Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Thursday, 2 Jun 2016

Vol. 911 No. 3

Priority Questions

Care of the Elderly Provision

Billy Kelleher


1. Deputy Billy Kelleher asked the Minister for Health the number of new nursing home places, home care packages and home help hours he will introduce under the programme for Government; and if he will make a statement on the matter. [14118/16]

I thank the Deputy for his question. As the Minister of State with responsibility for older people, I am sure that every Deputy's priority is to ensure that people live active, healthy, happy and fit lives in their communities as they get older and that they participate in their communities for as long as possible. Where people need support, we must be able to provide it.

The Government is committed to enhancing the quality of life of older people, supporting them in their homes and communities for as long as possible and, when required, providing access to quality long-term residential care. We are all living longer. The CSO figures predict that, in the next 30 years, the number of people aged 65 years or over will double and the number living into their 80s will quadruple. There will be a considerable increase in the demands placed on our services.

In 2016, the HSE has a core provision of €324 million for home support. An additional €20 million has been allocated to maintain the 2015 increase in service levels to 10.4 million home help hours, 15,450 home care packages, including 130 intensive home care packages, and 313 transitional care beds. A further 60 clients with dementia will be supported with co-funding from The Atlantic Philanthropies under the national dementia strategy. From working with the Meath Alzheimer's association, I know that there will be a significant increase in demand in this regard. The programme for a partnership Government commits to increasing funding for home care packages and home help year on year.

The nursing homes support scheme, with a net budget of €940 million, is expected to support 23,450 clients on average per week, representing an increase of 649 clients per week on last year's figures. The programme for Government commits to increasing resources in order to maintain current waiting times for funding approval. This year, that waiting time will not exceed four weeks compared with early last year when it was almost 11 weeks.

I am confident that, with continued economic growth, we will be able to expand services for older people based on the effective use of existing resources and additional funding.

I wish the Minister of State well and congratulate her on her appointment. We are embarking on a new era in terms of the challenge facing the Parliament, in that we must now reach a cross-party consensus when what we often did was take a partisan approach to issues. In the new dispensation in Irish politics following the general election, it is incumbent on us all not only to raise problems, but to find solutions.

Long-term residential care and the provision of home care packages and home help hours present a major challenge. If we are to face the demographic challenges of the years ahead that the Minister of State outlined, we must accept that residential care, home care packages and the bolstering of community services will comprise a critical component.

Under the programme for Government, there is a requirement to increase home help hours by approximately 2.2 million, the number of home care packages by 3,500 and the number of intensive home care packages, which are provided to people, in particular young people, who suffer from dementia. A commitment from the Government and all other sides is needed if we are to ensure that resources are prioritised for these key areas.

I am afraid so, but the Deputy can revert with a supplementary question.

I prepared long and hard for this question.

We will have plenty of opportunity to discuss everything that Deputy Kelleher has prepared. In the new era of cross-party consensus, we are all on the same page, in that we want to ensure that older people and those who deserve support at home get it.

We are trying to deal with a number of issues. For example, delayed discharges is a major one. In order to move people on from emergency departments who should not be there, people are being sent home with more complex needs, which costs more and places additional pressure on the system. We must manage our limited resources and examine where there are peaks and troughs in the system. For example, demand reduces as we approach summer. As we approach winter and demand increases again, we must manage funding so that it is available for those who need it. There is a commitment to increase funding where possible, although I cannot give the Deputy the exact figures. As the economy improves and more people return to work, which is already happening, I hope that further funding will be available for these badly needed resources.

I will diverge slightly. Those opposite held a meeting on the winter readiness of the country's emergency departments, but I assume that one of the key aims is to ensure that people, in particular the elderly, do not end up in emergency departments in the first instance. Home care packages, home help hours and bolstering primary and community care services form a critical component in that regard.

In the past 30 years, we have consistently referred to primary and community care as the way forward in addressing the challenges facing us. For a long time, though, we have been lacklustre in ensuring that people have as much support at home as they need. I hope that the Minister of State can give a commitment to the House that a strong emphasis will be placed on home help hours, home care packages and primary and community services in next year's Estimates and the budgetary preparations.

Yesterday, the House debated our intention to effect a ten-year plan for the health system. For a long time, we have been playing catch-up and going from year to year. As Deputy Kelleher rightly pointed out, of most importance is preventing people from reaching the stage at which they need to attend emergency departments at two, three or four times the cost to the State of providing a service at home. The financing that has been available to us in recent years has not met the increasing level of demand. If we can increase funding where it is needed as soon as possible, prevention will be better than cure. That is our commitment to the Deputy.

Ambulance Service

Louise O'Reilly


2. Deputy Louise O'Reilly asked the Minister for Health if he accepts the capacity review of the National Ambulance Service and its recommendations; if he will create a specific stand-alone yearly budget to implement it; when he will implement the recommendations; and if he will make a statement on the matter. [14020/16]

I thank Deputy O'Reilly for her question and I wish her well in her appointment as her party's spokesperson on health. I look forward to the debates that we will have in the Chamber. I hope that we will be able to build on yesterday's establishment of a cross-party committee to devise a singular vision for the health service and work together.

Last month, at my request the HSE published the National Ambulance Service capacity review with an action plan for implementation that incorporated the recommendations of the capacity review and the 2014 Health Information and Quality Authority, HIQA, report on the National Ambulance Service. The capacity review makes it clear that we will need a significant programme of investment in our ambulance services. In this context, a planned investment in a multi-annual programme involving manpower, vehicles and technology is required. Additional funding of €7.2 million has been provided for the National Ambulance Service in 2016. As the Deputy will be aware, the programme for a partnership Government commits to an additional annual investment in terms of ambulance personnel and vehicles.

It should be noted regarding the action plan that a number of the reviews' key recommendations are already being undertaken as part of a significant programme of reform and modernisation of the National Ambulance Service that has been under way for several years. The programme has achieved many of its key targets, including the establishment of the national emergency operations centre and the creation of an integrated deployment platform that allows our ambulance service to operate as a national fleet rather than as regional divisions, the continued delivery of improved technology to improve response times, and the expansion of the community first responder scheme.

There is much more to do and the capacity review is a good roadmap, as is the action plan. My Department continues to engage with the National Ambulance Service regarding the latter's requirements and performance and I will do all that I can to ensure that the action plan is implemented.

I welcome the three newly appointed Members opposite and congratulate them and wish them well in their new roles. My question was specific and referred to the creation of a stand-alone budget. In light of what was done to the mental health services budget, no one will dispute that a stand-alone budget is necessary to ensure that these measures are implemented.

The Minister and I may not agree on everything but we do agree there is a lot to be done with our ambulance services. Is there a plan and ring-fenced funding? Intending to do something is not the same as saying money has been put aside and that the Government fully intends to resource the service.

The Minister will be aware that the media are reporting that a woman who made a 999 call waited for 84 minutes for an ambulance to come to her in Cavan, which resulted in very serious outcomes. I am not for a moment making an assumption pending the investigation but I am suggesting 84 minutes is not acceptable. People cannot wait. They need to have confidence in the National Ambulance Service. Regrettably, they do not at present. We need to hear from the Minister that there is a specific, detailed plan and money to ensure that it can be implemented.

The Deputy makes a number of very fair points. She is correct that it is more than a question of generalities and is about what specifically we will do. I can tell the Deputy very clearly today that the programme for Government, which outlines my mandate and what I need to implement along with my colleagues in the Department of Health, commits the Government to increasing the number of staff working in the National Ambulance Service and the number of vehicles available to that service. I am happy to be judged on that in regard to the implementation of the programme for Government. Obviously, when the Deputy starts to see concrete details on the delivery in this regard, it will be in the run-up to the Estimates process and budget, at which time I will have to show the commitment we need to make regarding the National Ambulance Service. It will be a multi-annual process and it will take a number of years. The report is very clear about the challenges that face the service. The report is also very clear about the fact that even if we put all the resources together and could deal with all the recruitment issues, based on the difficulty at times in finding the appropriate staff, worldwide and not only in Ireland, there would still be a number of issues in rural areas in respect of which new solutions would have to be found.

To be honest with the Minister, I was looking for something a little more specific than the answer he was prepared to give me. I understand a significant increase in the number of personnel will be involved and that the trade unions representing the workers in Dublin Fire Brigade and the National Ambulance Service have sought a meeting with the Minister. Will he accede to the request for a meeting and advise the House on the result?

No one has a lack of confidence in the personnel in the National Ambulance Service. Everybody knows they do a fantastic job but we will need to see specific targets and figures. Unless and until we see them, people will not be confident that the capacity review's recommendations will be implemented in any meaningful way.

Let me be very specific. I have four specific points to make. First, there is €7.2 million for the ambulance service this year, as I have outlined. It will enable the creation of new developments within the service.

Second, within a week of my appointment as Minister for Health, I went to the Cabinet and got this report published. It was long overdue and needed to be published.

Third, with regard to the request for a meeting, I would be delighted to have one. I have already had an initial engagement with SIPTU on this. However, I would be very happy to have a specific meeting. If the Deputy wants to contact my office, we can certainly arrange that. I will update the House on that.

Fourth, I do not want anybody to believe these are all vague aspirations. The action plan available on the HSE's website is very specific. For example, on foot of the Lightfoot review, the external capacity review of the ambulance service, 60 actions were identified. Of those actions, 28% are deemed complete, 45% are ongoing and 27% have yet to start. With regard to the HIQA action plan, there were 54 actions, 35% of which are complete, 52% of which are ongoing and 13% of which have yet to start. The document is very detailed in respect of the timeline for commencement and delivery. It is the document with the roadmap for a national ambulance service.

It will cost money. We need to know.

Absolutely, it will cost money. The Government is absolutely committed to continuing to increase investment in the National Ambulance Service. We began this process with the last budget under the last Government, and we will continue under this Government.

Mental Health Services Funding

James Browne


3. Deputy James Browne asked the Minister for Health his priorities for mental health services under the new programme for Government; why there is no funding commitment on mental health services as there was in the programme for Government for the period 2011 to 2016; and if he will make a statement on the matter. [14119/16]

I thank the Deputy for his question and look forward to working with him in his capacity as spokesperson on mental health. As we all know, there has been a debate ongoing for a number of weeks on the key priorities of the Government in the area of mental health. The Deputy and many others have contributed to it. The Deputy put forward his own priorities and wishes and outlined what he feels needs to happen within this sphere. The Government has set out priorities and I have my own goals that I want to see achieved.

A Programme for a Partnership Government confirms the Government’s commitment to further developing and improving our mental health services in line with existing policy, as set out in A Vision for Change. We recognise the importance of fully implementing this long-standing policy in a manner that recognises both geographic problems and that will allow primary care teams, in particular, to provide or access a much greater range of care services. However, since A Vision for Change is ten years old this year the Government is committed to conducting an evidence-based expert review of progress on its implementation and the improvement of mental health services. The review will take account of international best practice and will inform the next steps in the development of our mental health policy, having regard to both human rights and health and well-being objectives.

There needs to be a constant review and consistent implementation following on from the report. We must consult continually on international and European best practice.

A Programme for a Partnership Government gives a clear commitment to increasing the mental health budget annually — I will stand over that commitment — so that we can build capacity in existing services and develop services that badly need to be developed. For example, we aim to extend counselling services in primary care to people on low incomes and to extend support for organisations that offer free counselling and psychological services. In addition, we will work to ensure every emergency department has a clinical nurse specialist in psychiatry on its team, with greater linkages to primary care. We acknowledge staffing is a problem, and I am committed to working on that. Maintaining the link with our communities and making services more accessible are key priorities.

I acknowledge that the Minister of State might not have been involved in the writing of the programme for Government, but many interested parties, including mental health groups, were struck by the fact that there was no specific funding committed in the programme, as there was in the programme for 2011 to 2016. Perhaps that commitment was not always honoured but at least it could be specifically pointed to in the programme. In 2014, some €20 million was allocated instead of the €35 million that was then promised. This year, €12 million was siphoned off.

My predecessor, former Deputy Colm Keaveney, highlighted concerns about these cuts when the service plan was published in December. Unfortunately, his predictions at the time were borne out with the mental health budget being seen as a soft target. Although the new programme for Government specifically states the mental health budget will be increased annually, which must be acknowledged, can the Minister of State be more specific? How much will be provided in budget 2017 for mental health services?

Some €115 million in additional funding for mental health services was made available at a time when other budgets across the spectrum were cut. That increase was made by the previous Government so there is no reason to fear no commitment to increasing funding on the part of the current Government. We have committed to an increase year upon year. Obviously, we would like to see the funding increased as much as possible. Our programme for partnership Government outlines clearly that we want to tackle this problem adopting a cross-party, cross-departmental approach and take on board the various issues more specifically.

I am committed to developing youth mental health services, as is the Government with its announcement of a youth mental health task force. That will require funding but the commitment has been made. We will increase funding year upon year but I cannot give the Deputy an exact figure.

The programme for Government outlines that the new Government is committed to meeting the recommendations of A Vision for Change. The confidence and supply agreement between Fianna Fáil and Fine Gael also pledges to implement fully the recommendations of A Vision for Change. That requires funding. The Fine Gael manifesto pledges €35 million annually so it seems strange that this was absent from the programme for Government. I hope it was an oversight.

Will the Minister of State work to ensure a funding increase in the region of €37.5 million per annum, which is required to meet the commitments in A Vision for Change, will be made and assure us that the mental health service staffing level, which is currently 75% of that recommended in A Vision for Change, will be adequate? It will require some €187.5 million to rectify this.

The full €35 million that was ring-fenced for this year will go into the base for next year. The budget will have to account for the fact that we are examining cross-departmental options.

As such, I intend to have each Department and Minister identify a specific element of their remit through which they can contribute to mental health services because the issue is not confined to the Department of Health or, for that matter, the Departments of Children and Youth Affairs and Education and Skills. The overall budget for mental health services is larger than it may appear and will continue to increase year on year. I hope it will also receive a greater focus than was the case in the past.

Health Services Staff Recruitment

Louise O'Reilly


4. Deputy Louise O'Reilly asked the Minister for Health the status of recruitment processes for all grades, groups and categories in the Health Service Executive; if there have been budgetary impediments to the recruitment processes in specific areas; if there has been a problem with recruitment because of budgets; where has this occurred, by area, hospital and location; how he will meet staffing needs; and if he will make a statement on the matter. [14021/16]

An easing of restrictions on the employment of additional staff was announced by the previous Government in budget 2015. Under this new approach, public sector organisations can obtain delegated sanction to recruit within the parameters of their pay budget once they obtain approval for their pay and numbers strategy from their parent Department and the Department of Public Expenditure and Reform. This change allows for greater autonomy to be delegated to Departments and agencies to manage their staffing levels within allocated pay frameworks. It also provides for further recruitment flexibility, for example, where it is determined that offering permanent contracts can achieve more economical service delivery than agency usage. This practice is evident across the health service.

The Health Service Executive is working with the Department of Health on the finalisation of its 2016 pay and numbers strategy. This has involved the development of detailed workforce plans at hospital and community service level. Rather than HSE head office telling health service entities what their recruitment requirements are, the strategy involves a bottom-up approach to recruitment requirements. Meanwhile, the HSE has emphasised to service providers that they must operate within their pay budgets. This does not impact on a hospital’s ability to recruit where there is funding available to facilitate recruitment, for example, in the case of funded replacement posts or where additional funding has been allocated for new positions under the HSE service plan. Mental health is one very important area in that regard, but recruitment can also take place in the areas of critical care and emergency services. I was pleased to be able to provide assurances for the Irish Nurses and Midwives Organisation in that regard this week.

The HSE has continuously increased staffing levels since the beginning of 2015. By the end of April this year, overall health service employee numbers had increased by more than 6,000 whole-time equivalents since the start of last year, with an extra 1,600 whole-time equivalent staff in the first four months of 2016 alone. The vast majority of these employees are in front-line positions. Numbers in the medical and dental category increased by almost 600 whole-time equivalents or 6.5% since the start of 2015, while nursing figures rose by more than 1,700 or 5% during the same timeframe. Let me be clear that the number of staff working on the front line of the health service increased this year and last year and will increase every year under the Government.

Let me be equally clear - activity levels in the health service are increasing but staffing levels are not matching them. The Minister can deny that there is a pause in recruitment, but I have in writing from the office of the assistant national director for oral health a statement that there is a pause in temporary recruitment pending the outcome of cost containment discussions. No one will contradict me when I state there is not a hospital or health facility in the State that is staffed to adequate levels. Is the Minister aware that between January and April 2016 the HSE spent €68 million on 2,379 whole-time equivalent agency staff? I sincerely hope I do not have to convince him that agency workers are less cost-effective than directly employed labour. If it is established that agency workers are less cost-effective and money is the main issue, why is more direct labour not being employed? Doing so would be a much better utilisation of budgets. I have a statement that there is effectively a pause in recruitment.

No, the health service must be cognisant of its budget. I am sure many areas of the public service need more front-line staff. I am aware that the public service went through an extraordinarily difficult time and that an increase in the numbers of front-line staff is needed. We increased staff numbers in 2015 and will increase them again this year and in subsequent years. However, if the Garda Commissioner wants 1,000 more gardaí tomorrow morning, she has to be cognisant of the budget available to her. Equally, hospitals must be cognisant of the budgets available to them. However, exemptions apply to emergency departments and critical posts and more autonomy is available at local level. This relates only to the pay budget and is not to offset overspending in any other area.

The Deputy makes an important point on agency staff. These posts can continue to be converted into permanent posts. Agency staff conversions continue in the health service and it is possible to recruit staff. As the Deputy is aware, it is not always possible to recruit staff in certain parts of the health service and certain locations. I am not suggesting there is an adequate number of employees on the front line of the health service. Approximately 12,000 health service posts were lost in the deep recession, of which approximately 6,000 have been reintroduced. I acknowledge, however, that we have much more to do.

Given that activity is increasing, even returning to the staff levels that applied before they were decimated will not cut it. The Minister referred to the Garda Commissioner. As he will be aware, we have had carnage and a great deal of blood spilled in the north inner city. Is this what we are waiting for before the budget will be increased? The Garda Commissioner sought an increase in the Garda budget and €5 million was provided. It is not acceptable to claim that staff levels are increasing when clearly they are not keeping up with demand. Activity levels are increasing month on month and year on year, but staffing levels are not matching the increases. I do not know if the Minister speaks to front-line staff, but I have spoken to nurses, porters and home helps and they are at crisis point. They have heard from the Minister and other Cabinet members that some recovery is under way, but they do not see one when they look around.

Of course, I speak to front-line staff. No one here has exclusivity on speaking to them and I will continue to speak regularly with them, as will, I am sure, Deputies from all sides. While staff accept that the economy is recovering because more money is being invested in the health service, they would be the first to tell me and I would be the first to agree that we must do much more to improve the health service. The only reason the previous Government was able to increase the health budget was that we had money available to do so. We could not increase it when the troika was in town. I find myself in my new position as Minister for Health at a time of reinvestment in the health service and there is much in which to reinvest. The health budget increased and will increase again. While we will continue to invest in the health service, we cannot fool people or pretend something is the case when clearly it is not. There are recruitment issues. There are vacant nursing posts which are funded and could be filled and we need to persuade more nurses to return from the United Kingdom. This can be done by a variety of means. I speak to nurses on the front line and representatives of nursing organisations. We also need to attract consultants from abroad and, as the Deputy correctly pointed out, we must continue to convert agency posts to front-line permanent posts. While a significant job of work remains to be done, let us not promote the myth that staff numbers are being reduced when the figures clearly show they are increasing.

Services for People with Disabilities

Margaret Murphy O'Mahony


5. Deputy Margaret Murphy O'Mahony asked the Minister for Health his plans to increase the numbers of personal assistant hours for persons with disabilities; and if he will make a statement on the matter. [14120/16]

I thank the Deputy for her question and wish her well in her new position as Fianna Fáil Party spokesperson on disabilities.

The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in A Programme for a Partnership Government which is guided by two principles, namely, equality of opportunity and improving the quality of life for people with disabilities.

With regard to assisted living services, the Health Service Executive's priority in the 2016 national service plan is to protect the level of services provided in 2015 and to provide 1.3 million hours of personal assistant services for 2,000 people with a physical and-or sensory disability and 2.6 million hours of home support for 7,300 people with a range of disabilities. The provision of personal assistant services has an annual cost of €30 million, with an annual cost of €52 million for home support services.

Personal assistant hours are reviewed on an ongoing basis to ensure the service is at all times responsive to clients needs and the hours available are allocated appropriately and in a timely manner. In 2015 the Health Service Executive exceeded the expected activity level for personal assistant hours by approximately 100,000. This reflects the responsive nature of the service provided and takes account of the fluctuation in assessed need over time. The need for increased personal assistant services is acknowledged and the HSE continues to explore various ways of responding effectively to this need from available resources.

I wish to congratulate the Minister of State, Deputy Finian McGrath, on his appointment. He has been a powerful advocate for people with disabilities during his time in public life. I know that will continue and I look forward to working closely with him.

The Minister has said a lot about plans, budgets and reviews, but with respect, the people who need these hours need them now. We need funding to be put in place now. It is quite disturbing that no extra funding has been put into personal assistant services since 2009. Currently there are people here who require but who have no personal assistant hours and also people who require extra hours. I would like the Minister of State to commit to working to ensure a significant increase in personal assistant hours is provided for in the next budget and HSE service plan and to setting a target for that.

I accept the Deputy's point that we have had some difficult years in regard to public finances following the international banking crisis and that there has been a reduction in resources over the past number of years. This has changed and it is now planned to invest in resources. As part of the programme for partnership Government, I have a new proposal coming on stream in regard to personalised budgets for people with disabilities.

The programme for partnership Government contains a commitment to establish a task force within three months for the implementation of personalised budgets for persons with disabilities. Personalised budgets provide an individual with more control in accessing services, giving the person greater independence, control and choice. The budget for the service is devolved to the person so that he or she can shop beyond traditional service providers to fit their needs. Other important policies in regard to transforming the lives of people with disabilities recommend the move towards a model of person-centred and individually chosen community based supports, underpinned by a more effective method of assessing need, allocating resources and monitoring resource use.

As the Minister well knows, it is almost impossible to overstate how crucial personal assistance is in the lives of people with disabilities. Unfortunately, many of those who receive a service only get four hours per week. This is not good enough as they must squeeze an awful lot into those four hours. I urge the Minister of State to consider a further allocation for the people who receive only four hours assistance.

Clearly, this service needs to be expanded and I believe the Minister of State will look into that. It is deeply disappointing that there will be no additional services provided for in 2016. Also, relative to the outturn in 2015, there are serious concerns that the service may even be reduced this year. A €10 million increase in 2017 could deliver 400,000 plus hours. I call on the Minister of State to make this his priority.

I accept the Deputy's point in regard to the allocation of only four hours per week to a person with a disability. I plan to change that because it is unacceptable. It is important that the rights of people with disabilities are recognised. They are citizens of this State and have a right to a quality service. Our plan is to work with the task force to ensure people with disabilities get the maximum support. For that reason, I am bringing in a group of people to the task force to deal with personalised budgets. The idea is to ensure the adoption of a national, coherent application system to develop budgets before the end of 2017. The adoption of a single national coherent system will provide accountability for spending and will ensure the exploration of brokerage models where people are assisted to connect with and purchase the services that meet their needs.

I am also working on the Estimates for this year's budget and I make a commitment to the Deputy that I will do my best in regard to funding. We must try to catch up following the lack of resources over the past number of years.