Colm Keaveney
Ceist:83. Deputy Colm Keaveney asked the Minister for Health his plans to address the ongoing delays in accessing the fair deal scheme; and if he will make a statement on the matter. [42996/14]
Priority Questions
Nursing Homes Support Scheme Administration
The fair deal scheme is currently in crisis. Up to 2,000 vulnerable people are waiting for the processing of applications under the scheme. Will the Minister of State explain why this inordinate delay is being imposed on the public in the context of the need for care in geriatric services?
I thank the Deputy for tabling the question. Waiting times on the nursing homes support scheme placement list are now running at approximately 15 weeks. This is a matter of concern for me, and my Department and the HSE are working to ensure the available resources deliver the best possible outcomes for older people. This will require an integrated approach across community, residential and other service areas.
The HSE controls the release of funding to manage the financial allocation available across the year. Funding is released to approved applicants according to their place, in order of their approval date, on the national placement list. Over the couse of the year to date, demand has exceeded what could be funded and the national placement list has increased as a result.
In July this year, the HSE allocated €5 million for an initiative to improve access to appropriate care for older people. To date, this has funded more than 300 transitional care beds for patients in acute hospitals from the placement list for the nursing homes support scheme and more than 200 home care packages to assist patients in acute hospitals who require a home care package to be discharged.
The Government has provided additional funding of €25 million in 2015 to address delayed discharges. This funding will be targeted at hospital and community services that can demonstrate initiatives to address the specific needs of delayed discharge patients most positively and, therefore, improve timelines for admissions from accident and emergency departments and waiting lists. These will include measures to place patients in more appropriate settings through the use of home care packages and intermediate and long-term care. It will include provision for an increased allocation to the nursing homes support scheme. Planning for this initiative is well advanced. Details will be finalised in the HSE's service plan later this month, with a view to their early implementation.
The review of the nursing homes support scheme, which is under way, will consider the future funding and sustainability of the scheme as well as how community and residential services are balanced. This review will be completed in the coming months, following which the Government will consider how best to meet the needs of older people in the future.
The crisis has targeted the most vulnerable people. I would like the Minister of State to explain to the House the reason there is a 15 week waiting time in respect of the processing of applications under the fair deal scheme.
The Minister, Deputy Varadkar, in the recent past blamed the crisis on his predecessor.
The Minister is on record in that regard in terms of his comments that this money was being diverted to other locations within the budget. What plans does he have in terms of immediate intervention to ensure families whose loved ones are stepping down from an acute setting get their rights in terms of supports under the fair deal system? The costs they are experiencing in terms of the absence of that support, often up to €1,000 per week and the 15 week waiting period in respect of the processing of applications, are all resulting in great concern for families of elderly citizens.
I thought I had explained in the course of my response how the increase in the waiting time had occurred. The argument is being constantly made that the Government should not have moved the €23 million from the fair deal budget to the enhancement of home care packages. Not everyone wants to go into long-term care. The list has increased. As the Deputy rightly points out, and which we have known for some time, the waiting time now stands at 15 weeks. This is unacceptable. We are currently addressing how to bring waiting times down to a more acceptable level. We are very conscious that a number of years ago, because there was no control in relation to not only who entered the scheme, but how money was dispersed, that the scheme ran out of money very early on in the year. We are determined to ensure this does not happen again. We are equally determined that into the future the scheme is managed in a way that will ensure that those who need long-term residential care will get it and that the resources to ensure its availability are in place.
I agree with the Minister of State that long-term care is a last resort. However, the traditional care structure has been shattered by the Government's approach with respect to the carer's allowance, home help hours, respite grants and so on. Will the Minister of State agree that delaying or adjusting budgets in this manner, as has been done in the area of mental health in terms of the time delay in respect of a critically important appointment as set out in the HSE service plan last year, is having a devastating affect on families who need the support of the fair deal scheme, particularly those with elderly family members who are stepping down from illness in an acute setting? The Government's decision in this regard is impacting greatly on such families.
I do not agree with the Deputy that social infrastructure in this country has been devastated by the Government. The same 2,500 people are not always on the waiting list. Some 515 people move to the fair deal scheme each month. In other words, there is a roll-over system in place. People are moved onto the scheme in a chronological order, which is the fairest way. That is the way in which the scheme was written and is the reason it is such a good scheme. The Government has not devastated the social infrastructure of this country. It is wrong of the Deputy to say that. I believe people are determined to keep their frail, elderly parents and relatives at home. We are working on the issue. If we do not work on it and put a good plan in place, then the waiting time for the scheme will increase. We do not intend to allow that to happen.
General Practitioner Services
Caoimhghín Ó Caoláin
Ceist:84. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the reason the Health Service Executive has failed to advertise vacant general practitioner posts with General Medical Services medical card lists in counties Cavan, Monaghan, Louth and Meath, filling these positions temporarily with locum appointments; when these vacant posts will be advertised; the number of such vacancies that exist by HSE region; and if he will make a statement on the matter. [43007/14]
I seek from the Minister an explanation as to the reason vacant general practitioner posts, which include GMS lists, have not been advertised and the reason these positions are being filled by locum appointments.
There are currently 12 vacant General Medical Services GP panels in the HSE Dublin north east region, which includes Cavan, Monaghan, Louth and Meath. Since January 2014, the HSE has advertised nine vacant panels in this region. Next month, the HSE is planning to advertise a further five posts in this region. Two of these posts are located in Cavan and are currently filled in a locum capacity. The Monaghan post is also being covered by a locum. The other two impending vacancies are due to upcoming retirements, one in Louth and one in Meath. In the meantime, both of these GPs are continuing to provide services to their patients. It is not uncommon for GMS panels to be covered by a locum GP while the recruitment process is progressing.
There are currently 18 GMS GP vacancies in the other HSE regions, three in Dublin mid-Leinster, seven in the south and eight in the west. Of these, one panel will be filled in December. Some 12 panels have already been advertised. Four panels will be advertised shortly and one panel is being dispersed among existing GPs in the relevant area.
The HSE is currently working on the development of a medical workforce planning system, which is expected to be completed by June 2015. As part of this, workforce planning for general practice will be prioritised in the development of projections based on both the supply of GPs and the demand for GP services over the next 20 years.
The Minister of State indicated that these positions will be advertised but we know from the facts already to hand that there has been a small number of vacant general practitioner positions in the north east area which have not been advertised for months. She made the point that challenges can be experienced in regard to the permanent filling of general practitioner vacancies in small panels while the process is proceeding but the critical thing is that they had not been proceeding. These posts were filled by locum appointment. There was no explanation in the Minister of State's reply as to why in regard to these vacancies - some already signalled before the exodus of the incumbent and some we already know in the Monaghan area are due to be vacated by the end of this year - we would not ensure these posts were advertised speedily in order to ensure notification and to create a general interest in taking up these essential positions in primary care across this region.
I suppose the Deputy is more conscious, in particular in the part of the country from which he comes, that there is a difficulty in terms of GPs and getting permanent posts. We need to continue to incentivise GPs to operate in areas in which one would not have a big customer base. That is something on which we are working. The workforce planning project being undertaken will ensure that whatever steps are necessary in order to ensure that we have cover throughout the country will be put in place. It is not as if we have not sought, within the system itself, GPs who may be able to spilt up the GMS panel and operate it among themselves, which is often the answer because it gives an increased customer base and increased revenue to a practice. There is, however, a difficulty in regard to particular areas of the country and we are very aware of that.
With respect, I do not think that is the answer. Only 24 general practitioners currently serve the county of Monaghan, which still has a significant population. It is also an extensive geographic area. Any contraction in the number of general practitioners would be a significant back slide in terms of primary care provision. None of the Minister of State's answers have given any clarity to the situation. If we have difficulties in attracting general practitioners to take up positions in what might be suggested to be less lucrative locations, and I acknowledge that can be the case, then surely we would not delay making the information available.
Why would the advertising be delayed? What other considerations explain the inordinate delay in some of these cases? It is beyond understanding. A proactive approach on the part of the HSE would ensure a greater interest through awareness and advertising. That has to be the way to entice and encourage people to take up any of these positions. The client base depending on those practices is very anxious to ensure that there is certainty and a future for that service.
I do not disagree with the Deputy but we have to ensure that, ideally, a locum system is put in place with the person who intends to retire. Location is often a big part of the difficulty but I take on board what the Deputy says.
Disability Support Services Provision
Finian McGrath
Ceist:85. Deputy Finian McGrath asked the Minister for Health if he will prioritise funding of disability services in line with the Government's pre-election commitments on disability; and if he will make a statement on the matter. [42900/14]
Will the Minister of State prioritise funding of disability services in line with the Government’s pre-election commitments on disabilities? Many families are on waiting lists for respite care and day care places. This affects young and middle-aged adults with intellectual disability. Young people with serious physical disabilities who had a five day a week service a couple of years ago have seen their service cut back to three days a week. In line with the Taoiseach’s and the Labour Party’s solemn pre-election promises on providing and supporting disability services will the Minister of State ensure that over the next 12 months she will prioritise funding for front-line services for people with disabilities?
The programme for Government committed to ensuring that the quality of life of people with disabilities is enhanced and that resources allocated reach the people who need them. We secured a slight increase in the budget for disability services this year but I am not certain that anyone noticed.
Since 2011 and in spite of the prevailing economic conditions, the Government has focussed on protecting front-line health and personal services for people with a disability to the greatest possible extent. In 2014, the HSE has been provided with funding in the order of €1.4 billion to fund the disability services programme. This programme aims to contribute to the realisation of a society where people with disabilities are supported, as far as possible, to participate to their full potential in economic and social life, and have access to a range of quality personal social supports and services to enhance their quality of life. A range of developments and reform proposals, as outlined in the value for money and policy review published in 2012, are being carried out in an environment of effective communications and engagement with all those involved.
The 2014 funding includes an additional €10 million for school-leavers, rehabilitative training graduates, emergency residential placements and €4 million to develop therapy services under the progressing disability services for children and young people aged zero to eighteen programme. In 2015, additional funding will be provided to the HSE to address identified priority needs within disability services. This includes provision for the emerging needs of young people with a disability leaving school and those leaving rehabilitation training who will require a day place. Additional funding will also be allocated to improve services under the progressing disability services programme. Details regarding this funding and its use will be set out in the HSE's 2015 service plan which is currently being finalised.
I thank the Minister of State for her response. We have to deal with the lack of connection between announcing sums of money and front-line services. There is something going on in that respect. This morning I met the Minister of State at the Central Remedial Clinic in Clontarf and I welcome the fact that she visited the centre. I commend her for making it a low-key visit. I also met there the family of a severely disabled young man whose five day a week service has been cut back to three days a week. That is unacceptable.
I welcome any extra funding for people with disabilities.
It is important that funding trickles down to front-line services, including residential, day care and respite services. People with disabilities and their families want to see those services delivered on the ground. They do not want to see the money disappearing into the system, which is a problem we have had over the past five or six years. Not only have the families of people with disabilities had to tolerate cuts, they have also had to put up with the mismanagement of many of the resources that were given to their children and young adults.
The transformation of disability services in this country is exactly what the Deputy is talking about. The team involved with the value for money report, the policy review and the ongoing service reform are going into individual services to deal with issues such as those raised by the Deputy. We are talking about a service that is directed in many cases by people with disabilities themselves. I think the capacity legislation will have a great deal to do with that. It will ensure there is more consultation. We are going to change the service. The progressing disabilities programme, which relates to those aged 18 and under, will bring the services out of the institutions and settings in which they are normally found. Those services will be brought into the communities in order that everyone will have access to them. I keep saying that if we want to bring people with disabilities into mainstream services, we will have to ensure the service itself is mainstreamed. I do not think the Deputy and I are in disagreement on this issue. We are on the same page.
Will the Minister of State ensure all people with disabilities are guaranteed a quality service as a right? She has accepted that all cuts to front-line services have now ended. Is that correct? I would like to mention another issue. If we were going to be radical and reformist, why did the Taoiseach not appoint a senior Minister to deal with the disability issue? The tens of thousands of families that are directly affected by this issue would welcome a full-time senior Minister with sole responsibility for people with disabilities. While I accept that the Minister of State is doing the work herself, I would like to put this radical idea for reform and change to her.
I always feel I have to bow to the disappointment that people find in my performance. If a full-time Minister were appointed, I am sure he or she would do a far better job than I do.
Mental Health Services Funding
Colm Keaveney
Ceist:86. Deputy Colm Keaveney asked the Minister for Health the position regarding the underspend of €46.8 million in the mental health budget in 2013; and if he will make a statement on the matter. [42997/14]
The Minister of State recently confirmed in response to a parliamentary question that there had been a underspend of up to €46.8 million in the mental health budget. In light of the severe pressure the service is encountering, will the Minister of State offer the House some rationale for the underspend of €46.8 million in that budget?
I wish to say once again that budgetary and other pressures within the HSE delayed the full utilisation of the €35 million that was allocated in 2012 and 2013. The underspend in planned mental health expenditure and the timing of the recruitment of staff developments can be attributed to the time required to get various programmes up and running. I refer, for example, to the counselling in primary care programme, which is one of the most successful programmes we have put in; the enhanced teamworking programme, which has also been hugely successful; the successful mental health information system programme, which should have been in place many years ago; the clinical programmes; and the opening of additional inpatient beds in the area of child and adolescent mental health services.
The provision of additional funding of €35 million in budget 2015 will bring to €125 million the total investment for mental health services since 2012 for the development and modernisation of services in line with the recommendations of A Vision for Change, mostly through the provision of additional posts to strengthen community mental health teams for adults and children. The additional funding is also being used to enhance specialist community mental health services for older people with mental illness or those with an intellectual disability and mental illness, forensic mental health services and suicide prevention initiatives. I believe these things should have been in place many years ago.
At the end of September, an additional 770 posts of the 990 posts provided for in 2012 and 2013 had been recruited, with the remainder at various stages in the recruitment process. There have been difficulties in identifying some outstanding candidates for geographic and qualification reasons.
Therefore, duty has been taken up in approximately 77% of combined two-year posts.
While €20 million was provided for mental health services in 2014, the HSE national service plan outlined that this expenditure would be phased in to allow the HSE to live within its overall available resources. Accordingly, it was decided that the recruitment of the 2014 posts would be commenced to provide for the posts to come on stream during the last quarter of 2014. To this end and informed by the analysis, 200 posts have been identified from the 2014 allocation and the recruitment process has commenced. It is important to stress, however, that the entire underspent funds have been made available to mental health services for spending in 2014 and subsequent years. They have not vanished.
Treatment delayed is treatment denied. The service plan for the recruitment to critical posts that the Minister of State stands over was denied to ensure staff were not on the books until the fourth quarter of 2014, thereby avoiding that payroll cost. Subsequent to last year's budget, the Minister of State publicly committed to ring-fencing €15 million to address the Government's failure in 2013 to protect that valuable resource for recruitment. I welcome this approach and we support A Vision for Change.
So the Deputy says.
The Minister of State keeps beating over the head everyone who does not support her version of A Vision for Change.
There is only one version.
The Minister of State has not listened to the concerns of front-line staff regarding financial resources, for example, those in Beaumont Hospital who resigned citing overcrowding in that hospital as well as funding for A Vision for Change. The Government has underspent.
I am sure the gentleman to whom the Deputy referred would like us to correct the record. He did not resign. He stepped down as clinical director.
From his post.
That happens because people do not always stay in the same posts. I do not disagree with people who disagree with my view of the world. They are quite entitled to have their view and to put pressure on a Minister to get the best possible outcome. I have a difficulty, however, with people - not just in the Dáil - time and again claiming to be in favour of A Vision for Change, only not the way we are doing it when we start implementing it and not in their back gardens. The Deputy knows this. He was involved in one of the many campaigns throughout the country. People must step up to the plate. We need more resources and to do this a bit more quickly, but we are going in the right direction.
Tell us about the back gardens.
I support A Vision for Change, but I do not support the Government's cherry-picking of certain aspects to meet targets of which I am unaware. The Minister of State underspent the budget last year and failed to protect it under the commitment in the programme for Government to recruit specialists. The Minister of State gave a commitment to the public and the House to restore the budget.
I support the fabric of A Vision for Change and the spirit in which it was designed but, by cherry-picking aspects the Minister of State believed would deliver cost savings in other services where someone had proven incapable of spending a budget properly, she failed to protect her budget. This was the core point.
A question, please.
People with mental health issues are not waiting for time-delayed recruitment. They need help and support now.
And extra resources and care.
What the Deputy fails to understand is that we are changing a service. We do not necessarily want the same people who have been working in the service for a long number of years, even though they have done an incredible job. The bulk are nurses who have since upskilled and are doing a different type of job. They would agree with this. I speak with them regularly. They have told me that the expertise they have gained as a result of being allowed to do different tasks is working.
They also tell me it is a better service, in which they prefer working to what had been there previously. Clearly, there will be people who will disagree and who do not wish to change. I can understand this and am not certain that any of us jumps up and down for joy when change is mentioned. However, the Government is determined to change how mental health services are delivered in Ireland. No matter what pressures may come on me, I am determined that the Government will proceed along these lines and on the lines as laid out for us in A Vision for Change.
Pharmacy Services
Finian McGrath
Ceist:87. Deputy Finian McGrath asked the Minister for Health if he will support the pharmacy-based minor ailments scheme to provide access to effective treatment for common ailments; and if he will make a statement on the matter. [42901/14]
My question is to ask the Minister for Health whether he will support the pharmacy-based minor ailments scheme to provide access to effective treatment for common ailments. I raise this question in light of the ongoing crisis in the health service and it is a proposal to free up other services to deal with people. Over the past six weeks, 32,000 people have received their flu vaccinations from their local pharmacists. This is a worthwhile project that should be developed because it will give a break to other people. Serious consideration should be given to developing this proposal.
The development of primary care services is an essential component of the health reform process. In a developed primary care system, up to 95% of people's day-to-day health and social care needs can be met in the primary care setting. Pharmacy services are well placed within the community to provide essential health advice and to support effective care at the lowest level of complexity and in a cost-effective manner. As part of its pre-budget submission, the Irish Pharmacy Union, IPU, proposed that a minor ailments scheme be introduced for General Medical Services, GMS, patients on a cost-neutral basis. The proposed scheme would allow medical card patients access to non-prescription medications to treat minor ailments without the need for a visit to a general practitioner, GP, for a prescription.
As the Government continues to experience increased pressure and demand on the resources within the health system, it is necessary to consider new and innovative ways to provide the services required. The expansion of the role of the community pharmacist to include provision of services such as a minor ailments scheme is worth exploring as the Government seeks to expand further and develop the primary care sector. It is important that such proposals generate real savings on existing public expenditure since the health service continues to operate within tight budget constraints. The Department is further examining the proposal submitted by the IPU, having regard to the evidence base for such a service and any contractual or funding implications.
I wish to push strongly the point that this proposal being put forward has the support of all pharmacists, as well as being cost effective. However, the big issue for me is that it would decrease the pressures in the accident and emergency departments. If one considers what has happened over the past six weeks, 18% of those who received the flu vaccine from their own local pharmacist had never had such a vaccine previously even though 93% of those people were at risk. The point I am making is they were in the at-risk category. This proposal will deal with at-risk groups, will assist in making the service sensible and will ensure the provision of a quality, cost-effective service. I ask the Minister of State to really push this issue because a pharmacy-based minor ailments scheme provides timely access for effective treatment for common ailments and is a sensible proposal. Moreover, I am glad the senior Minister in the Department of Health is also present in the Chamber because he is always having a go at Independents about not putting forward constructive ideas. This is a constructive idea and the Minister of State should up her game and see whether she can deliver on it.
No one would ever accuse Deputy Finian McGrath of not being proactive in respect of ideas. There is everything to recommend a scheme. Basically, who do people trust more and what is the door through which they most commonly go if feeling a little bit under the weather? It is the door of the pharmacy. People usually know them and they usually know everyone in their own community. They usually have been there for a long number of years and are embedded in their own community. As for encouraging patients to self-treat minor injuries, they do from time to time, as well as using the pharmacy as a first point of call for health advice. While such advice may well be that one needs to visit one's GP or perhaps that one must attend the local accident and emergency unit, nevertheless, it is there, it is available and they are trusted. It is as simple as that. Most of us use the pharmacy far more than we imagine and were one to outline the things about which we go there to seek advice, I believe the list would be quite extensive.
I am of the view that it would be important to broaden the range of treatments available, particularly in the context of cost-effectiveness and in light of the fact that 18% of people never previously had access to that which we are discussing. It is unacceptable that senior citizens often end up lying on trolleys or sitting on chairs in accident and emergency departments in, for example, Beaumont Hospital and other facilities, for 20, 24 or 26 hours while they wait for services. The proposals to which I refer would assist in terms of ameliorating the crisis that exists in the area of front-line services. I urge the Minister of State to give consideration to them because they contain a number of brilliant ideas. I agree with her regarding the important trust that exists between local pharmacists and their customers. There is huge potential to develop the service.
I agree with the Deputy. However, when people are obliged to present in accident and emergency departments, it is often for very good reason. We must be conscious of that fact, particularly in the context of those who are frail and vulnerable.