Barry Cowen
Ceist:8Deputy Barry Cowen asked the Minister for Health the average waiting time for medical cards in January 2012; the average waiting time in January 2011; and if he will make a statement on the matter. [16467/12]
Other Questions
Medical Cards
Bernard J. Durkan
Ceist:11Deputy Bernard J. Durkan asked the Minister for Health when it is likely that provisions can be put in place to address the difficulty and hardship being caused by delays in the issue of medical cards; if any evaluation has been carried out as to the main factors causing such delays; the number of applications in the system currently pending and in respect of which repeated submissions of information have been made by the applicant which in turn has resulted in further requests for more information; if as a matter of urgency he will put in place a reliable and universal system for the determination of eligibility and a reduction in the administrative procedures now causing serious delays; and if he will make a statement on the matter. [16249/12]
I propose to take Questions Nos. 8 and 11 together. A number of difficulties arose with the processing of medical cards in the final quarter of last year. These difficulties gave rise to a very large backlog and long delays for both new applicants and medical card renewals. A separate significant backlog also arose in respect of medical card appeals.
Reviews of the problems have identified a number of factors as to how these problems arose, including the decision by the HSE to fully centralise the processing of medical cards before the centralised service was fully resourced, a significant backlog that already existed prior to centralisation, poor communication with medical card applicants and the public, limited support from local health offices and poor communication between local offices and the centralised service and poor administrative and customer service practices and procedures in the handling, filing and processing of medical card documentation.
These issues are a matter of serious concern to me and I have had a number of meetings with the HSE over the past number of months to raise my concerns. The HSE has introduced a number of changes in recent months to the administration of the medical card application system.
These include increased staffing levels in the centralised processing service and in respect of medical card appeals, improvements to how medical card renewals are assessed and the frequency with which they are assessed, increased flexibility for GPs to add certain categories of patients to their GMS lists, and the fast-tracking of backlogged cases and cases where documentation has been misfiled. A number of additional changes will be implemented by the HSE in the coming months. I am particularly keen to see changes to how medical card renewals in respect of people with permanent disability are assessed. I am in discussions with the HSE on this and other matters and expect changes to be implemented soon.
While a number of customer service and communication issues remain to be addressed, the HSE has nevertheless been making good progress in eliminating the backlog and preventing further backlogs occurring. The HSE has reported to me that 96% of completed applications received in late February and early March have been processed within 15 days, compared to a turnaround target of 90% in its service plan for this year. The HSE has also reported to me that the backlog in processing applications from last year has been reduced by 77% since January. As of yesterday evening, the backlog in respect of medical card applications and renewals had been further reduced to 10,770, down from 58,000 in January, and in the vast majority of these cases, additional information is awaited from the applicant. The backlog in respect of medical card appeals has been reduced to 569, or less than half of what it was in January. The HSE is on course to clear both backlogs by the end of the month.
Average waiting times are not collated because the performance metric used by the HSE is the 15-day turnaround time for complete applications. I have reported the latest information for that measure. For January 2012, more than 47,000 new and renewal applications were received. As of 21 March, 3,700 applications were incomplete and the HSE is assisting people with their applications. Some 42,600 applications have been completed, and 1,000 other applications are in the process of being completed by the PCRS.
Additional information not given on the floor of the House.
Figures for January 2011 are not available to PCRS as the centralisation programme was only completed on 1 July 2011. Prior to that date local health offices were responsible for processing medical card applications. Finally, a review of medical card processing has been undertaken by PricewaterhouseCoopers on behalf of the HSE and contains a number of recommendations that the HSE is considering.
Can the Minister of State assure the House that some of the delays were not intentional in terms of trying to address budgetary problems in place in the HSE? Many people are of the belief that medical card renewals were being delayed for a long time to ensure they could come in within budget. When we consider how fast they have been able to address the backlog in January and February of this year it would lead one to believe there was a deliberate winding down of assessment, processing and renewal of medical cards. We have had several cases where people waiting for a renewal of their medical card had to fund their own medical needs in the intervening period. Will those people be fully recompensed for the cost incurred while they were waiting for the renewal in 2011?
In terms of communications, every Deputy in the House has been raising this issue for a long time and I acknowledge the efforts being made by the Department and the HSE but when Deputies raise these issues on a continual basis the HSE should respond with haste in trying to address them because there are still terrible cases across the country, not just those I have raised.
With regard to the 15 day turnaround for completed forms, the main problem is that it takes too long for the applicants to be informed that their application is not complete. That area must be addressed. The form should be assessed and the applicant informed quickly of the required information needed to make the application form complete.
I assure the Deputy that under no circumstances was any direction given or intentional decision taken to slow down the issuing of medical cards. I want to rule that out because allegations were made at the end of last year that somehow this was an intentional policy to reduce the number of medical cards. I refute that.
In terms of what I stated in my reply, it would seem at this point that there is an acceptance that the HSE bit off more than it could chew in the overnight centralisation of medical cards in the middle of last year without the system being geared up to cope with that. That all came to a head at the end of last year and resulted in a situation which I have said on a number of occasions in this House was unacceptable as a public service. People were treated very badly during that period when this backlog had built up and the level of service being provided to people was unacceptable. A great deal of effort has been made in recent months to get on top of this problem and I am hopeful that all the backlogs will be cleared by the end of April and that this situation will not recur. I take the opportunity to state there was no intentional decision taken in this regard and the situation is being addressed rapidly.
I welcome the indication that there is improved processing in terms of the Finglas operation. I welcome once again, as was advised to us on our recent visit to Finglas when we met Mr. Patrick Burke and his staff, that the powers have now been given to general practitioners to extend medical cards beyond the expiry date where, for whatever reason, the person concerned was unable to respond to the review process because of a medical condition or social circumstances and where there was a clear error that the doctor can confirm. Are there any statistics on the take-up of that? I know that correspondence only issued a few days before our recent visit to Finglas at the end of last month but is there any indication even at this point in time of the take-up by general practitioners of this option? Has the Minister any feedback from the profession?
May I use the opportunity to ask if serious consideration is being given to extend that power to general practitioners in the cases of people who are terminally ill and those suffering from lifelong, non-recoverable illnesses because this continual review process is very frustrating when somebody is sadly trapped in a situation that will not change for whatever life expectancy they may have. It can be very upsetting, and we have all had experiences of that. It would be a huge advance if that, too, could be granted to general practitioners and the need for a review every so often for people in end of life situations and those suffering from lifelong illnesses.
The agreement recently reached with GPs in terms of the processing of medical cards is a very welcome one and it enables a number of actions to be done. The first is to extend a person's eligibility in the case of vulnerable patients where they may not be in a position to do that themselves. The second is in regard to patients who are deceased. Their names are being removed from the panel from the date of date. The names of newborn babies are being added now by GPs from the date of birth. That is real progress. It is a new functionality for GPs and is very much to be welcomed.
Regarding terminally ill patients, there is a new arrangement that has been clarified. In the case of a person with a terminal illness, where that terminal illness is validated by a GP or a consultant, there is a nominated person in the local health office who has a direct line to the primary care reimbursement service, PCRS, and where that person is contacted an emergency medical card can be provided within a 24 hour period. I am in the process of producing an information sheet to go out to Members of this House to inform them of that new arrangement and I am waiting for confirmation that all of the staff concerned are aware of these arrangements but I can confirm that all GPs and all social workers are aware of that new arrangement. I hope that will work smoothly from now on.
Regarding incomplete forms, most of the current backlog relates to incomplete forms and to get those on the move staff in the PCRS are contacting people directly by telephone to fill in those blanks and get their hands on the missing documents required to process that. I am very hopeful that all of the backlog will be cleared by the end of April.
Hospitals Building Programme
Bernard J. Durkan
Ceist:9Deputy Bernard J. Durkan asked the Minister for Health if the expert group currently examining the issue of the location of the proposed new children’s hospital will be asked to make a single recommendation for a particular site or if a recommendation for two or more sites is likely to emerge thus leaving the final decision to him; if he intends to carry out a thorough examination of the costs to date associated with the issue including site, consultancy or architectural costs; the extent to which the costs to date have arisen from payments to particular agencies or consultants associated in any way with the examination of the project; if influence can be brought to bear on the recipients of fees to date to carry out any further work required on a pro bono basis; and if he will make a statement on the matter. [16250/12]
Dara Calleary
Ceist:23Deputy Dara Calleary asked the Minister for Health when the first meeting of the Dolphin Group will be held; and if he will make a statement on the matter. [16462/12]
I propose to take Questions Nos. 9 and 23 together.
I am committed to ensuring the delivery of a world class hospital for the children of Ireland providing the highest quality treatment they deserve, in other words, the best treatment in the best environment. This project is one of the main priorities for the Government and is a commitment under the programme for Government.
The decision to refuse planning for the new children's hospital was disappointing. Immediately following the decision, however, I announced my intention to establish a review group to consider the decision of An Bord Pleanála to refuse planning permission for the national paediatric hospital. The Government has agreed the terms of reference for the review group. The terms of reference are as follows:
To inform itself about the planning considerations and processes affecting this project.
To consider the different options which now exist for progressing the construction of a national children's hospital having regard to –
· Government policy on the delivery of health services, including accessibility and paediatric services in particular and best clinical practice considerations,
· the cost and value for money considerations of the different options,
· the likely timelines associated with the different options,
· the implementation risks associated with the different options.
To advise me, in the light of these considerations, on the appropriate next steps to take with a view to ensuring that a national paediatric hospital can be constructed with minimal delay.
To report to the Minister within 56 days of the first meeting of the group.
The aim of the review is to consider all the possible options for the earliest possible delivery of a new children's hospital. The review group will present its findings on each of the possible options for my consideration. The group will not be undertaking a site selection process as such.
I have appointed Dr. Frank Dolphin to chair the review group. There is a wealth of expertise on the group. The membership is composed of senior planners, an architect, the CEO of a major UK paediatric hospital and senior clinicians in the field of paediatrics. Dr. Dolphin is currently in contact with the other group members and expects to hold the first meeting of the group within days. I will await the completion of the work of the review group and do not wish to make any further comment on the matter at this time.
We welcome the fact the Minister appointed the Dolphin group which is to report 56 days after its first meeting. I do not know what its findings will be but it has been asked to look at the Mater site, a greenfield site, a brownfield site, co-location and whether a stand-alone national paediatric hospital can be established.
These are quite broad terms of reference, which are welcome in the sense that at least everything is on the table again.
There is no doubt the report of the Dolphin group and its recommendations will delay the building of a national children's hospital because wherever it will be located, a process will be required. Obviously we would like it to go ahead as quickly as possible. In the meantime our children's hospitals, including the one in Crumlin, suffer greatly from a lack of capital investment. I do not expect any Minister to fund huge capital investment programmes without knowing where the national children's hospital will be located, but in the meantime the existing children's hospitals are at crisis point. What will happen these facilities in the coming years while we wait for the national children's hospital? This is a key issue for the delivery of paediatric services and health care in the short to medium term because there will be a delay regardless of what decision or recommendations are made by the Dolphin group.
I welcome the Deputy's assertion that we are all on the one side, as we all want to see the hospital progress as quickly as possible. Nonetheless, the refusal on the Mater site requires time for reflection. The two months to be taken to report, including the month that has passed, will stand to serve the children of the State for 100 to 200 years and must be viewed in this timescale. I doubt there is any one more in a hurry than me to have the hospital built.
The last thing I want to see is scarce capital reserves and resources ploughed into temporary accommodation that will prove to be no longer necessary in a few years. I want this expedited. I have made it very clear that all options are on the table and that the advice the Government and I want is on the pros and cons of each option and for us to make a decision quickly to get on with this and provide what is a right for our children. We have some of the best nursing, medical and paramedical practitioners and we need to provide them with the best setting to provide treatment.
Will the Minister comment on recent remarks by the chairman of NAMA, Mr. Frank Daly, that NAMA is actively considering a number of potential sites for the proposed children's hospital? How will this fit in with the work of the expert group? Will NAMA come before the group with a recommended site or sites or will these be considered only after the current site is rejected, if it is? Is the Minister aware of any potential sites in NAMA, for example, the Elm Park site by St. Vincent's hospital?
I am aware of all of the issues raised by the Deputy. It is the role of the group not necessarily to interview NAMA on all of its sites, but to give an indication of the pros and cons on a new site, a brownfield site or a greenfield site. It is not my intention that it will inspect every site because if it did so months would turn into years very quickly. I am aware of the sites to which the Deputy referred and there are quite a number of them. NAMA has written to me and has identified 11 sites, some of which might have use for hospitals of a different nature and provide opportunities on another occasion. I am not here to prejudge what the review group will tell me; I await its advices and I will act accordingly.
I am also very concerned about the situation regarding our existing paediatric hospital sites in Crumlin, Temple Street and Tallaght. I am particularly concerned about the hospitals in Crumlin and Temple Street because front line service providers have spoken out and made the case very strongly that one cannot suspend the resourcing of these services while the construction of the new hospital gets under way, and we are not even at that starting point yet.
Reflecting on the earlier comments, I appeal to the Minister not to use the intention of moving to a new paediatric national hospital as a reason not to continue to properly resource the existing paediatric sites, because there is ample evidence of intolerable situations where children are left waiting in totally inappropriate circumstances in accident and emergency departments trying to access beds in a number of these sites. I appeal to the Minister to say something positive on this matter.
The Minister indicated the Dolphin group would not have the responsibility for site selection but would report to the Minister on the various proposals presented heretofore. Do these include the very recently circulated proposal from the Coombe hospital? As far as I am aware, it was presented in the past week. Will the Dolphin group have an opportunity to appraise all cases known during the course of its period of deliberation? Will it offer an opinion on all of these and others which may yet present before it concludes its business? How soon after it reports does the Minister intend, and with whom, to make the decision?
The previous expert group that examined the Mater site indicated it was the most suitable site for co-location between an adult teaching hospital and a paediatric hospital. Is this principle still firmly the internationally recognised best practice? I know clinicians, planners and broad spectrum of expertise is involved in examining the matter. I presume the idea of co-locating an adult teaching hospital with a paediatric hospital is weighted or encouraged as the most suitable in terms of best care and health service delivery for children and mothers given the complications that can arise.
The issue of co-location with an adult hospital is a major requirement. The expert group comprising four chief executive officers of some of the biggest paediatric hospitals in the world, three of whom were clinicians themselves, were unanimous on the fact that it needed to be co-located with an adult hospital. The basis for this is our childhood population would not be able to sustain an expert in rare disorders as his or her skills would diminish due to the infrequency with which he or she would treat patients. Therefore, the group felt treating adults and children is the route forward for a country of our size. The CEO of Great Ormond Street Hospital for Children was involved. This is a stand-alone hospital but even she acknowledged co-location is the best way to go.
Great people work in our paediatric services but there are limitations on the buildings in which they work. Our Lady's Children's Hospital in Crumlin has been very successful in fundraising and treats 80% of our tertiary cases, with Temple Street hospital treating 20%. I have visited Temple Street hospital, which is staffed by wonderful people but they point out it is made up of Victorian buildings joined with little attics and steps. It is utterly inappropriate. We need a modern facility to provide the best care for our children. We will expedite this.
The Dolphin group will report later this month, 56 days after its first meeting, and only a few days remain this month. It will be made aware of all of the options available. Rather than giving us the choice of a single place, I have asked it to point out the pros and cons of each option so the Government can make a decision in the interests of the people.
Health Service Staff
Catherine Murphy
Ceist:10Deputy Catherine Murphy asked the Minister for Health if, following the retirement of large numbers of staff from the health service in recent weeks, he has identified the services which have been particularly affected by staffing resource reductions; if he will outline these shortfalls in detail by type of service and geographical area affected; if he will outline proposed redeployments intended to alleviate gaps in service provision; and if he will make a statement on the matter. [16442/12]
The main service areas that have been identified as critical in the context of the grace period retirements include maternity hospitals and critical and intensive care, as well as community nursing services.
It is, therefore, necessary to be as innovative and flexible as possible in order to mitigate the impact on services of reduced budgets and staffing. The mitigation measures which are in place include changes in work practices, staff redeployment, rostering and skill-mix changes, revised business processes, integration of services and streamlining of management structures. I acknowledge the great work and commitment of staff in ensuring a safe service has been maintained and in maintaining the number of people on trolleys throughout March at 17% despite the challenges they faced.
Some limited recruitment of new staff is also taking place to ensure that key specialist services are maintained. However, the priority is to reform how health services are delivered to ensure a more productive and cost effective health system. The need for dynamic and proactive management of the reduced budgets and staff will continue throughout the year. Last week, I announced a new initiative around training of clinical leaders, managers, nursing staff and GPs in management, which will ensure they are given the skill set and tools to do the job we require of them. Many excellent people who previously worked in administration or as clinicians are currently in managerial positions in respect of which they have received no specific training. While they are willing and able to do the job we need to ensure they have the required tools to do it.
The HSE National Service Plan 2012 acknowledges that there will be inevitable and unavoidable reductions in services this year owing to the scale of the financial and staffing challenge facing the health service. I am satisfied that suitable arrangements are in place at national, regional and service specific levels to proactively manage the impact on front line services. Since the end of the grace period there has been daily communication between the national director of integrated services and regional management teams to ensure that any issues or risks identified are addressed. No new issues have arisen and all essential services are being maintained.
I have been contacted by constituents who are concerned about the delivery of services in my area. One particular area of concern is that of disability services in terms of specialty, in respect of which there has always been a lopsided distribution of specialist staff, based either on discipline or geography. Getting information regarding disability services for young children even by way of a telephone call is seriously problematic in my area, never mind delivery of services. I would welcome a national audit of disability services delivery. It is not justifiable that one particular county can have a service while another does not.
My second question relates to maternity care, in respect of which the master of the Rotunda expressed concern prior to the deadline of 29 February. Is the Minister satisfied that maternity care can be safely delivered in this country with the current number of staff?
I visited the National Maternity Hospital and met with the new master, who is the first female master in the history of this State. Staff at the hospital are dynamic and the recently opened new theatre will provide greater access for the patients they serve. There is no question but that from a capital perspective we could do with new maternity hospitals. While in the past I have been told that our hospitals should not perhaps deliver more than 10,000 to 12,000 babies I have since been told during discussions with clinical leads in this area that there is no reason we could not have two, or even one, maternity hospital in Dublin. I am not suggesting that will be the outcome but it is an issue we need to look at. I would like to see facilities greatly improved.
The Deputy asked if we have sufficient staff to maintain a safe service. The answer to that question is "Yes, we do." Every endeavour has been made and arrangements have been put in place to ensure delivery of a safe service. The last thing we want to do is create further anxiety for those looking forward to the birth of their child. It is a nervous enough time for people. I am happy, having met with the clinical lead for obstetrics and gynaecology, and having visited several of the hospitals, that a safe service is being delivered.
On the disability issue, every effort was made to ensure protection of disability services, in respect of which the budget cut was a maximum of 3.5% while the cut elsewhere in the health services ranged from 5% to 7.5%. I have discussed this matter with my colleague, the Minister of State, Deputy Lynch. There is a recognition that there are huge resources within the NGOs in terms of ancillary care, including psychologists and so on, which could be freed up to allow the provision of greater care within the system.
We are looking at all areas in an effort to reform how services are delivered and people work, thus allowing for more service to be delivered to the patient.
Before we move on, I understand the Tánaiste would like to make an announcement.