determined that progress will be made during the Government's term of office on this important issue.

My concern arises because it was felt that the drugs issue would not be taken as seriously as Cabinet level as previously and the issue will not be covered specifically by any Cabinet sub-committees. I acknowledge responsibility has transferred to the Department of Health and Children but drugs is very much a community-based problem for many people. We have good, effective community-based drug projects in Dublin Central in the north inner city, including SAOL, Soilse, Crinan, the Cavan Centre, Chrysalis and Oasis. Will the Minister of State ensure their funding will not be cut? They provide an outstanding service with a limited budget. Where stands the inclusion of the alcohol strategy in the NDS?

I agree with the Deputy that valuable work is being done by community-based drug projects and I am familiar with those in my constituency and other Dublin constituencies. There is no question of them discontinuing. Funding has been set aside for this year and that will continue to be available. The key work under the national drugs strategy is done by the local drugs task forces and it will continue apace. The oversight of that work will also continue.

With regard to implementation of the strategy, there is an oversight committee, which I will chair, and that will continue to meet on a quarterly basis and identify any logjams, difficulties or delays in implementing the strategy. We are, therefore, serious about ensuring it is implemented in full. In addition, the Minister will be responsible for this issue at Cabinet level and it will continue to have a voice at the Cabinet table. The Cabinet sub-committee on social exclusion will deal with this issue as well and many of the officials involved in the oversight will feed into the sub-committee. It will receive attention there and the sub-committee will meet later this week. I will attend that meeting and I will be a voice in respect of the NDS.

More deaths results from drugs and alcohol-related issues, including suicide, than from road traffic accidents. Significant resources are devoted to road safety and I do not begrudge that but we need the same emphasis on drug-related deaths. When something new emerges, for example, crystal meth, it should be tackled quickly. Is that being considered?

With regard to the Deputy's earlier question, the alcohol strategy will be included in the national drugs strategy. It was scheduled to happen this year. I have a particular interest in this area and I want to ensure it is addressed in the NDS. Alcohol abuse is a serious social problem and alcohol is also a gateway to the abuse of other substances. For that reason, it will be included in the NDS and I want early progress on that, particularly in respect of the enforcement of the law on underage drinking. I hope to report back on that over the coming months.

The purpose of the oversight committee is to address issues such as crystal meth and other developments relating to illegal drugs. All the relevant bodies are represented at a senior level and one of the committee's functions is to update all the members on current trends in respect of drug misuse. I give an assurance that all of the relevant agencies are represented at a senior level. I will convene the first meeting of the oversight committee in the coming weeks.