Dáil Éireann díospóireacht -
Thursday, 26 Sep 2019

Vol. 986 No. 6

Saincheisteanna Tráthúla - Topical Issue Debate

Disability Services Funding

Deputy John McGuinness

Last week, I met with SOS on Callan Road, Kilkenny about the services that it delivers. It was originally founded on the basis of delivering lifelong services of various kinds to people with intellectual disabilities. In recent years, because of the lack of funding and the fact that it is not being paid for the services delivered, the range of services it has and its capacity to deal with different clients who come forward are now under threat. It is unable to provide that lifelong service to its clients. SOS is an extremely good service that works efficiently and well. The manager there, Mr. Francis Coughlan, has done everything in his power to ensure that the money he gets is spread evenly and deals with the issues. At present, he has 50 cases. They are called business cases but they are really cases requesting funding from the Department to satisfy the need of an intellectually-challenged individual. There is no decision from the Department on these cases. In fact, to bring its services to where they were previously and keep them at a standstill would require €1 million. SOS would have to have those 50 cases dealt with immediately, with full funding being granted. These is no respite care for those who use the service and SOS has urgently asked that the Minister would consider providing the funding to have two respite beds available when they are needed for those who are attending that service.

To give the Minister an example I raised with the Taoiseach, a client of that service for 30 years has been in St. Luke's General Hospital since last November. He is medically discharged but there is no place for him within SOS because it cannot provide the funding. The infrastructure and the building are there. It requires immediate funding of €600,000 for that project. The hospital setting is costing nearly €2,000 per day and is inappropriate for the man's needs. He is not getting the services that he requires. His parents are deeply concerned that this is an emerging trend within that organisation that is so well respected and supportive of the parents and the clients. They were deeply concerned and expressed their worry, as the parents or the guardians of the children in care, about who would look after the children when their lives were over. This is a question that has to be answered. Francis Coughlan and SOS deserve a direct reply and response.

The management of the services by the HSE is appalling. It is willing to stand to one side and allow these services to deteriorate and to allow people to be left in inappropriate settings in hospitals.

There is literally no response. When I asked the Taoiseach that morning I was taken aback by the cold way in which he answered the question. I followed him out of the Chamber and gave him a written note about the difficulties facing that individual but I am now talking about the overall plan to provide the life care services required by the clients by SOS. I ask the Minister of State to address the issue comprehensively and to deal with the fact that this man has been in hospital since last November. That is a separate issue but he is a client of SOS.

Minister of State at the Department of Health (Deputy Catherine Byrne)

I am taking this debate on behalf of the Minister of State, Deputy Finian McGrath. I thank Deputy McGuinness for raising this important issue and for giving me the opportunity to outline the position with regard to the provision of respite services to clients of SOS in Kilkenny.

This Government's ongoing priority is the safeguarding of vulnerable people in the care of the health service. We are committed to providing services and supports for people with disabilities, which will empower them to live independent lives. Respite services are an important part of the range of services supporting people with disabilities and their families. Short breaks can also provide an opportunity for individuals to meet new people, widen their social circles, and gain new experiences. Respite care is crucial in helping to reduce family stress, preserve family units, and provide stability.

The need for increased respite services is acknowledged and the HSE continues to work with all service providers to explore various ways of responding to this need in line with the budget available. As part of its ongoing service provision, the HSE will provide more than 182,500 respite nights and 32,662 day respite sessions this year to families in need right across the country. In 2018, there was a significant improvement in respite. An additional €10 million was provided to fund 12 new respite homes. This comprises one in each HSE community healthcare organisation, CHO, area and an additional three houses in the greater Dublin area to respond to the very high demand for respite in this region. These 12 additional houses are providing additional respite for families that need it.

This year the HSE will also fund a number of alternative respite services. These are practical and important solutions, such as summer camps and evening and Saturday clubs, which benefit hundreds of adults and children. The number of adult service users continually increases as service users transfer from child to adult services. This impacts on the level of respite existing service users receive.

The budget allocation for SOS in 2019 is approximately €10.7 million, which represents an increase of 4.5% on the 2018 allocation of €10.2 million. This allocation provides for the maintenance of the 2018 level of approved services in 2019.

South East Community Healthcare is proactively working with the SOS CEO and team to develop a plan that will contribute to resolving the organisation's financial position in a structured way over a time-defined period. In addition, the respite house in Tullow, County Carlow is expected to open in due course. To ensure the continued provision of respite services across the south east, a task force group has been established to review respite services and ensure delivery in a fair and equitable way that meets the needs of the service users. SOS Kilkenny is a member of this task force group.

If Deputy McGuinness would like to forward me some information regarding the person about whom he spoke, I will bring it to the attention of the Minister, Deputy Harris, straight away.

Deputy John McGuinness

I thank the Minister of State for her response, but she is being misled by the HSE. I ask that she rings Dr. Cathal Morgan, Ms Janette Dwyer, and Ms Kate Killeen White, all of whom work for the HSE. Each of those three are involved in managing services in the area in which SOS Kilkenny is located. The Minister of State should ask them why that man is in hospital and why services in SOS are being continually run down. She should ask them why the 50 business cases are not being approved and why there is no direct engagement with SOS to assist Francis Coughlan in delivering the services committed to.

The Minister of State says that the budget is there and that approved services will be maintained at their 2018 levels. The 2018 levels do not reflect the amount of activity that should be taking place in the service. It represents a reduction on the services provided in 2017, which was itself a reduction on 2016. The Minister of State's comment was not inaccurate, but it is very misleading to say that services are at their 2018 levels. We do not want them at those levels. We want to fulfil the commitment given by those who started the service, which was to deliver a lifelong service to those who need it. That is not being done. It is not being achieved. People and their families are appalled that the HSE has not responded. It is showing no humanity and no compassion whatsoever. It is hard to stand by and listen to that type of answer from the HSE or the Department of Health when they know full well that the services are pushed to the pin of their collar and are unable to deliver what is demanded of them, let alone what they wish to deliver, because clients requiring services are turning up in great numbers. The HSE is turning a blind eye.

I revert to the issue of management. Those in management must explain why this is happening. They must be made accountable and must be transparent. I again encourage the Minister of State to make those three phone calls and to seek some form of humanity, compassion or relief in respect of what SOS is trying to achieve in Kilkenny.

Deputy Catherine Byrne

I reiterate that the Minister of State, Deputy Finian McGrath, is very aware of the importance of access to planned respite and that he assures the Deputy that everything possible will be done to help those who need respite, particularly families with an ongoing need for respite for their child and adult members in order to have a break. I have taken down the names of HSE staff the Deputy mentioned. Will he repeat the last person? I got the first two. I will certainly ask the Minister, Deputy Harris, to make contact with these people and to ask that the manager of the SOS service be assured that the HSE knows that the services being provided at present are not adequate, particularly for that young man who needs the service but who cannot take it up because funding is not available. I will then go back to the Minister and ask him to engage with the HSE's management team for the area.

Deputy John McGuinness

The names were Ms Kate Killeen White, Ms Janette Dwyer, and Dr. Cathal Morgan, who is the national director. If I may, my point is not just about that man but about the overall services provided by SOS.

Cross-Border Health Services Provision

Deputy Joan Collins

I raise the issue of delays in processing applications and reimbursing payments under the cross-border directive. I will provide two examples. I know of one person who applied last December. He was advised that he had a knee problem and would have to get an operation. He got a scan done here in the South of Ireland. When he went up to the North he was told that it did not look like a knee operation was necessary. A full body scan was carried out and it was found that three vertebrae had fused; it was not his knee but his back. He had to apply for a change of code because different procedures are paid under different codes. It took from 23 July until 9 September for that application for a change of code to go through. It finally went through just before the consultant emailed him for his pre-operation consultation. The operation was carried out only last week. He has been waiting for reimbursement since June, when he was in hospital in the North. He rang up and was told that he could not be given a date for reimbursement. This scheme was brought in on the basis that people would be reimbursed within 30 days. People are getting credit union loans. This particular gentleman has been out of work for so long while waiting for his operation that he is on the pension rate of pay. He could not afford to pay the €15,000. His brother took out a loan of €15,000 from the credit union to pay it.

He is paying back €150 per week and still awaiting reimbursement. In another case of mine a young man who had an operation in March is still waiting to be reimbursed.

There is no point in setting up a scheme if it cannot be relied on. If a patient is told that he or she will be reimbursed within 30 days but must wait for 90 or 100, it causes major financial problems. The HSE will have to get its act together. I acknowledge there are problems, including staffing problems. If there are no staff, they should be put in place. There is definitely something perverse about the public health service being run down, with 194,000 additional outpatients since 2015, representing an increase of 50%. The report on this issue came out last week. There are 18-month waiting periods for operations. Patients are being forced into this. Taxpayers' money is being pumped into private hospitals in France, Germany, Spain, Britain, the North and here. There are Spanish public patients transferred to Ireland to private hospitals under the cross-border directive. I read an article that stated €2.5 million was paid in 2016 to private hospitals and €12.3 million last year. In the meantime, we are not even filling vacancies. Consultants have gone through the interview process. The figure for Galway is 11 and for Donegal, 100. There is a deliberate EU policy of running down public services and forcing taxpayers to line the pockets of private hospitals.

I would like the Minister of State to outline that there is something happening, that the extra staff are being put in place and that the Government is committed to reimbursement within 30 days in order that when patients obtain loans, they can make a commitment to pay them back in that timeframe and not be left high and dry, as is happening.

Deputy Catherine Byrne

On behalf of the Minister, Deputy Harris, I thank the Deputy for raising this issue.

The directive on patients' rights in cross-border healthcare, commonly called the cross-border directive, provides rules for the reimbursement to patients of the cost of receiving treatment abroad where the patient would be entitled to such treatment in his or her home member state. The directive seeks to ensure a clear and transparent framework for the provision of cross-border healthcare within the European Union, for those occasions where the care patients seek is provided in another member state, rather than in their home country. The HSE is responsible for the operation of the cross-border directive and has a dedicated office resourced for this purpose. The office acts as the national contact point, as set out in governing European legislation, and processes applications for treatment received for the purposes of the operation of the directive.

As part of its functions as the national contact point, the cross-border directive office gives prior authorisation to patients availing of the directive where their treatment involves an overnight stay. I am informed by the HSE that applications for prior authorisation are generally processed within 15 to 20 working days. The vast majority of applications for prior authorisation currently in hand will be processed within that timeframe, with the remainder likely to be processed within 25 working days.

The cross-border directive was transposed into Irish legislation in June 2014. Since its transposition, awareness of the provisions of the directive has grown steadily. The number of claims for reimbursement being processed by the cross-border directive office has grown from 150 in the first full year, 2015, to 3,886 at the end of 2018. A total of 3,041 claims for reimbursement were received this year up until the end of August. The significant growth in use of the scheme and the associated increase in the number of applications being submitted have given rise to an increasing workload and a build-up of applications. The HSE has advised that the cross-border directive office is operating with a three-month backlog in the processing of claims.

Recognising this issue, officials from the Department met representatives of the HSE in July to discuss the issue of reimbursement delays affecting patients who had availed of treatment under the directive. The HSE has subsequently been requested to examine the current resourcing of the cross-border directive office and identify any necessary action needed to mitigate waiting times arising from current demand under the scheme. The Minister is aware that some measures have been put in place in the short term, for example, overtime and the deployment of trained staff to address the significant backlog in processing applications. Officials from the Department will continue to engage with the HSE to ensure appropriate action is taken to provide longer term solutions.

This matter was raised this morning during Leaders' Questions. The Minister for Communications, Climate Action and Environment, Deputy Bruton, made a commitment to the Deputy who raised it to bring it to the attention of the Minister for Health. I will do so also. If Deputy Joan Collins furnishes me with the email pertaining to the individuals in question, we might be able to process it.

Deputy Joan Collins

I do not know how to respond. The Minister of State's reply indicates that the Minister has known about this issue since July, yet, at the end of September and heading into October, patients are still waiting for over 90 days to be reimbursed money they borrowed. They do not have the money to pay €15,000 for a back operation. That is the cost in the hospital in the North. The individual in question is on a pension rate of pay and his family are supporting him by paying back the credit union loan. Reimbursement was expected within 30 days, but it could now be Christmas before that occurs. The individual is still waiting to be reimbursed for expenditure incurred in June when he had a consultation with the consultant.

A total of 3,886 people are being forced to use the cross-border directive because they cannot have an operation in the South. They may be waiting for over 18 months, two years or two and a half years. It is perverse. The European Union set up the cross-border directive to try to bring people abroad for treatment, involving a stay of one night or more, for which we pay as taxpayers. Spanish taxpayers are paying for public patients receiving private care in England. This issue has to be dealt with immediately. It has been known about since July. Overtime has been provided. The Government has to commit to reimbursement within 30 days for those who borrowed money. That is a very basic point. Extra staff can be brought in quickly and should have been by now. I cannot understand how it has not happened, given that the Department has known about this issue since July and spoken to the section concerned. I would like to see a commitment from the Minister in that regard. It is not good enough to run down the health service and tell people to borrow money they cannot afford if it is not paid back within the timeframe committed to by the HSE and under the cross-border directive.

Deputy Catherine Byrne

Nobody is forced to use the cross-border treatment scheme. It is an option for patients if they wish to avail of it.

Deputy Joan Collins

If they do not opt for it, they must wait for two and a half years here.

Deputy Catherine Byrne

The Minister, Deputy Harris, is fully aware of the matter and has spoken to the HSE about it. Overtime has been increased and trained staff have been deployed to deal with the backlog. There is a backlog because the scheme has been such a success.

Deputy Joan Collins

It has been a failure because public patients cannot have operations here.

Deputy Catherine Byrne

I will continue to outline to the Minister the need to reimburse those who have to borrow to have an operation abroad. Having to wait for 90 days falls short of what is desired. Patients should be reimbursed within 30 days. I will continue to follow up on the matter with the Minister on behalf of all those who raised it in the Dáil this morning and afternoon. I cannot make a commitment to sort out the matter of reimbursement within 30 days, but I commit to making it my business, straight after this debate, to speak to the Minister about it. I shall ask him to consider urgently the need to reimburse patients who have taken out loans, some of which are quite substantial, to pay for treatment abroad. Provision should be made to reimburse patients as soon as possible, certainly within 90 days.

I note the frustration that has been expressed by Deputy Joan Collins and by others in the Chamber this morning. I assure them that when I speak to the Minister, Deputy Harris, about this matter, I will be as strong and powerful as I can. I agree that people are having to wait a long time to be reimbursed. Deputy Joan Collins has rightly pointed out that some of those who have borrowed to have procedures done cannot afford to wait any longer for these payments to be made. There is an urgent need to address these issues, which I will raise with the Minister, Deputy Harris. The Minister, Deputy Bruton, said he would do likewise when he replied this morning to some of the other Deputies who raised concerns about this matter.