Vol. 803 No. 1
76. Deputy Billy Kelleher asked the Minister for Health the measures he will take to tackle the regional disparity in outpatient waiting times particularly in relation to those waiting more than four years; and if he will make a statement on the matter. [22954/13]
In 2012 the National Treatment Purchase Fund initiated a national project to compile, for the first time, an outpatient waiting list database based on patient-level information from individual hospitals. Collaborating with individual hospitals, the NTPF, together with the special delivery unit, SDU, in the HSE, has developed the outpatient waiting list minimum data set that allows for these data to be submitted to the NTPF from hospitals on a weekly basis. This builds on the work previously undertaken by the HSE outpatient data quality programme. Clear data on the outpatient waiting list are now being reported for the first time. It is rather astonishing that for the first time in the history of the State we have actually gone to the trouble of counting the number of people who have to wait on an outpatient list before they can see a consultant to get on a list for whatever treatment a consultant might consider appropriate. The waiting list for outpatients is updated monthly. The data show numbers waiting over the various timebands for a first appointment at a consultant-led clinic. In a further enhancement of the reporting, future updates will for the first time include numbers reported by specialty in addition to the breakdown by hospital. Currently, the focus is on ensuring that hospitals continue the validation of waiting lists. All hospitals have been engaged in this process, which is expected to be complete by the middle of this month.
Reform of the delivery of outpatient services is being addressed through the outpatient service performance improvement programme. This programme encompasses the HSE, the SDU, the NTPF and all hospitals providing outpatient services. It is a national programme which is being implemented between 2012 and 2015. The overall aim of the programme is to ensure timely and appropriate access to outpatient services so that the most appropriate member of the clinical team sees the right patient at the right time. Key elements of this large programme of reform will include: ongoing validation of waiting lists; systematic and standardised management of referrals from primary care; a reduction in unacceptably high non-attendance rates; appropriate discharging from outpatient services when clinically appropriate; and strict chronological management of the longest waiters.
Additional information not given on the floor of the House
For 2013, a maximum waiting time target of 12 months has been set for a first-time consultant-led outpatient appointment and this is reflected in the HSE service plan. The total number of people waiting on the outpatient waiting list as at 3 May 2013 was 376,751. This is a reduction of 7,881 in comparison with the NTPF-published figures to March 2013. The data also show that of the total number of people waiting, 199,513, or 52.6%, have been waiting less than six months and almost 278,666, or 74%, have been waiting less than 12 months.
The arrangement for supplementary questions and answers is one minute for each question and reply during the four minutes.
The figures are quite alarming. The Minister made great play of the fact that an outpatient waiting list is now being compiled for the first time in the history of the State. However, some 384,000 people are waiting for a first-time appointment as an outpatient at a consultants' clinic. Approximately 100,000 have been on the waiting list for more than a year, with 23,000 waiting for between two and three years. Another 7,750 have been waiting for between three and four years, with almost 7,700 waiting for four years or more.
The most alarming issue is the regional disparity among those waiting to see a consultant for an outpatient appointment. For example, in the mid-west large numbers of people have been waiting for a protracted period for their first outpatient appointments. What is the reason for the regional disparity? Clearly, at this stage, this must have come to light.
In many respects the question is disingenuous, given that Fianna Fáil was in power for so long and failed to do anything about it. At least the Government has tried to identify the problem and throw it open to the broad light of day so it can be dealt with in a fair and equitable fashion, in the same way as we dealt with the emergency department trolley waits and, more particularly, in the same way as we dealt with inpatient waiting times where the longest waiters are dealt with first after urgent cases and cancer cases have been dealt with. The real scandal is that more than 16,000 people have been waiting for longer than four years. Four years is twice the length of time the Government has been in power. I will keep my response short, as the Cathaoirleach wishes, but it is important to point out this problem was stewing away in the background being ignored by a Government which held the reins for 14 years. We are not ignoring it; we are dealing with it.
The Minister spoke about the question being disingenuous but the reply is even more disingenuous. He campaigned on promises but is governing on broken promises. There is regional disparity, and the fact these data have been compiled shows large groups of people in the mid-west have been waiting four years or more for their first outpatient appointments. The key question I am asking is what measures the Minister will take to tackle regional disparity in outpatient waiting times, particularly with regard to those waiting for more than four years. It is a very clear and concise question. I want to know whether the Minister has identified the reasons for regional disparity and if so whether he will do anything about it.
I will do something about it and as we speak Mr. Ian Carter, the new chief of the hospital directorate, and Ms Liz Nixon, head of the special delivery unit, are in Limerick examining the situation as it relates to inpatient and outpatient treatment times, the trolley situation and the capacity issue which has arisen. What we have done on the inpatient side is very clear, with 95% of people who had been waiting longer than nine months now being treated within this timeframe, and we are heading towards eight months this year. In the short period of time we have had the honour and privilege of being in government we have done more than was done for several years prior, despite the countless billions of euro poured in.
To put it in one sentence, it was simply a case that Fianna Fáil, and Deputy Micheál Martin in particular, were prepared to sweep the problem under the carpet and not expose it to the light of day or else throw money at it and keep their fingers crossed in the vain hope it would go away.
77. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if there is a revised timetable for delivery of the national children's hospital; the reason it has taken more than six months since the decision to locate at the St. James's Hospital site, Dublin, for the interim board to begin tendering for a design team; if he will intervene to expedite the process; if enhanced resources will be made available to the existing children's hospitals; and if he will make a statement on the matter. [22733/13]
The decision to locate the new children's hospital on the St. James's campus was announced on 6 November 2012. Co-location, and ultimately tri-location with a maternity hospital, on the St. James's campus will support the provision of excellence in clinical care that our children deserve. The new children’s hospital is a key commitment in the programme for Government and the largest project in the current capital plan.
The national paediatric hospital development board is the body charged with building the hospital. I intend to restructure the board so its sole focus is on the core function of planning, designing, building and equipping the new hospital, and that its membership includes the expertise needed to deal with a very large and complex capital project. Pending the necessary appointments to the board, senior officials from my Department and the HSE, appointed to the board in January 2013, have been working to progress the project at its new location. In this first phase of the project, the transitional board's focus is on reconciling the brief with the new site, site preparation, close-out of existing contracts and new procurement processes. A joint group involving the HSE and St. James's Hospital meets regularly to progress the enabling and decant work required. A shared services group is in place focusing on identifying the facilities which can be shared so as to optimise the build, and a review of urgent care centres configuration is under way and expected to be completed in the coming weeks. The contract notice for the procurement of a new design team is expected to be published in the coming weeks. The aim is to have the new design team in place within six months and to secure planning permission by December 2014.
Work on developing a detailed project timeline is continuing under the transitional board, recognising the urgency and priority attached to the project as well as its scale and complexity.
I am also establishing a children's hospital group, comprising the three existing children's hospitals. This is an important step in moving towards the transition of the three hospitals to a single entity. With regard to resources for the existing children's hospitals, the HSE National Service Plan 2013 sets out the quantum and type of health services to be provided in 2013 within the overall level of funding provided.
Additional information not given on the floor of the House
The three children's hospitals have stated their commitment to becoming a single service across three sites and are working closely together, with a single clinical director across the three sites, to ensure optimisation of resources and facilities.
This project is of huge importance for the provision of acute paediatric services for all children in Ireland and is a priority for me and for this Government. I am confident that the project governance and management arrangements which I have outlined will ensure the swiftest possible completion, with optimal design and value for money.
Can the Minister confirm, as reported last week, that the interim or transitional board, as the Minister refers to it, of the new national children's hospital will only begin tendering for a design team next month and that it will be summer 2014 before a planning application is submitted? As the Minister has indicated in his reply, the decision to locate the hospital at St. James's was made way back in early November, so this is a full six months later. Why has the tendering for a design team not begun before now, given the urgency of this major health infrastructure project? How does the Minister account for the delay? Given the disappointment that has been created by the decisions relevant to the initial Mater site identification, what will happen now concerning the project's ultimate delivery and completion? Are we really talking about 2018? Will the Minister intervene to help expedite this badly needed hospital facility?
As I have stated, there is a huge amount of work under way. A decanting process is to take place at St. James's Hospital and several buildings have to be depopulated. The services there have to be moved and those buildings have to be taken down. An extensive project is going on at St. James's under the control of the board which has appointed a project manager with a view to providing us with a brown site - a clear site - by 1 January 2015. There are timelines on which I will have further information in the next couple of weeks concerning each building and area that needs to be cleared, and what else has to be done. Furthermore, Dr. Jim Brown has been appointed chair and now has an office on the grounds of St. James's. A strategic advisory group has been established whose chair is Dr. Frank Dolphin. In addition, the NPHD or - for want of a better word and to save confusion - the building board will also have a new chair. Somebody has been contacted and has accepted the position. We look forward to him taking up his position and continuing to expedite this important project.
Given the importance of this project and the Minister's disappointment at the further delay indicated last week, can he take any step to help expedite this important development? The Minister knows that the existing children's hospitals are suffering. We also know that budgets for two of them - Crumlin and Temple Street - were cut this year.
Briefly, before concluding, I would like to reflect on the comments of the late teenager, Donal Walsh. Among many of the issues he addressed was his experience at Our Lady's Children's Hospital in Crumlin. He indicated that the ratio of toilet facilities to beds there was one to 18. He raised thousands of euro for Crumlin hospital and identified the requirements of young children there.
Thank you, Deputy.
I will conclude with this, a Chathaoirligh. What will happen concerning Crumlin, Tallaght and Temple Street hospitals in the intervening period? Will we find that inappropriate and inadequate resourcing will continue beyond 2018? If so, what will the Minister do about that in the meantime?
Deputy Ó Caoláin has left that question hanging in suspense because there is no time for the Minister to reply, unfortunately. Let us be careful about the time.
I object. This is not about the Chairman's clock or mine. This is about trying to elicit information about a serious infrastructure matter which I have raised here with the Minister. Once a month we get this chance-----
Deputy Ó Caoláin.
-----and I do not appreciate the Chairman's intervention and his closing off the response.
Deputy Ó Caoláin, please resume your seat.
I put it to the Chairman, in his position, that it is inappropriate given the seriousness of the matter. I would hope the Minister would respect the House.
The Deputy should respect the Chair.
It is a disgrace.
Deputy Ó Caoláin, please desist.
78. Deputy Maureen O'Sullivan asked the Minister for Health in response to the recent statistics on the physical implications of alcohol abuse, including liver disease, as published by the Royal College of Physicians of Ireland, "Reducing Alcohol Health Harm", the strategies he intends to take to tackle the abuse and misuse of alcohol particularly in the young population where alcohol-drug abuse and misuse also leads to anti-social behaviour, violence and poor relationships. [22735/13]
The problems of alcohol misuse and the recommendations to deal with these in the report of the Royal College of Physicians of Ireland are similar to those reported by the substance misuse steering group. Both reports provide a robust analysis of the problems of alcohol misuse and key recommendations based on a thorough review of national and international evidence.
I will be submitting proposals to the Government very shortly to deal with the misuse of alcohol. These proposals are based on the recommendations of the substance misuse report. These proposals are real and tangible, and cover all of the areas mentioned in the latter report including, but not limited to legislation on minimum unit pricing, which is about setting a statutory floor price per gram of alcohol; access and availability of alcohol, including separation of alcohol from other products in retail units where alcohol is sold; and advertising and sponsorship. The Cabinet committee on social policy has already considered these proposals and in developing them. My officials and I have also had frequent discussions with a number of Departments.
At the same time, work by my officials on developing a framework for the necessary Department of Health legislation governing, among other matters, minimum pricing, has continued. For example, in conjunction with Northern Ireland, a health impact assessment is being commissioned as part of the process of developing a legislative basis for minimum unit pricing. Scotland commissioned the same sort of assessment when it was developing its legal framework on minimum unit pricing, approved in the Scottish High Court only last week on 3 May, which I am very pleased to see. The health impact assessment will study the impact of different minimum prices on a range of areas such as health, crime and likely economic impact.
I thank the Minister of State and wish him well with bringing those proposals to Cabinet. I hope they make progress. There is no doubt we have a very unhealthy relationship with alcohol and the statistics on the role of alcohol in murder, assault, sexual assault and public order offences is frightening. Particularly frightening is the increase in liver disease particularly among young people. An 18 year old woman was the most recent casualty of that.
We are moving away from what was our pub culture, which was centered on the pub as an occasion to go out to socialise and meet people. Now we have a very serious situation where, when purchasing a bottle of milk or petrol, one can also buy alcohol. These are very serious issues. Young people can dial to have drink delivered to their house and nobody is checking the age. That must come into the Minister of State's deliberations. The later people start drinking the better so we must examine underage drinking. Last week I was involved in a youth convention with five schools from the north inner city and what emerged was frightening. More than 95% of them, whose average age was 16, were drinking regularly.
I agree very much with what Deputy Maureen O'Sullivan has said and the insight she has brought to this. I recently met with members of the Royal College of Physicians and had the opportunity to discuss these issues with them. The Deputy has outlined some of their concerns in her question. Although the proposals have not yet gone to Cabinet, the proposals I regard as important are also regarded as very important, relevant and necessary by the Royal College of Physicians. The Deputy mentioned the increasing instance of liver disease and she is right about that. On the broader population issue, the risk is very high for young people in particular, particularly older teenagers and those coming into adulthood, and it must be addressed.
I am also having a meeting next Tuesday and delegates include Professor Joe Barry and somebody from the Royal College of Physicians. We looked at marketing and certain advertisements that the drinks companies were coming up with, which were very clever and glamorous.
Young people spoke about how these advertisements associated alcohol with having fun and being healthy, with confidence-building and having relationships. The whole area of advertising must be looked at. When I met people from the gambling industry recently I asked them about the possibility of a levy related to gambling addiction. What contribution will the alcohol industry make? If it is making any, its contribution should be much more about these alcohol-related issues that cost everybody so much.
Each of the issues the Deputy has touched on has exercised me in the course of the preparation of this memo to Government and the intended preparation, for the first time, of public health alcohol legislation. We have a public health perspective on this issue. Traditionally, our only perspective on this in terms of public policy was the licensing laws. These laws are very important, of course, and are one of the reasons we have had such a proliferation of outlets where alcohol can be obtained. However, my perspective and that of my colleague, the Minister for Health, on this is public health and that is what we are bringing to bear. I hope and expect a broad degree of support for the measures I am proposing.
79. Deputy Billy Kelleher asked the Minister for Health the way he proposes to reduce the cost of private health insurance for consumers; the measures he will take to ensure a better age balance in the market; and if he will make a statement on the matter. [22955/13]
I have consistently raised the issue of costs with health insurers and am determined to address costs in the sector in the interests of consumers. Last year I established the consultative forum on health insurance, which comprises representatives from the country's main health insurance companies, the Health Insurance Authority, HIA, and my Department. This forum was established to generate ideas that would help address health insurance costs, while always respecting the requirements of competition law. I have made it clear to the health insurers that I believe significant savings could be made which could contain the cost of health insurance premiums.
Given VHI’s very significant share of overall costs in the market, I will continue to focus strongly on the need for VHI to address its costs. At my instruction, VHI recently compiled a detailed cost containment plan, which sets out savings targets for 2013 and for the 2014-16 period so as to minimise the need for any future premium increases. The savings targets over this period are to be achieved through a combination of initiatives, including rate reductions with private hospitals and consultants, utilisation management, expansion of clinical audit, reductions in high-cost drugs and prostheses, provider reviews and the continued transition of procedures to lower cost and medically appropriate settings. I will continue to focus strongly on this issue as one of the measures to ensure the sustainability of the private health insurance market in the transition to a universal health insurance system.
The continued participation of younger customers is important in keeping the health insurance market on a sustainable path. In addition to the work of the forum, a subgroup of the consultative forum was established earlier this year to consider regulatory issues relevant to the health insurance market, including measures and proposals to encourage greater participation of younger, healthier people in the market. The forum and the subgroup provide a useful platform for continued engagement with the commercial insurers. It is envisaged that further work will be undertaken over the coming months, which will include consideration of any measure necessary to assist the maintenance of an appropriate age balance within the health insurance market.
At the outset the Minister stated that he consistently raised the issue of health insurance, but I would say he has consistently raised the price of health insurance through his policies. What I cannot understand is the fact that this has been facing the Minister for the past two years. The Health Insurance Authority of Ireland made recommendations to him which he summarily dismissed. For example, there was the issue of non-advance payments, where the authority recommended there should be a reduction in the actual levy and the Minister decided to increase it by €5. It has made some other key policy recommendations which the Minister has also dismissed.
The simple point is that the health insurance market is in crisis. We all know that the reason for the difficulties in the health insurance market is the economic downturn. However, what cannot be explained is the spiralling cost to individuals of private health insurance. The only explanation I can find, which is being borne out by people who have examined the health insurance industry - such as Colm McCarthy in his recent report - is that the policies being pursued by the Minister are adding to the cost of private health insurance. It looks as though more than 90,000 people will stop paying for private health insurance between now and next year. The debt spiral will continue.
This problem faced the Deputy and his Government for 14 years, during which time we saw year-on-year rises of up to 25%, so for the Deputy to come across, after two years, as concerned and wanting action on it is a little rich.
That is not the way his Government left the country. It was left in poverty and in tatters. His Government destroyed our financial sovereignty. It accounts for much of the reason why so many people are unemployed or cannot afford private insurance. Professor McCarthy is right. Insurance will become unaffordable unless insurers take the issue of cost containment seriously. Why are we still paying for procedures on the basis that they take two hours when they only take 20 minutes with modern technology? Why are people still reporting to me that their bills listed procedures that were not carried out? Where is the audit and why is there no clinical audit by a group of doctors who could challenge the treating clinicians on the necessity of tests? Why are we still paying on a per diem basis instead of per procedure? That is what we have offered insurers and it is what we would like to see them do in private hospitals.
We can take the history lessons for as long as the Minister likes but I am only trying to get information on why the cost of private health insurance is escalating. Two and a half years ago he was apoplectic with rage in this House. He nearly fell over the benches at insurance increases of 3% to 5%. We are now speaking about increases of up to 30% on premiums for normal families.
They are putative, not real. Where are they? The Deputy wants to confuse facts with supposition.
It is happening as we speak. The projection is that as young people continue to opt out of private health insurance, the burden will fall on fewer numbers of customers and it will cost them more. One does not have to be an actuary or expert in logarithmic expressions to realise that private health insurance is becoming unaffordable. The full cost of private beds in public hospitals is one area and the levy is another. The Minister has refused to take on board any of the recommendations of the HIA. He dismissed them all.
Deputy Kelleher has used his entire four minutes.
I have to respond to that.
The Minister has ten seconds.
The HIA recommendations have not been refused. The Deputy is trying, as Fianna Fáil always does, to muddy the waters-----
I am not.
-----and confuse fact with supposition and fiction. This will happen if no action is taken to address runaway costs of health insurance.
We must move on. The rules of the House provide for two minutes for replies and four minutes for the interchange of supplementary questions and answers. They are not my rules.
80. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he has now abandoned the commitment to extend free general practitioner care to all, commencing with long-term illness patients; and if he will make a statement on the matter. [22734/13]
The Government is committed to introducing on a phased basis a universal GP service without fees within its first term of office, as set out in the programme for Government and the future health strategy framework. This policy constitutes a fundamental element in the Government’s health reform programme. There has been no change to the Government’s over-arching commitment to this goal. This Government is the first in the history of the State to commit itself to implementing a universal GP service for the entire population.
Having examined the progress made in the universal GP care plan, it became clear that the legal and administrative framework required to provide a robust basis for eligibility for a GP service based on having a particular medical condition is likely to be overly complex and bureaucratic for a short-term arrangement. Relatively complex primary legislation would be required in order to provide a GP service to a person on the basis of having a particular illness. The assessment system for such an approach would have to be robust, objective and auditable in order to have the confidence of this House as well as the general public. This legislation would have to address how a person could be certified as having such an illness, who could do the certification and how to select the diagnostic basis for medical conditions. As well as primary legislation, there would be a need for secondary legislation to give full effect to this approach for each condition. While it would not be impossible to achieve, it would take several months more to finalise the primary legislation, followed by the preparation of statutory instruments. In my view, this would entail putting in place a cumbersome legal and administrative infrastructure to deal with what is only a temporary first phase on the way to universal GP service to the entire population.
The Cabinet committee on health has discussed the issues relating to the delay in the initial step of the roll-out of the universal GP service. In doing so, it has considered the importance of weighing the balance between, on the one hand, resolving the legal issues but with a further delay and, on the other, the need to bring forward an important programme for Government commitment with the minimum of further delay.
Additional information not given on the floor of the House
No decision has been taken by the Cabinet committee or by Government on changing the first step of the plan to extend GP care without fees to persons with chronic illnesses. Instead, it has been agreed that we should prepare and set out a number of alternative options with regard to the phased implementation of a universal GP service without fees. The Minister, Deputy Reilly, and I expect to report back to the Cabinet committee in the near future. As part of this work, consideration will be given to the approaches, timing and financial implications of the phased implementation this universal health service.
The Government has already made clear its commitment to delivering on the implementation of a GP service for the entire population by providing additional financial resources in the two most recent budgets. The HSE Vote now contains funding of €30 million for this year for an initial phase of the provision of GP services as part of this programme for Government commitment. Far from abandoning its commitment to universal GP care, this Government is determined to expedite the implementation of a national GP service for the entire population, something to which no previous Government has ever aspired.
Will the Minister of State spell out exactly what alleged legal issues have arisen with regard to the promised extension of free general practitioner care to people on the long-term illness scheme? He indicated this could only be done over a protracted period. His words will offer little solace to those on the long-term illness scheme who are coping with serious health issues. They were expecting free general practitioner care to be extended to them on the basis of a commitment to do so set out in the programme for Government. This commitment was to be the first element in the roll-out of the plan to introduce free GP care for all. What exactly are the legal difficulties to which the Minister of State referred? Will he indicate for what other purpose the €17 million allocated for the first phase of the roll-out will be used?
The funding allocated for the measure was not €17 million, but €15 million last year and a further €15 million this year. As such, the HSE Vote contains funding of €30 million for this year for an initial phase of the provision of general practitioner services as part of the programme for Government commitment.
I touched on the legal issues in my initial response. I have never stated in the House during any of the discussions on this matter that the legal issues that have arisen were insurmountable. I have stated, however, that addressing these complex legal issues would require more time and result in the establishment of a complex and cumbersome bureaucratic structure for only one phase of what will be a large project. It would not make sense to do so much additional work to put in place an infrastructure or legal framework that would only deal with the allocation of medical cards on the basis of a medical condition. While the legal issues are not insurmountable, having reviewed the entire project, it has been decided that it would not make sense to go down that road.
It does not make sense that it has taken a couple of years to make that determination. The Minister of State's argument is absolute nonsense and offers cold comfort to those who are dependent on the long-term illness scheme. He has added to their difficulties in life by dashing their expectations.
The Minister of State indicated he would present an alternative plan within a matter of weeks. I ask him to spell out exactly what he proposes to do. Given that phase one of the planned roll-out of free GP care has been abandoned, what is the position regarding the second phase, which was to extend free GP care to those on the high-tech drug scheme? What message does the Minister of State have for the cohort of people who depend on the scheme? Where stands the promised new general practitioner contract?
I know I do not have much time.
The Minister of State has one minute to reply.
With respect to Deputy Ó Caoláin, it is a pity he will not address the issue we are dealing with.
The Minister of State should answer the questions. I had only one damn minute to put them.
From what I can see, the Deputy may need to take some chill pills. Let us try to be serious about a serious proposal. It will have been clear to anyone listening that going down the route envisaged would entail further delay. I will be straight with the Deputy: the delay is regrettable. We are now putting serious shape on something that looked like it would cause more delay. We are taking it into a-----
What is the position regarding phase two of the Government's commitment? Will free GP care be extended to people on the high-tech drug scheme?
Deputy Ó Caoláin's problem is that he does not like to be given an answer. He goes on about seeking an answer and then complains when one is provided. I will not be able to tell the House-----
The Minister of State is blathering.
That is rich coming from the Deputy. If he wishes to talk about blather, he had better look closer to home.
The Minister of State is filibustering and failing to provide the information I seek.
The plan will be presented to the Government before the summer. That is the commitment and it will be met. I will be delighted to hear what the Deputy has to say at that stage.
The Minister of State provides a mighty crutch for his senior Minister.
