Vol. 1033 No. 5
83. Deputy David Cullinane asked the Minister for Health if he will put in place a redress scheme for residents of long-term residential disability services who were wrongfully charged for their care; and if he will make a statement on the matter. [7552/23]
The first question relates to residents of long-term residential disability services who were wrongfully charged for their care. This is part of the long-stay care issue that was at the heart of a number of memos which were published in the Irish Daily Mail a number of weeks ago and have been discussed at the Committee of Public Accounts and the Oireachtas Joint Committee on Health. What work are the Minister and his departmental officials doing to establish if additional residents of residential disability services may have been covered by the redress scheme and may need to be contacted by the Department?
It has been a long-standing principle that people receiving residential care would contribute to the cost through a charge or contribution, based on their means, if any. As we are aware, inpatient long-stay charges which were levied up to 2004 under regulations from 1954 and 1976 were deemed to not have a legal basis. A repayment scheme was established in 2006 and the scope of the scheme, as set out in the Act establishing it, was specifically limited to inpatient charges levied under these regulations.
I understand that the Deputy's question relates to contributions towards household charges in residential care facilities. As these contributions were not inpatient charges raised under the regulations, they did not come under the definition of recoverable charges under the scheme. I am aware that repayments were made under the scheme in respect of residents in a small number of disability institutions following a decision of the independent appeals officer, based on the specific circumstances of these cases.
It is a complex matter and there is further examination. The work is being comprehended within a broader examination of matters recently raised.
The 2011 memo which was published identified 9,000 people with disabilities who may also have been wrongly charged with an estimated liability of €350 million. Yesterday at the Oireachtas Joint Committee on Health, the Secretary General of the Department of Health said he has seen a database that underpins the figure of €350 million, which he believes may be too high as not all of those people may have had entitlement. However, he accepts that some people may have had an entitlement. The 2011 memo is quite explicit in stating that there are and were people at the time who were analogous to those 512 people in those three homes who got compensation, fully settled, provided for by the Department. Those are the three homes the Minister referred to. The memo was very clear. There were other residents with the exact same entitlement. The problem is they never applied under the scheme because they were told they were not entitled. They did not appeal decision because obviously they did not apply in the first place. We need to establish who these people are and if they had a liability under the scheme, as those other 512 people did. We should seek them out and make sure they are properly compensated.
We should all be slightly wary of the estimate. It seems that estimates associated with many of these issues were very high relative to the reality. For example, a €5 billion estimate was put on the repayment scheme and it ended up being less than 10% of that. It would seem that very high estimates were put against many of these issues over time. The issue at hand essentially is whether with regard to the household contributions, which were not covered in the repayment scheme and were judged by the scheme itself to be not covered under it, there are individual cases where the level of care provided would be considered inpatient services rather than household contributions. That is exactly what the Department is looking into.
It needs to be done very quickly. I have seen the 2011 memo which is quite explicit in stating that there are other residents in similar homes who would have a similar if not identical entitlement to the 512 people in those three homes. I accept that the potential liability of €350 million as stated in the memo is a worst-case scenario; it is just an estimation. However, it is very clear that when that memo was written, the Department had knowledge of people who had exactly the same entitlement as those 512 people had. It is an issue of fairness. The Secretary General of the Department of Health said yesterday that while many of these issues are unfair, they are policy issues. It rests with the Minister and the Government to deal with this once and for all. It does not matter if it is 50, 100 or 1,000 people. They are people with disabilities who would have had an entitlement. They accepted that they did not qualify under the scheme, as advised by the HSE and the Department at the time, and yet we know that 512 people did once they appealed it. The Department needs to find out who they are, do the trawl, seek them out and make sure they get what they should have got back in the day.
The Department is looking at exactly those issues. As I said, it will come down to a case-by-case basis. The advice I have is that it would not be applied as broadly as the scheme for nursing homes which were broadly defined as inpatient services. The question really is in what individual institutions, and in what individual cases, were they deemed to be household charges rather than inpatient services.
84. Deputy Duncan Smith asked the Minister for Health for an update on the roll-out of the pandemic recognition payment to front-line workers not directly employed by the HSE; and if he will make a statement on the matter. [7762/23]
This question will be introduced by Deputy Nash.
We are seeking an update on the roll-out of the pandemic recognition payment to front-line workers who are not directly employed by the HSE. Hardly a day goes by when I do not receive an email or phone call from an agency nurse or a contract security guard who may have worked throughout the pandemic in an acute hospital setting but has yet to receive the payment. I seek a status update on that process and why there are so many delays.
To recognise their role during the pandemic, the Government announced that a recognition payment of €1,000 tax-free would be made to all eligible staff. I am very happy to inform the House that over 188,000 staff have been paid. This measure compares favourably internationally. For example, in Northern Ireland it is £500 versus €1,000 in the Republic.
In the public health service, roll-out is substantially complete, with over 88,500 HSE staff and over 52,500 section 38 staff having been paid. For eligible defence and Dublin Fire Brigade staff, funding was transferred to their employing bodies and I am advised that payment to these groups is substantially complete.
While commencing the roll-out beyond the public sector took some time, it was important to get it right. The HSE had a very legitimate concern that if double payments were made or if payments were made in circumstances where they should not have been made, we in the Oireachtas would have been asking it difficult questions about allocations of public money. The HSE was understandably cautious and that took additional time.
However, I directed the HSE to move to a self-assessment model rather than a much more comprehensive audit that it was planning on doing which really would have delayed these payments. While it would have been very thorough in allocating funding, it would have potentially delayed these payments for a very long time. Therefore, I directed it to move to a self-assessment process. We need to be honest in here at the Dáil that the self-assessment process may lead to some double payments but it is a trade-off between getting it 100% right and actually getting the money to the staff we are looking to get it to.
The roll-out is now progressing at pace. As of last Friday, 542 of the 694 claims received from eligible employers have now been paid. This means 78% of these organisations and over 45,000 staff have now paid. I am advised that the remaining payments will be made in the coming weeks.
We have been told time and again that payments were imminent. This is beyond frustrating. For a contract security guard working in a hospital, for example, it could amount to almost two weeks' wages. We are only too well aware of the cost-of-living pressures being experienced, especially by those on low pay.
This has been a frustrating process from start to finish. It has been about two years since my colleague, Deputy Kelly, first called for a pandemic recognition payment to be paid to those who protected and helped us through this pandemic. These are the people we applauded in our homes during lockdown and the people who had no option other than to go to work during the height of the pandemic. They put themselves in harm's way and far too many people are still waiting for that modest €1,000 payment in recognition of the services and supports they provided to us all across this country. It is welcome that progress is being made but the Minister would agree that the process has been far from perfect and satisfactory. It was a year ago that the Minister announced that this payment would be made.
It was a year ago and I was not satisfied with the pace of the process, which is why I intervened and for a move to a self-assessment model. However, while we all would have liked the payment to have gone out to everybody quicker than it did, I have no doubt that if the HSE had moved off its own bat, at a pace where there would have been significant errors made, there would have been double payments made. For example, let us say you had a clinician working in a HSE hospital and working in a nursing home as well, he or she is due to get the payment once. If double payments had been made or if payments had been made to people who were not eligible based on the amount of time they had worked or where they had been, I have no doubt that the Committee of Public Accounts would be pulling in those same HSE officials and lambasting them for not treating public money with the care that is required. While I agree that it needed to move quicker - and that is why I intervened - we need to be honest that we have a role in all of this as well. HSE senior managers are genuinely cautious because of the political reaction to any errors they might make while trying to implement Government policy.
We should all be more concerned about people who are on the breadline and people who require this money. I understand the position the Minister has on double payments. A large organisation like the HSE, with the best will in the world, can often make overpayments to staff. Those payments are recouped quite quickly and we have all dealt with cases like that in the past. My concern would be getting the money to people in the first instance; that should trump any consideration. We deal all of the time with double payments, recoupments and so on, so that should not have been an issue. However, I understand what the Minister is saying. Can he confirm precisely when he believes all of this will be resolved? He mentioned that in the next few weeks he expects everybody who is eligible for the payment to receive it. He is saying on the record of the Dáil that in the next few weeks those who are yet to receive the payment will receive it. Is that correct?
The advice I have from the HSE and the Department is that for the 22% of private sector organisations that have submitted their applications, those payments will be made in the next few weeks. It is inevitable that we will be discussing individuals here or there or a particular contracting company within a particular hospital where a payment has been delayed. These payments should not be delayed though. Can we guarantee that every single person will be paid in the next few weeks? We can say that at an organisational level the remaining 22% are due to be paid in the next few weeks.
85. Deputy David Cullinane asked the Minister for Health if he will publish a multi-annual capacity and wait time reduction plan to tackle overcrowding, cancellations, extreme patient experience times in emergency departments and hospital waiting lists; if he will include measures to expand primary and community care in such a plan to aid admission avoidance and rapid discharge; and if he will make a statement on the matter. [7553/23]
This question is on hospital overcrowding and waiting lists. For some time I have been asking for the publication of a multi-annual capacity and waiting list reduction plan. We need to tackle overcrowding in hospitals, cancellations and extreme patient wait times in accident and emergency departments. The figures for December, November and October were particularly high and I will get to that in a second. I ask the Minister to outline what measures will be put in place to expand primary and community care to aid admission avoidance and to speed up rapid discharges from hospitals into community settings.
This question goes to the heart of our priorities in healthcare. The goal is universal healthcare, which means affordable, accessible and high-quality care. A lot of good progress has been made in patient outcomes and clinical strategies being rolled out, including in women's healthcare, and there have been other positive initiatives. A lot of progress is being made on affordability as well. Progress is being made on access but that is the highest priority. To the Deputy's point, there are various initiatives in place, one of which is enhanced community care, which he asked about. That is going well and I have sanctioned 3,500 staff, about 2,500 of whom are in place. Some 92 of the 96 new primary care teams are in place and they are staffing up. Some 21 of the 30 chronic disease management teams and 21 of the 30 older persons teams are in place. All 21 community intervention teams are in place so enhanced community care is moving at pace.
We have an urgent care plan, which is being finalised. I am keen that we move away from winter planning to urgent care planning, access to injury units, access to out-of-hours GPs and access to accident and emergency departments where necessary. As we have discussed before, the numbers through the year are too high. This is not a winter issue but a systemic issue in terms of quicker access to urgent care right through the year. A plan is being finalised between the Department and the HSE and that will be a multi-year plan. There has been multi-year investment right through the first three budgets of this Government.
Second, a waiting list action plan is being finalised for this year. The plan for last year had some positive impacts. The overall target was not hit and I am not satisfied with that. However, the number of patients waiting beyond the Sláintecare targets, which essentially is our main focus, fell by 11% last year. It is encouraging to see that and we want to see that accelerate through this year and beyond.
Short-term waiting lists were never going to work and I have said for some time that winter plans are simply window dressing. They were also never going to work and the winter plan failed spectacularly this year. The Minister’s short-term waiting list plan for the year gone promised to take 132,000 people off waiting lists but it only took 10,000 people off waiting lists. The target that was set was modest but we came nowhere near that. The number of people waiting over 12 months and over 18 months decreased, and I welcome that, but there are still over 170,000 patients waiting over a year. However, the length of time that people are waiting in accident and emergency departments in some hospitals is crazy.
I got the following details from a response to a parliamentary question I put to the Minister. The average wait time for patients over 75 in Cork University Hospital in December of last year was 40 hours. Let that sink in; the average wait time for all patients over 75 in a major hospital in this State was over 40 hours. How can anybody stand over that? Why are there so many variations between hospitals such that in a major hospital like Cork University Hospital we can get it so wrong that this is the average wait time for patients over 75?
I am not satisfied, nor are any of us, with either the number of people waiting on trolleys or the amount of time people are waiting. There are two parts to how we will solve this. First, we need extra capacity, including more emergency medicine, consultants, nurses, healthcare assistants, beds in hospitals, home care packages and preventative measures. A lot of work is going on there and I accept, on behalf of the State, that more capacity is needed.
Second, we need significant reform in how hospitals are managing patient flow. We know that some hospitals are doing well and that other hospitals are not doing well. The Deputy will be aware that I intervened after the new year bank holiday to instruct that the clinical teams, both community and acute, were rostered for weekends and evenings. We saw the number of people waiting on trolleys fall by 60% in about four or five days after that. I fully agree that we need more capacity, and we are committed to that. At the same time, we must see reforms and better ways of working from some hospitals.
We need more capacity but the problem is that in the budget just gone, apart from beds that were not delivered from the previous budget, there were no additional inpatient beds provided. What additional beds will be put in this year to ensure that next year those hospitals will have the capacity? The reality is that beyond what was previously committed to, none will be added.
On hospitals and variations, in the same figures I got for December, in University Hospital Waterford the average time patients were waiting for admission to a bed was cut by four hours. Riddle me that. This was a massive drop, which is really positive but in other hospitals there are massive increases. Resources and capacity are problems but there is also the issue of how we are managing patients in hospitals, which the Minister has recognised. We have to deal with that issue, therefore. I go back to University Hospital Galway, Cork University Hospital, some of the major hospitals in Dublin, and University Hospital Limerick.
The waiting times are too high. It is the same hospitals over and over again. There are capacity issues in those hospitals and issues about how we are managing patients and patient flow. We must deal with it. Why is Waterford Hospital doing it so well and why are other hospitals not? No one has been able to answer that question for me.
We have some pretty clear ideas as to why not only Waterford Hospital, but also the hospitals in Portlaoise, Tullamore and others are doing better. Some of it comes down to rostering patterns, some of it to patient flow and advance triage in the emergency department, block booking of private beds and nursing home beds for discharge, strong leadership on patient flow through the hospitals and many other issues. At this stage we have a pretty good idea as to why some hospitals are doing better.
Why are the other hospitals not doing it?
That is exactly what we are focusing on. It is incumbent on the Members of the Oireachtas to keep the focus on both. I fully accept the position of clinicians who say they need more capacity. They do. As the Deputy will be aware, we have added more community and hospital capacity than at any time since the foundation of the HSE and we will continue to do that. At the same time, we must keep focusing on different ways of working. That is the core of the new consultant contract, which we will be offering later this month.
86. Deputy Róisín Shortall asked the Minister for Health if his attention has been drawn to the inordinate number of senior staff who left his Department in 2022; the analysis, if any, of the reasons for these high numbers; if exit interviews were carried out and, if so, the outcome of these; and the steps that will be taken to address this concerning matter. [8013/23]
I have a serious concern about the high turnover of staff in the Department of Health in the past two years. In 2021, the number of staff leaving jumped considerably and it jumped again in 2022. I am concerned about the instability this will cause and is causing in the health service. What is the Minister doing about it and what exactly is going on in the Department of Health?
I thank the Deputy for the question. There have been changes in the Department of Health. Broadly they have been positive. The Department is in a much better position now than it was when I was appointed to office. There is a strong culture of decision making, more openness and more stakeholder engagement. For example, we saw that in respect of the Bill that passed Committee Stage in this House last night. A strong senior team is in place and it is working well. I have seen important changes and improvements in performance in the Department of Health. I acknowledge the team that works there and the Secretary General who has been involved in leading important changes in the Department. He deserves great credit for that.
I will turn specifically to the numbers in the Deputy's question. The headcount in the Department at the end of 2019 was 521. It increased to a high point in October 2021 of 714 and then went back down again to 649 at the end of last year. The big increase was due to a number of seconded and contracted staff whose employment was short term by nature. As the Deputy will appreciate, many of their contracts were connected to Covid-19. Churn in any organisation is normal. The Department of Health is not unique in that. A review of figures reported by the Department of Public Expenditure, National Development Plan Delivery and Reform shows that for 2021 the churn at the Department of Health is broadly in line with other Departments and I expect we will see that for 2022 as well. Last year, 65 staff left the Department at assistant principal grade and above. This number includes staff whose secondments and contracts to the Department ended, staff who were successful in Civil Service mobility as well as those who retired.
By any standard the level of turnover is exceptional. For example, overall last year, 155 staff left, which represents about 24%. Almost one quarter of all staff in the Department of Health left last year. That must create instability and there must be some underlying reason for it. It is exceptional and completely out of line with previous years. Let us consider who those people were. Two assistant secretaries, two deputy secretaries, 17 principal officers and 49 assistant principal officers left. They were all senior staff. Why are they leaving? There must be a reason for this. Serious problems must be left behind with that level of turnover of senior staff.
I imagine the figure of 24% relates partly to secondments and other issues connected to the fact that the Department scaled up for Covid-19 and then scaled back down again. There have been movements. Some are due to retirement and some people are moving on to other Departments, which is normal. I repeat that the Department of Health is in a much stronger position than it was two and a half years ago.
I am asking about the turnover.
The figures I have show that the churn in the Department of Health is similar to other Departments. I am not concerned about the numbers who have left. Strong teams have been put in place.
There is something for us all to reflect on. As the Deputy will be aware from her time as a Minister of State at the Department, those who work in the Department of Health are on the receiving end of relentless negativity every day, every week. At a human level it can be difficult to work in that environment day in and day out, where the only thing a person hears is that nothing is working in healthcare - which is not true - and that there is a perpetual crisis. It is probably something we should all reflect on. It is difficult for anyone working year after year in that environment.
It is not helpful for the Minister to deny the situation exists. These are exceptional figures. Almost a quarter of staff in the Department of Health left last year, including a large number of senior people. They have walked out of the Department of Health. These are not retirements. These people chose to leave the Department of Health. Why did that happen and, more important, what is the Minister doing about it? He must recognise there is an issue. It does not seem to be a particularly healthy place to work. Large numbers of people, including senior people, are leaving. Has any analysis of those figures been done? The Minister provided the figures to me in replies to parliamentary questions so he should be aware of them. Almost a quarter of staff members have left. Has the Minister carried out any analysis of the reasons people have left? Have exit interviews been carried out? This is a serious matter. It has serious implications for the health service and the Minister must get on top of it.
I simply do not accept the premise. The Deputy states that there is a significant issue in the Department of Health and I am telling her straight that there is not. The Department of Health is in a much more robust and healthy place than it was two and a half years ago.
The Minister should speak about the numbers.
Am I concerned about it? I am not
The Minister should speak about the numbers. They do not lie.
I have addressed the numbers several times now.
No, the Minister has not.
I am telling the Deputy that according to the Department of Public Expenditure, National Development Plan Delivery and Reform, the figures in the Department of Health are matched in other Departments. If what the Deputy is saying is true, it is true across the Civil Service. As I said, I have no doubt some of it is down to people who were on secondment because of Covid-19 and have left. For example, we have moved an entire disability team to the Minister, Deputy O'Gorman's, Department. At senior level, ten people retired; 14 were contracted for secondments which have ended; 25 left for mobility reasons, that is they moved on to other jobs, often to promotions in other Departments, which as the Deputy will be aware is quite normal; and 16 left and are accounted for due to a variety of reasons, including promotion, competition, resignation and death in service.
