I welcome the Tánaiste and Minister for Health and Children and her officials. A proposed timetable for the meeting has been circulated to members. It allows for opening statements by the Tánaiste and Opposition spokespersons, followed by an open discussion on the Revised Estimates by way of a question and answer session. Is that agreed? Agreed. The Tánaiste has another important engagement immediately after this meeting. Is it agreed that we conclude the meeting at 11 a.m.? Agreed.
Vote 40 — Health Service Executive (Revised).
I am accompanied by Dermot Magan, finance officer of the Department of Health and Children, Liam Woods, director of finance at the Health Service Executive, Dolores Moran, principal officer in the Department of Health and Children, Denis O'Sullivan, principal officer in the Department of Health and Children, Jim Breslin, Health Service Executive, and Tom Finn, Health Service Executive. The script I have circulated is rather long but I will just go through a few of the main issues. I know the select committee dealt with the Office of the Minister for Children, as a separate Vote, some time ago. Today we will deal with Vote 39 for the Department of Health and Children, and Vote 40 for the Health Service Executive.
The Revised Estimate for 2006 for Votes 39 and 40 combined shows a total gross Estimate of €12.781 billion for health services. Vote 39 contains funding for my Department and allows a level of gross expenditure of some €392.438 million and net expenditure of €392.058 million.
Vote 40 contains the funding for the Health Service Executive for day-to-day expenditure on health services. The gross provision for the HSE is €12,388.657 million and the net Exchequer funding is €10,017 million. Therefore, the total of €12.781 billion consists of €12.186 billion current funding and €595 million capital funding. The underlying increase over Revised Estimates for 2005 in current funding for Votes 39 and 40 is 10.3%. Total funding for the Health Service Executive has increased by 10% over this time last year.
This level of growth in public spending on health is made possible by the success of our economy. Health spending in Ireland has grown the fastest of all OECD countries in recent years. The OECD reports that Ireland had an average of 11.4% annual growth in public health spending per capita between 1998 and 2003, which was the highest among 30 OECD countries.
In 1997, Irish health spending was 15% below the OECD average. By 2003, it was 17% above the OECD average. Our health spending per capita, adjusted for cost of living differences, was higher in 2003 than in Austria, Finland, Italy, Japan, Spain and the United Kingdom. Current figures show that we have higher per capita spending than a number of other countries, including France. Therefore, the case is conclusive that, as a country, we are investing heavily in public health services.
On the public side, about 75% of what we are investing comes from the taxpayer and 25% from private health care funding, including insurance and people paying for their health care in some cases. This is around the average for most OECD countries, excluding the USA, which has a totally different mix of 44% from the public purse and 56% from private sources. Public funding will continue to remain at about three quarters of all health spending in our country. This is entirely consistent with encouraging a complementary role for a vibrant private sector in health care provision.
For the future, we can envisage significant investment by the Government in our public health services, to accompany substantial reform. Reform is necessary now to make our public health services scalable upwards for the years ahead and thus capable of expanding services like cancer care and long-term care, for example.
Since 1997, we have seen a 15% decrease in mortality from cancer in the under-65 age group, which was achieved three years ahead of target. Over 1 million in-patients and day cases were treated in our acute hospitals last year. Some 505,588 people were treated as day cases in 2005, which is almost double the 1997 level. It represents 48% of those treated in our acute hospital system. Nearly 65,000 more cancer patients were treated in our public hospitals in 2004 compared with 1998. The number of consultants in the heath care system has increased by 720 to 2,012 in the period January 1997 to January 2006, which is an increase of 56%.
Some 43,000 patients have been treated under the National Treatment Purchase Fund. There are now over 13,255 beds in public acute hospitals. This is an increase of over 1,500 since 1997 and nearly 900 more since 2001.
We are now undertaking the largest ever expansion of services for people with disabilities with multiannual funding. This year, we are also making the largest ever expansion of services for older people.
In the acute hospitals programme, €60 million of additional revenue has been provided for the commissioning of a number of new units in acute and non-acute facilities throughout the country. Later today, I will be announcing the capital plan for 2006, which has been approved by the Department of Finance and my own Department.
lnpatient and day case discharges from acute hospitals amounted to over 1 million people in 2005. Additional funding of €3 million was announced in the Estimates to enhance neurology and neurophysiology services. This additional funding will allow the HSE to further progress the implementation of the Comhairle na nOspidéal report of 2003.
Additional revenue funding of €4.78 million has been allocated specifically for the development of cystic fibrosis services. A purpose-built unit for CF patients is a key element of the second phase of a major capital plan for St. Vincent's Hospital. While this unit is being completed, St. Vincent's is putting in place measures that will improve facilities for CF patients.
Additional revenue funding of €8 million is being provided in 2006 to develop renal services. Some €2 million of this additional funding will be utilised to establish a living donor transplant programme.
An additional sum of €3 million revenue funding has been provided in 2006 for the area of obesity and specifically for the implementation of the recommendations of the national task force on obesity. In the area of pre-hospital emergency care, an additional €2 million has been provided in 2006.
Since the implementation of the national cancer strategy commenced in 1997, approximately €920 million has been invested in the development of cancer services. This substantial investment has enabled the funding of approximately 110 additional consultant posts. It has also provided for the recruitment of an additional 329 clinical nurse specialists. In 2006, €9 million has been provided for the HSE to continue to meet the additional pressures in cancer care.
BreastCheck is now available to approximately 160,000 women in the eastern, north-eastern, south-eastern and midland regions. Revenue funding for BreastCheck currently stands at €13.693 million in 2006, while cumulative revenue funding of €73.5 million has been made available to support the current programme since its introduction in 2000. This year's funding includes €2.3 million providing for, among other things, the recruitment and training of staff to commence the roll-out of the screening programme to the remaining regions of the country, which is on target for the start of next year.
Capital funding of €21 million has been approved to provide for the necessary infrastructure for the national roll-out. The notice for the procurement of the construction company for the new clinical units in Cork and Galway has been published in the EU Journal and the design team is now in the process of short-listing applicants
Funding for the National Treatment Purchase Fund has been increased to €78.6 million in 2006. To date, the fund has facilitated the treatment of some 43,000 people. Some €8 million has been provided in additional funding for child care services.
Total additional funding of €100 million is provided in 2006 for the area of disability services. Some €26 million of this relates to funding for mental health issues to implement the report published recently on mental health services.
Funding available to the Mental Health Commission in 2006 amounts to €12 million. I have already mentioned the additional funding for older people.
As regards medical card services, the commitment to increase the number of traditional medical cards has been exceeded and as of May 2006, some 36,000 more people have medical cards than in January 2005. The number in receipt of GP-only cards is 15,000. The low take-up is disappointing. The HSE will shortly write to everybody involved in the drugs payment scheme, which involves over 1 million people, to make them aware of the doctor-only card. Notwithstanding the high profile advertising campaign, including television advertisements at peak viewing times, the take-up has been extremely disappointing.
Additional funding of €2 million has been provided to enable further implementation of the actions in the national Traveller health strategy, and another €2 million has been provided for adult homelessness. An additional €3 million has been allocated to drugs services.
On a number of previous occasions, this committee has raised the issues of medical education and training. This year, €9 million has been provided in the Estimates for such education and training, including moving children's nursing and undergraduate midwifery from the apprentice model to a degree model. Additional resources are also being made available for speech and language therapy.
We will also increase substantially the number of students we take into medical education. We will effectively double the number of Irish or EU students and will also provide for graduate entry from the beginning of the 2007 academic year. Additional clinical placements have been put in place this year to accommodate the increase.
I have increased bed charges and accident and emergency charges. The 10% increase in bed charges is the cost of private beds for the public hospital system. Even with the 10% increase these beds are subsidised by the taxpayer to the tune of 40%. The capital funding for them is totally provided by the taxpayer.
Accident and emergency charges have been increased by €5 to €60 to try to ensure there is no incentive for somebody to attend an accident and emergency unit rather than a general practitioner.
A sum of €30.541 million net non-capital expenditure was approved for the Health Research Board for 2006. There is a huge intellectual resource in our health services and clearly research is fundamental in devising new products and therapies for patients. We have been substantially increasing the resources available to the Health Research Board but still, by international standards, the amount of money we have put into health research is very small. We must continue to do more in this respect.
The capital programme for 2006 will be announced later today. It is an overall sum of €595 million. This is an increase on top of the €585 million provided in 2005. It also includes the €49.5 million for the Office of the Minister for Children.
The main issue from the public perspective is the ongoing situation in accident and emergency departments. Notwithstanding the ten-point plan, most of which has been, or is being, implemented, we still have major pressures in accident and emergency units. Each day approximately 3,300 attend our accident and emergency departments throughout the country. Thankfully, the vast majority have a positive experience. The length of stay on trolleys for many people has been greatly reduced but unfortunately from time to time, up to 10% of cases end up spending a prolonged period awaiting admission to our acute hospital system.
There have been a number of initiatives. Step-down facilities were acquired for 500 patients last year and for 380 patients so far this year. Continuing care facilities are being acquired for older people who are not in a position to return to their homes. So far this year, we have acquired 250 beds to enable older persons to move from the acute hospital system into long-term care. Further beds will be acquired this year.
Reform of the health service generally, but particularly of the hospital system, will be fundamental to ensure everybody has the positive experience which 90% of people have. I referred to Mullingar and Cavan hospitals earlier this week. Each has 198 in-hospital beds but Mullingar accommodated 31,000 patients last year while Cavan accommodated 20,000. Mullingar deals with 14,000 cases in its accident and emergency department while Cavan deals with 11,000. However, Mullingar very rarely, if ever, has people on trolleys. I believe on one occasion this year it had two people on trolleys for a prolonged period. The reason is that in Mullingar, the length of stay in the acute hospital is 4.5 days while the length of stay in Cavan is over seven days.
If these processes in hospitals are not effective and efficient, they lead to undue delays in accident and emergency departments. That is why the HSE commissioned research in ten different hospitals to look at their internal processes. It is now working with those hospitals to resolve the issues in them. The issues are different in each of the hospitals. In some hospitals, such as Wexford and Letterkenny, there are capacity issues. We are making provision for additional beds to be provided where bed capacity is the issue. Bed capacity is not the issue in every hospital. If some of the internal workings of the hospital are changed, it would have a profound effect, especially on accident and emergency services. I will deal with other issues by way of response to questions raised by Members.
I thank the Tánaiste for her presentation. One of the points to which the Tánaiste keeps coming back and the Government continues to restate like some type of mantra is that funding has increased significantly, which is true. However, we are not exceptional in European terms since we started from a very low base and there is much catching up to be done. Regrettably, under this Government we have got very poor value for the patient from that extra funding and there has been much waste and incompetence. Even today two parallel organisations are represented here, namely, the HSE and the Department of Health and Children. It raises questions about the exact role of the Department of Health and Children given that powers have been extended to the HSE, which is now in its third year of existence.
A long list of agencies remain the responsibility of the Department of Health and Children but there is no clear policy as to whether they should remain with the Department or move to the HSE. If they should have been moved to the HSE, why are they still with the Department? I recollect in the early days getting a briefing in the Department about the change, which was undertaken in great haste and for which we are now paying the price, and the fact there would be approximately 400 staff who would no longer be needed in the Department of Health and Children. The future of the Department of Health and Children is not clear from the Tánaiste's presentation. There is obviously a role for the Department but it is not clear what it is and how it fits in with a completely new bureaucracy, namely, the HSE which employs a large number of people.
It is important to be straight about the accident and emergency crisis because it is the issue uppermost in most people's minds, not only because of the excellent RTE programme shown on Monday night but because of ongoing suffering in accident and emergency units which disturbs and distresses many people. The Tánaiste said her ten-point plan has been largely delivered. That is news to me and, I suspect, to many people. It would be interesting to know if the minor injury units and the medical assessment units are in place in all hospitals in which they are required. Has Beaumont Hospital received the MRI scanner for which it has been waiting a long time? I cannot understand why something as simple as the acquisition of an MRI scanner should take so long. The new scanner will replace a mobile scanner which was removed. The Tánaiste announced this perhaps over 18 months ago. It was part of the ten-point plan but even something as simple as that seems to have run into great difficulties.
What we see in these Estimates is essentially the existing level of service being maintained in the hospital sector. We cannot run away from the issue of bed capacity. The Government, of which the Tánaiste is part, committed itself to 3,000 new hospital beds — not day beds or chairs. That commitment was made after a report was drawn up on the issue. Where is the funding in these Estimates for the extra beds desperately needed in certain hospitals throughout the country?
More importantly, how can the Tánaiste explain the fact there has been a reduction in long-stay community beds for the elderly since 1997 — during this Government's reign? Despite all the talk about care for the elderly, the reality is that the number of nursing beds in the community has dropped significantly. It would appear from research now being carried out that buying beds in the private sector is not reducing the incidence of bed blocking. The indications are that people are not moving their family members out of hospital because they are waiting for one of these beds since the subvention scheme is so inadequate. The situation is a bit of a mess. It does not impress when one considers the amount of rhetoric about step-down facilities and community beds. They are not being provided — in fact, the situation is getting worse. Perhaps the Tánaiste will clarify where in the Estimates is the commitment to provide the new community and public beds desperately needed.
We all agree there must be changes in the acute hospital sector. The Tánaiste spoke about reversing the ratio of 2,000 consultants to 4,000 non-consultant hospital doctors. How many new consultants were appointed in 2005? A number of rheumatologists appeared before the committee last week. They went to the Department over one year ago to look for additional consultants because they were very concerned that patients must wait seven years in certain parts of the country to see a rheumatologist. They told us no new posts had been created and the post in Manorhamilton, which became vacant, had not been filled. What progress has been made in reversing the ratio of consultants to non-consultant hospital doctors? How many additional consultant posts have been created?
Presumably, there will be costs involved in the consultant, NCHD and general practitioner negotiations. Where is that accounted for in the Estimates? Is it likely these issues will be addressed within months? The Minister stated she wanted the consultants' constract agreed by April but there is no sign of it being amended. It will be a painful and slow process and perhaps she might comment on that.
The Minister needs to examine the general practitioner only medical card. A total of 200,000 cards were promised but she has only delivered 15,000. That should tell her people need a traditional medical card if their income is below a certain level. Up to 40% of the cards could be provided before a contract is agreed for people on low incomes who want to visit a doctor but cannot afford the visit or the medicines prescribed and who need the community services the medical card provides. How much of a loss has been incurred in the over 70s category as a result of foregoing the health levy? The Department no longer receives the levy from wealthier over 70s patients and the loss was reported to be €50 million, according to one newspaper, which is not peanuts.
I welcome the roll-out of the BreastCheck programme and I hope the Minister can meet her commitment in this regard because it is crucial. Anything that can be done to support her in that will be done because there has been too much of a delay.
I refer to the elderly who move out of hospital. There is still a serious delay in providing disabled person's grants and home help services. The Minister and the local authorities should get their act together because the grant makes a difference to those returning home from hospital.
I am not clear where the cost of PPARS fits into the Estimate. Will the Minister update the committee on the project? Will the cost be fixed into the future? Will she explain the "technical adjustments" on page 11? I do not understand what the term means because while it is stated there are no financial implications, it appears there are.
I refer to appropriations-in-aid and the charges for maintenance of public and semi-private accommodation in public hospitals. I take it that money is paid by private patients. It amounts to €250 million. The Minister stated she will not only preside over the loss of that kind of income to public hospitals but she wants it to happen. How will the shortfall be made up in future? This will result in a significant reduction in funding for public hospitals. It will be siphoned off to hospitals driven by the ambition to make money and not to provide for the patient.
I apologise for missing the Minister's contribution but I was on radio trying to counteract the negative spin, which is regularly put out by her and her Department.
Expenditure this year has increased by 9% but given that €120 million is allocated to cover PRSI and overdrafts for the former health boards, the real increase is 7%, which does not exceed medical inflation. There must have been a reduction, therefore, in services this year. Hospitals in the north east, which may exceed their budgets by €40 million by the end of the year, have been more or less told to rein in their spending to bring their budgets in line. Have the same issues arisen in other acute hospitals? Will they also be asked to rein in their spending for the rest of the year? If hospitals do so, they will have to cut back services to patients.
The 7% increase in expenditure indicates there must be a reduction in the services provided to patients. If the Minister states she has improved a service, she will have done so at the expense of another service. Benchmarking payments are due this year, which will mean more money being diverted from the delivery of services. The Minister should clarify what services will be cut back this year.
The Minister stated more than 1 million inpatient and day cases were treated in acute hospitals in 2005 but the number of inpatients has decreased marginally since the Government parties got back into power. More people are being treated as day cases and, therefore, the heath services should be more efficient.
I did not realise the number of hospital consultants had trebled over the past eight years. The numbers began to increase in 1996 when I left the acute hospital sector as a junior doctor. At the time, 29,000 people were on hospital waiting lists but the number remains the same. The use of trolleys for patients was not a major problem then but half the patients admitted to hospital now during peak times are treated on trolleys. The issue of work practices was as live back then as it is today. At the time the European working time directive was on the way. The directive was due to the implemented in the health service in 2004 but that has not happened.
The consultants' contract was also an issue in 1996 because it was having a bearing on how patients were being treated. When representatives of the Irish Hospital Consultants Association appeared before the committee last week, they pointed out that when the Minister's predecessor, Deputy Martin, was discussing the renegotiation of the contract with them, they offered an extended working day as part of the negotiations but this was rejected out of hand by the then Secretary General, Mr. Kelly with, I assume, Deputy Martin's approval. I can only assume that because it is difficult to know what the previous Minister knew about what was happening in his own Department. We offered the Tánaiste every support in renegotiating the consultants' contract in order that it would be easier for patients to visit a senior clinician. However, the Government and herself have been disingenuous about giving serious consideration to an extended working day. The opportunity presented itself in 2000 and it would have resulted in a dramatic improvement in services in recent years but it was rejected out of hand. The Minister should issue a clear statement in this regard because the consultants and herself are poles apart. It is important that the people should know whether they are only hearing nice words about what the Minister will do after nine years in government. Why was this issue not taken up in the past?
Both the Minister and Professor Drumm are taking poetic licence about what is happening with the health services. For instance, they are moving too slowly to increase the number of places in medical education to train doctors. In the area of primary care, to which they both refer a great deal, 40% of general practitioners could retire in the next eight years. It takes five years to turn a young doctor into a general practitioner. It can also take up to ten years to train a 19 year old as a general practitioner. If half of the general practitioners who propose to retire within the next eight years begin to retire now, in a few years' time we will have the same crisis in general practice as we have currently in our accident and emergency units.
The pace set by the Minister for improving the number of training places for doctors is too slow and the number of places announced for the training of general practitioners is way off course. We are supposed to train 150 young doctors for general practice every year, but we only train approximately 100. Every year of delay means we fall behind by 50 doctors. We can add to this loss the large numbers expected to retire in the next five or six years, doctors who joined the health care service in the 1970s when the GMS was established. The forward planning to cater for the fall in numbers is pathetic. The Minister and Professor Drumm use poetic licence in talking about what they will do. However, the reality is that they will not, by any stretch of the imagination, be able to fulfil the promises made to the people this side of the election. They will not be able to train the number of people required and should be more honest and truthful about what the situation will be.
The same goes with regard to the out-of-hours service for Dublin. Professor Drumm has announced that this service will be up and running in four months. When we set up the out-of-hours co-op in County Wexford, with the full co-operation of doctors, the health board and funding from the Department of Health and Children, it still took us four months to get it up and running. Therefore, I believe the professor is wrong about the Dublin service and should be more honest.
The Tánaiste should not mislead people about how services are working. On "Questions and Answers" on Monday, we discussed the hospitals in Kilkenny, Waterford and Mullingar. Kilkenny hospital has changed its management structure and there is no doubt that the consultants, general practitioners and management work well together. However, to infer that this is the only change we need to make the health services work is bunkum. Kilkenny hospital has the same catchment area as Wexford General Hospital, but it has 60 more beds. Despite the improvement made by the changed management structure in Kilkenny hospital, it still has the advantage of 60 more beds compared to Wexford hospital's 220 beds. Kilkenny hospital's 60-bed advantage makes a huge difference.
It was mentioned that Waterford Regional Hospital has no patients on trolleys in the accident and emergency department. The reason for this is that the hospital has a 30-bed ENT unit which is used for accident and emergency patients. The ENT surgeons in the hospital regularly come into their day ward in the morning to see which patients are supposed to have grommets inserted, tonsils removed or other more complex ENT procedures, but they find that all their day cases have been cancelled because the beds are occupied by patients from the accident and emergency unit.
If the accident and emergency crisis is ever solved, the next problem we will have to face is that of the thousands of patients who have procedures cancelled on a daily basis, for example, procedures such as tonsillectomies or insertion of grommets. Investigations for heart disease and cancer are also cancelled and these patients suffer and their condition deteriorates as a result. The National Treatment Purchase Fund will not take up the slack in this regard.
We need to make the situation clear to people and should not try to put a gloss on something that is not working. We must also be clear about what is going wrong. The Minister mentioned the total expenditure on health services, but we are simply maintaining the level of service as in previous years. This has been going on for four years. We must be honest that the health service will deteriorate year by year unless the Minister and the HSE make the radical reforms that have been talked about but not implemented.
The Tánaiste has said that we exceed the OECD countries average for total expenditure. However, our health budget includes millions of euro which in other countries would be considered social welfare spending. If we stripped that social welfare spending from our health budget, we would find ourselves just above the OECD average for the past two or three years. We have been chronically underfunding our health service for a number of years and that is why we have such major problems.
We need to be honest with the public. Health spending is not at the level the Minister has tried to portray this morning nor has the level of service improved dramatically in the past four to five years. Many of the radical reforms talked about are not happening fast enough as is clear with regard to primary care, medical education and the problems in our hospitals. We need to be honest with people about the difficulties faced by the health service and face the fact that there is a huge job to be done.
I will not waste the committee's time on the Minister's plan for private hospitals except to say it is bad for patient care and taxpayers. She should review the plan and look instead at the proposals coming forward from Fine Gael in that regard. They would be more cost effective and far better for patient care.
I apologise for being late. The matter that delayed me this morning reflects the state of the health service. I spent 20 minutes on the telephone to a mother in east Cavan who is concerned about her 20 year old son who was in a bad accident, developed epilepsy and has between four to six fits per day. The young lad is on a priority list to see a neurologist, which means he may see a neurologist within 12 months. This is a private list, yet this is the best service he can get. While I understand we have a scarcity of neurologists, I find this difficult to accept. It is the type of impossible situation I come across daily and try to represent. Such situations reflect the current state of the health system and the pressures on those involved.
I would like to concentrate on a local situation which I believe is replicated nationally. In Cavan we have a difficulty with regard to special care beds and the pressure on these as a result of the VRE virus. The presence of this virus means no new patients are being taken into special care in Cavan hospital. The alternative is to try and find beds for them in Our Lady of Lourdes Hospital in Drogheda, which is already creaking at the seams and has little bed space, or to find beds in Dublin or Northern Ireland.
Special care beds are not freely available and are difficult to find. This means we need to think outside the box, as the Minister suggested at our previous committee. I like to think I have done that to find an alternative. I suggest we look at what is currently available. Every general hospital in the country has a large volume of patients not receiving any active form of treatment who are in expensive hospital beds, which cost approximately €700 per day to maintain. Nursing home beds cost approximately €700 per week. There is a major cost in keeping a patient in a hospital bed and this should be a big incentive to look at ways of moving that patient.
Broadly, there are three categories of people in hospital beds who do not receive active care. We should ask why they are in that bed, whether they have finished with their treatment and what can be done about them. The first category is a type of tertiary group awaiting nursing home care. These occupy a significant number of beds in general hospitals. Another group is those who have been clinically discharged but who have no place to go. Sometimes these fall between stools and may have a social, psychiatric or nursing home problem or need some work done on their home. They occupy beds although their treatment is finished. We also have people waiting for CAT scans or further investigations. These three groups occupy a significant number of beds.
In Cavan-Monaghan we are currently seeking special care beds outside of our area because beds are not available in our hospital. Serious consideration must be given to the possibility of providing upwards of 20 beds in both Cavan and Monaghan general hospitals to special care patients in order that they can be moved on. I will offer a solution to the problem. A precedent has been set in the Cavan and Monaghan situation, whereby for other reasons, day services for Monaghan General Hospital are being delivered from the site of St. Davnet's in Monaghan. This site has a large floor area which is available. Patients who have been clinically discharged do not need the same level of care, such as oxygen lines. They require a lower level of care.
I ask the Tánaiste to consider this solution. It could free up 20 beds in two general hospitals which could become special care beds, thus avoiding patients being sent to Our Lady of Lourdes Hospital which may not be able to accept them or to the Dublin hospitals which are also creaking at the seams. My suggestion is a less costly option and it should be considered. It will free up beds that cost €700 per day. It may be more cost efficient to move patients into a hotel once they are clinically discharged rather than have them in a bed costing €700 a day in a hospital. A hotel bed and meals would not cost €700 a day. The Tánaiste may well smile at this suggestion but at least it is a solution that should be examined. We cannot continue spending €700 a day on patients who are not receiving any active level of care.
The hospital care and the community care budgets are guarded by hospitals with great authority. The community care people will not accept somebody from the hospital care budget onto their budget without trying to bring a budget with them. For example, nursing home care is a drain on the community care budget. There is an ongoing war between the hospital care budget and the community care budget. It applies to nursing home beds but also at the level of the cost of taxis. If a hospital refers a patient to another hospital for a procedure and a taxi is required, the community care personnel will insist the cost of the taxi should come out of the hospital care budget and the hospital care personnel will argue it should come out of the community care budget. There is no cohesion between the two groups. They seem to be completely opposed to each other and there is no sense that they are working together. They both guard their budgets.
It seems the five hospitals in the north east are running over budget. Everything is budget-driven, as referred to by Deputy Twomey and it is a question of passing costs to budgets in another department. There is no thought about working together in order to reduce the overall budget. These are real health management issues which should be examined. Programme managers will guard their own territory. Will the Tánaiste and Professor Drumm take some form of action? These issues are at the bottom rung but they should be addressed now and be followed by action on the bigger issues. I agree we need high care and special care beds but we should consider how the existing beds are being managed.
Public representatives are always contacted with regard to medical cards. The cases are often people with long-term illnesses who were previously fit to work and had good, secure jobs, as may be the case for people with MS. They will have contributed to society and to the welfare of their families prior to contracting the illness but they are then struck down. It may be the case that a husband is outside the limit for a medical card. The family will not qualify for one but when the wife with a long term illness applies for a card, she will also not qualify for it. I know of a young man who is trying to develop a business but whose wife who was employed in a well-paid job contracted MS and is now wheelchair-bound. He is working seven days a week trying to better his situation and employing people. Every penny counts in his case. His wife does not qualify for a medical card. I know of another man who has a small 20 acre farm in north County Monaghan with a couple of chicken houses. He is a hard worker with a good work ethos and fills out his accounts properly and because of that he is just over the guideline. His wife is wheelchair-bound and does not qualify for a medical card.
The Government gave medical cards to people over 70 but there has been much negative reaction because some of those people are well-heeled, compared to some children. I ask the Tánaiste to consider a special category of people, those who suffer from a long-term illness and those in wheelchairs. They should qualify for a medical card in their own right as they require care which can often upset the balance of family life. It is often the case that a young person still at school or even a child at national school is being asked to care for their mother. They will not go to a doctor and then their medical condition will deteriorate because they are not looking after themselves. Such people should be automatically entitled to a medical card. I acknowledge a sense of begrudgery existed about the over-70s being given medical cards but nobody would begrudge somebody with a long term illness receiving a medical card.
I will seek to deal with the queries raised by the spokespersons for the Labour Party, Fine Gael and the Independent group.
Deputy McManus asked about the information on page 11 of my script. These were technical, once-off adjustments to the overdrafts of the health boards and to PAYE and PRSI elements for the month of December which were carried over into the following year.
The HSE seems to have a different calendar year to Departments.
No, it has a calendar year which is the same.
Why do we have to wait so long for the HSE to submit its statement of account?
The HSE is allowed until the end of March to produce accounts and this is not unusual. I will ask Mr. Woods, the finance officer, to comment. The true picture of the previous year would not be available before that. This explains why confusion arose over the so-called money in January.
Mr. Liam Woods
Our year-end is 31 December which is the same as the year-end for Vote accounting. The technical adjustments relate to a switch from non-Vote to Vote accounting and are once-off adjustments associated with the introduction of a Vote accounting system within the health system. In terms of the time to report, our statutory deadline for reporting is the end of March and we complied with this, both on the annual financial statements and Vote accounts.
A number of questions were asked about consultants. Last year, 53 additional consultants were appointed to the health care system. I accept what Dr. Twomey said about the extended day. We are probably unique in the world in that our key clinicians are the consultants and they are the most qualified people in the health care system. They give the diagnosis, lead and deliver the treatment. To the best of my knowledge it is a unique situation that they are not employees of any hospital; they are all independent contractors. This is totally unsatisfactory. Consultants will frequently say they work in a certain hospital rather than for it. Somebody recently said to me: "I don't work for that hospital; I work in it", which is incredible.
We need a new contract of employment where the consultants become employees of the big public hospitals and where they work in teams with each other with a clinical director in charge of the team. While the "Prime Time" programme on Monday was shocking and distressing, among the issues it showed was one person who presented with a haemorrhage at 2.15 p.m. and was not seen for four hours. Nothing is more serious than a haemorrhage. Another person with throat cancer was advised to go home. Somebody with a blocked bowel was sent home. We need clinical directors in charge of clinical teams to make sure that such decisions are not made and that people in an emergency are seen in an emergency department.
The contract of employment that our doctors have is essentially a 9 a.m. to 5 p.m. contract. That is not to say that people work only those hours. Some people work well into the night and are there at weekends, etc. However, they are not contracted or rostered to do so. If they do so they are paid on an emergency basis, which is not a satisfactory way to run the health care system. We need contracts of employment with all the key staff in our health care system, particularly in the hospital system, but also in primary care, where services are available to the public on a 24-hour basis. This does not mean that people need to work for 24 hours or anything like it. We want people to have reasonable working conditions and a normal working pattern.
However, we need people working in a team in order that somebody from the team is on duty when they are required. This is why there is a huge divergence between what is called the "trolley count" at 8 a.m., because the patients have been there overnight, and the trolley count by the time they have been seen by consultants who can decide that certain people do not need to remain and can go home. We need 24-hour medical cover — as is the case in all the best hospitals in the world. I was in three such hospitals in the United States last week.
We often hear criticism of hospitals in the United States. These were three big university teaching public hospitals with 24-hour cover. They have substantially more consultants than we have. We could not have 24-hour cover at the moment with 4,000 junior doctors and 2,000 senior doctors. We are paying more than €200 million per year on overtime to junior doctors. It is not a productive use of the resource.
Are they new consultant posts?
The 53 are new posts in 2005.
They are brand new posts.
Seven new posts in the hospital in Blanchardstown alone were approved last year. This year——
Has the number of junior hospital doctors reduced? If the Tánaiste wishes to change the ratio, is it proposed to keep the number of NCHDs and add on consultants?
The plan is very much subject to a new contract with both. The working time directive needs to be implemented. As Deputy Twomey has acknowledged, it should have been implemented in 2004. The plan is to reduce the junior doctors to approximately 2,000.
I know that. However, has this been done for new consultant posts or will the number of consultant posts be built up? I am trying to figure out how it is being done.
We are not reducing the number of junior hospital doctors, as we have not reached agreement with the IMO on their working time. That has not begun to happen. I hope we will reach agreement on both the consultant contract and the contract with the junior hospital doctors later this year. Clearly the contract needs to be flexible to meet the needs of our health care system, both on the hospital side and in commitments to primary and continuing care. Many consultants work in the community-based system, particularly those who work with elderly people or with psychiatric and other patients.
This year seven new consultant posts will be filled in neurology and neurophysiology, which will greatly assist. I accept what Deputy Connolly said about the excessive waiting times to see a neurologist in our current system.
Deputy McManus asked about the health levy. Some €20 million was lost——
The Tánaiste referred to seven additional neurologist posts. Where will they be located?
Seven have been approved for this year. I do not believe they have been appointed yet. Perhaps somebody from the HSE might be able to assist me in advising their location.
Some €20 million was lost in the levy from the over 70s to the Health Vote. Some €350 million has been allocated for new services as follows: €110 million for the elderly; €130 million of €140 million for the disability sector; and €100 million for hospitals, including the opening of new units and their staffing in Cork, St. Vincent's and Tullamore. Some 70% of health spending goes on pay and salaries. Some 16% goes on the drugs bill. That is a rising cost and we are in negotiations with the pharmaceutical sector in that regard. Even though our per capita spend on drugs is low by international standards — certainly when compared with the United States — it is rising very rapidly and is of major concern.
On the question of private beds, Deputy McManus said that the hospitals get between €200 million and €250 million form the insurers. Those beds cost the hospitals €600 million, leading to a shortfall of €350 million. They are heavily subsidised. All the nursing staff and the administration are paid through the public system. I want people to get access in our public hospitals on the basis of medical need and where no staff member has an incentive to take one patient instead of another. It is not possible to have equitable access when a particular staff member, in this case the consultant, is the only one to get paid additional money for seeing private patients. Nurses, paramedics, etc., do not get paid for treating private patients. Uniquely, consultants get paid a fee for seeing private patients in our public hospital system even though the infrastructure has been funded 100% by the taxpayer and the beds are heavily subsidised by the taxpayer.
Our public hospitals have 2,500 such beds. My plan is to reduce that by 1,000 and to have those beds provided and managed by the private sector. At present, on average, it costs €1 million in capital to provide a hospital bed. Under this proposal it would cost less than half that amount. Instead of 1,000 beds costing €1 billion they would cost no more under this system depending on the tax arrangements. The maximum they could cost is €420 million. I cannot see a more cost-effective way of providing additional capacity to the public system. I understand the HSE will advertise for expressions of interest later this week or next week and that a number of hospitals are interested.
The HSE can use this proposal to negotiate particular flexibility on hospital sites around the needs of the public hospital system. This is all about complementing and supporting the public hospital system. Clearly the land will need to be either sold or leased — it will not be given to anybody for free. Perhaps the private hospital might purchase diagnostics from the public system or vice versa. The idea is to have flexibility at ground level. For example the doctors in Waterford have said that they have 70 private beds which they will convert to public beds. They will provide services to those public patients and will fund the equivalent number of beds on the site. That will result in 70 extra beds where the consultants are committing to staff those beds and providing services to the patients occupying them.
How will private patients be prevented from using public beds? Some 70% of patients come through accident and emergency units. Will the hospitals stop private patients occupying those beds?
We will not stop anyone, but we will not give preference——
In that case the money could be lost.
Most private patients end up in public beds in a hospital, but their doctors get paid for them.
Exactly.
If a private patient ends up in a public hospital the consultant will get a fee for that patient regardless of whether he or she is in a private bed. I recently described this as being akin to travelling on an aeroplane where certain passengers could be classified as business-class passengers regardless of the seats they occupied and the pilot could get the fee for them, which would be crazy. That is what happens in our public hospital system.
I want everyone to be able to gain access. Everyone is entitled to access to our public hospitals and should have access on the same basis. The public hospital system should not be in a position to take one patient ahead of another patient perhaps because he or she can pay a fee to one group of workers within that hospital. It is not fair or equitable and is unique. If it happens anywhere else in the world nobody has brought it to my attention. We will have more beds. This is a cost-effective way of providing more beds.
If we look at our bed capacity, we will see we have more beds than Finland or Sweden. If we factor in the population difference with the UK, we will see we have more beds than the UK. Finland and Sweden put more people through the system than Ireland does, even though they have fewer beds. The point I am making is that it is not necessarily about numbers of beds — it is about how those beds are used. There are some great examples in this country of beds being used very efficiently. I accept that there are issues with continuing care in the Dublin area, in particular, and in some other places. I also accept that our efforts to improve facilities in some of our community hospitals will result in fewer beds being available. We have to move away from the Florence Nightingale type of ward. I saw 28 patients in one ward last year — there was not even room for a wardrobe. As we seek to change those conditions, there will probably be fewer beds in each facility. We have recently been acquiring that capacity in the private sector.
Can I interrupt the Tánaiste on that point? I am interested in what she said about the proposed private hospital in Waterford. It is important that we participate in the debate in this matter.
Sure.
The Tánaiste has spoken about consultants getting money for private patients, but the reality is that a consultant might get €290 or €300 for looking after a private patient over a five-day stay, whereas the hospital might get between €5,000 and €10,000 because of the use of the operating theatre, the bed, the room and other facilities. That huge income will disappear out of the public sector when these private hospitals are built. As the new private hospitals will be owned by private enterprise, they will not contribute to what might be called the stock of the nation. I wonder whether we have done our sums in this regard. If we borrowed that money in order that the hospitals could be built by the HSE, thereby building up the stock of what is actually owned by the health service, would we be better off than we will be after the Tánaiste has given €420 million to private investors? This is not an ideological argument — I have no problem with the private sector building on greenfield sites — but I wonder whether this is the best possible use of State properties.
The Tánaiste said that the consultants in Waterford Regional Hospital are quite happy to give up their private beds when the new private hospital is constructed on the regional hospital's grounds. Every time she discusses this matter, she says that the doctors who will work in such private hospitals will not be the consultants who are currently working in our public hospitals. The Tánaiste has always referred to public only contracts, meaning that the doctors in the private hospitals will have to work exclusively in the private sector and not in the public hospitals. Therefore, we can assume the doctors who will work in the new private hospitals will be private consultants. I cannot understand why the consultants who work in Waterford Regional Hospital will be giving up their private beds if they are, technically, not supposed to be working in the new private hospital and any new consultants appointed to Waterford Regional Hospital are, technically, not supposed to be working in the new private hospital.
I will discuss what will happen when the new private hospitals are built on the grounds of public hospitals. If, as the Tánaiste is implying, there will be contracts other than public-only contracts, the category 1 contracts which are in place at the moment will be continued. Private consultants will look after their patients in the private hospitals from 9 a.m. to 5 p.m. and the public patients will be looked after by junior doctors in the public hospitals. That will mirror what is going wrong in the system at present. The private patients in the private hospitals will be looked after by untrained and unsupervised doctors at night. The public hospitals will continue to rely on the system as it is in place. If the policy being proposed by the Tánaiste is to be implemented on the same basis as category 1 contracts are currently being implemented, I cannot see that it presents any advantages to patients or taxpayers.
The Tánaiste's comments this morning — that the new private hospitals will be staffed by private-only consultants — do not reflect what she is saying publicly. It seems that taxpayers are to be asked to forgo €440 million in lost taxes, that we will give incentives to private sector interests in the form of the transfer to them of State lands and that income will be lost to the public sector on foot of changes in the care of private patients. We need to be clear about where this policy is going. We also need to be clear about what the Tánaiste is actually doing with the consultants. The Tánaiste is trying to imply that she is somehow pursuing this policy to improve the services for public patients. From what I have read, however, I do not think this policy will be good for public or private patients. Under the Tánaiste's policy, consultants will have the same sweetheart deal tomorrow as they had yesterday. We need to clarify exactly where this policy will end up before we allow the HSE to throw out contracts and give away State land.
I do not know how often I have to explain this policy. The Deputy referred to foregone tax of €420 million or a similar sum. The people who will make investments in this instance will probably invest in other properties if they do not make these investments. Many Irish high income earners use tax-based incentives to minimise their tax liabilities. Some of them invest in this country and many of them invest abroad. Some €8 billion of Irish money will be invested outside the country this year. I do not accept the idea that €420 million will be taken from the tax base in this way. If the people in question are not investing in hospital-based tax proposals, they will invest in some other tax proposal or make an investment outside this country. The figure of €420 million is the maximum this policy will cost, taking into account the tax. The capital infrastructure needed to provide those beds would cost approximately €1 billion.
The current contract of employment for consultants will last the lifetime of the current stock of consultants, up to 1,000 of whom have been employed in the last 12 years and will be in the health care system for another 25 years. It is clear that the contract of employment could be broken, but I do not believe it is a realistic option because those involved would have to be heavily compensated. The only other way of bringing about change in this regard is by negotiation and I hope the negotiations in which we have engaged will resume.
I would like a contract of employment to be put in place that ensures that any patient in a public hospital that is funded by taxpayers is not worth more to consultants than another patient in the same hospital. There is such a contract in many other countries and works extraordinarily well. It is in place in the United States, where hospitals get money from insurers and consultants get a particular salary and may get a bonus depending on performance. Under such contracts, it is certainly not the case that one patient is worth a fee and another is not. Such a system would not be equitable and I want to ensure we have a contract that avoids it.
Deputy Twomey also spoke about staffing. I hate to keep using the example of Waterford, but I understand that the application in Waterford would come from the consultants and the management — it is not just about the consultants. The reality is that the consultants in Waterford have category 1 contracts — perhaps some of them have category 2 contracts. When a new private facility opens in the region, which is due to happen this summer, I would prefer to see the consultants working on the hospital grounds. The whole idea is that the two facilities will be integrated. It is not planned that they will be run as separate operations. In other words, if it does not suit the public hospital, the HSE should say it is not interested in the proposal. If it suits the public hospital, the HSE should say it is interested. There are consultants working in a private facility on the grounds of St. James's Hospital, which is one of the most effective hospitals in the country.
That is just an outpatient facility.
There is a private wing in St. James's Hospital.
There is a private wing, but the consultants are on the site of the hospital.
That is exactly what I am saying. It works extremely well.
It is not a separate facility. It is like what is in place — there are private and public beds in the same facility.
The Tánaiste just argued against herself by saying that it works well in St. James's Hospital.
It works well in St. James's Hospital and they want to build another new facility there.
I would applaud the objective of ensuring that all patients are equal, but the Tánaiste's plans will make them even more unequal. This proposal will mean that public patients will have no choice, whereas private patients will have a choice between going to public hospitals and going to private hospitals. Private hospitals will have a completely different objective, which will be to make money for their investors.
It will not be a question of comparing like with like. Private beds in private hospitals will not be the same as private beds in public hospitals. The motivation for running private hospitals will be completely different to the motivation for running public hospitals. Private patients will have a choice between public and private hospitals. The freeing up of beds that has been suggested by the Tánaiste will not take place. There will not be equality between patients — if anything, there will be greater inequality.
The points made by Professor Drumm, who implicitly criticised this proposal, are valid. He suggested that people will have a choice between going to nice and beautifully decorated private hospitals and going to HSE hospitals, rather shamefacedly in his words. The old dispensary model at primary care level is being introduced to the acute hospitals sector for the first time. The aim is laudable but this is not the correct approach.
The practice by which taxpayers fully fund private beds in public hospitals at a cost of €1 million per bed per annum and one group of workers in the health care system, who are not even hospital employees, receive a fee for treating patients in these beds should not be allowed to continue.
The HSE gets most of the income from private beds.
Let us take the example of Tallaght Hospital, where 46% of elective work last year was on private patients. This figure does not reflect the catchment of the hospital or the throughput of its accident and emergency department which has a public-private ratio of about 70:30. Why is 46% of elective work carried out on private patients? The reason is that they are fee-paying. Under my proposals, if private patients end up in a public hospital, they will treated on the same basis as other patients, that is, medical need, and no one will have a financial incentive to choose one patient in preference to another.
The public will lose out.
I know a number of consultants in this city who work in three different hospitals. This is not a good idea and the more we——
It is what the Minister is proposing.
No, public and private hospitals will be located on the same site and the Health Service Executive should only approve any such co-location proposal if it suits the public hospital in question.
The Minister's proposals do not reflect her public statements.
They do.
They are far removed from her public statements. Patient needs should be central but the Minister's proposals discriminate against and endanger public and private patients. Both sets of patients will ultimately fare worse if the Minister proceeds with her proposal to separate private from public practice and allow consultants in public hospitals to work in a private and public hospital on the same campus.
The reason we removed category 2 type consultants was that consultants were not on the grounds of the public hospital. It is of no benefit if a consultant is in a private facility on the other side of the public hospital's carpark. He should work in the public hospital. If the Minister persists with this proposal to allow consultants to simultaneously work in private and public hospitals, at least she should have the new private hospitals built as annexes of the public hospitals as this would ensure that consultants would at least remain within the hospital facility at all times and be available to their junior doctors for public and private patients.
The Minister's plans will result in junior doctors trying to sort out major problems in the public hospital from 9 a.m. to 5 p.m. because the inequalities to which the Minister referred will persist and consultants will continue to provide care for private patients in the private facility. Private hospitals do not accept serious cases and have lower levels of nursing and medical staff. In addition, doctors are not usually supervised because they are not in training posts, which sometimes results in variations in quality.
The Minister will consolidate the inequalities in the health system we are trying to eliminate. She should change her policies before she makes a complete mess of the health service. If, however, she chooses not to introduce public-only contracts and opts instead to retain the category 1 type consultant contract, she should ensure that private wings are built as annexes to public hospitals.
While arguments can be made on the issue of tax breaks and the loss of income to public hospitals, the current proposals will have a disastrous effect on patient care and perpetuate the very problems the Minister claims to be trying to remove from the system. If additional beds are to be made available in public hospitals, extensions or annexes should be built to allow consultants to see private patients in the same building. This would mean that a junior doctor who encounters a problem with a public patient will be assured his consultant is nearby rather than looking after patients in a private suite on the other side of the carpark.
Private patients will not be able to sleep as well at night knowing that levels of staffing in the private facility are lower than in the public hospital. They would be better off in a private wing of the public hospital because senior registrars in training, specialist registrars and senior house officers with considerable experience would be available nearby if they needed care. This is the way the system operated in the old Meath Hospital, which had an east wing for private patients. Junior doctors and consultants could walk from the main hospital to the private wing to provide patient care.
The Minister proposes to give away State land. Ideology does not enter the equation because the investors she is trying to attract would be as happy to build on greenfield sites as on the sites of public hospitals, as occurred in the case of the Beacon Clinic, Hermitage and Blackrock Clinic. The Minister's proposals are bad public policy and must be reconsidered.
On Vote 39, subhead E — Inquiries — the inquiry into the circumstances surrounding the death of Mr. Pat Joe Walsh is not listed. Will further legal costs accrue in this case? What percentage of the Department's budget is allocated to legal matters?
With regard to the Crisis Pregnancy Agency which features in subhead F, the Minister will be aware of recent controversy concerning CURA. As part of the Crisis Pregnancy Agency's service agreement, CURA agreed to distribute Positive Options leaflets but reneged on the agreement. Did the Department recoup any of the €600,000 the Crisis Pregnancy Agency provided for CURA for this purpose? If not, is it intended to recoup these moneys?
To conclude on the earlier points, Deputy Twomey should note that many hospitals are spread over several buildings. If the argument is about having everything in one building, it has no basis. The issue is how one finances additional beds and increases public capacity.
Deputy McManus asked about the Department's role in the re-organisation. Its role is one of making policy, setting standards, participating in the legislative process, deciding on the budget available, negotiating with the Department of Finance, dealing with international relations and so forth. I accept that in health, as in many other areas, the operational and policy sides must work hand and glove. Many policy decisions will be made on foot of advice from those who are operating frontline services.
The Department and the Health Service Executive are working well together. These are early days as the HSE has only been legally established since 1 January 2005. While issues arose when assembling the management team and these created some delay, the relationship is working well. Meetings between senior officials of the HSE and Department take place almost every week. I have a meeting with Professor Drumm and the chairman of the HSE twice every month, once when we attend the Cabinet sub-committee and a second time to discuss policy and other issues. It is planned to continue to hold these meetings for the foreseeable future.
The allocation for the HSE legal costs this year is €25 million. The report on the death of Mr. Pat Joe Walsh has been presented to the HSE but I have not yet had sight of it. I gave a commitment to the family when I met them that the report would be discussed with them before publication and I understand these discussions will take place this week. The HSE intends to publish the report quickly thereafter.
In October, when the report into the death of Mr. Pat Joe Walsh was commissioned, Members were informed that it would be published within eight weeks and willingly accepted this timeframe. It is now mid-May and the HSE received the report at the beginning of this week. For how long will the HSE and the Walsh family, who should have access to the report prior to publication, consider the report? The Minister indicated it would be published quickly. Will she be more specific?
That is a matter for the HSE but I understand the family will receive a copy of the report this week. They may wish to have a couple of days or a week to study it or consult advisers, after which the report will be published immediately. I believe it will be published in the next week.
It will be published within one week.
That is my understanding, subject to the wishes of the family.
The board of the Crisis Pregnancy Agency recently wrote to CURA regarding the issues raised by Deputy Fiona O'Malley, including the distribution of Positive Options, and I understand it awaits a response. Clearly, it is important that any agency being funded provide the range of services expected on foot of that funding.
Deputy Connolly raised issues concerning continuing and long-term care. There are such issues and the real challenge is to provide appropriate care for older people, particularly more home-based and community-based supports. This is why a substantial increase was given to the HSE this year for care of the elderly. It is provided particularly for putting in place a range of professional expert services, such as chiropody and physiotherapy services, at community level to facilitate people living at home. These services, in addition to family supports, are extremely important if we are to facilitate older people who wish to live in their communities.
The ten-point plan was raised by a number of Deputies.
I actually made a suggestion to the Minister regarding the resource base available on a particular campus where day services have already been moved.
I will ask the HSE to examine the issue being raised in respect of primary, community and continuing care. I am not in a position to say whether it is a good idea.
The Minister will ask the HSE to do so.
I will ask it to consider the suggestion.
Will we solve the problem of interdepartmental rows over budgets? It is a real issue.
Now that we have a unified organisation, there is a hospital budget and a primary, community and continuing care budget. We must ensure that the HSE's incentive process operates effectively such that there will be no disincentive for a hospital to move a patient to a long-term facility, or vice versa.
There are two entirely separate budgets.
That is a matter for HSE management.
It is also a matter affecting the public, who are suffering the consequences of interdepartmental rows over budgets.
We now have a single entity and a clear line of management and I am therefore confident that some of the issues that arose in the past in respect of the funding of services can be avoided in the future.
I mentioned the issue of medical cards for people with long-term illnesses.
I said here before that nothing has been added to the long-term illness card since 1978. The card must be examined in the context of the significant legislation to clarify people's entitlements, which is being drafted in the Department of Health and Children.
Hardship cases arise from time to time even among those with incomes in excess of the medical card threshold. On the last occasion I looked at the figures, I noted that some 70,000 patients had a medical card based on particular hardship. The HSE has flexibility in hardship cases and the case the Deputy mentioned should be examined in this context.
On the ten-point plan, the second MRI scanner in Beaumont will be commissioned at the end of this year. In the meantime the hospital has available to it the services of a private provider. On acute medical units and minor injury, chest pain and respiratory clinics, St. Vincent's Hospital will have a clinic in place in June of this year and Beaumont Hospital is developing one. Tallaght Hospital opted for what is known as a transit ward instead and the issue of the acute medical unit is being discussed with it. The high-dependency beds have been acquired. We were not able to get 100 of these from the private sector so patients were moved from some of the public institutions into the private sector. I believe we acquired 48 in the private sector and the balance was provided in the public system.
We have facilities for 500 people to receive intermediate care, of which over 300 people have availed so far this year. In the majority of cases there is a period of six weeks between acute hospital treatment and returning to one's home or to long-term care. Some 560 people availed of the intermediate facilities last year. The hygiene audit and the second audit were completed recently. Some 500 additional home care packages were provided last year, and this year the number will be trebled from 1,000 to 3,000. People will benefit from this.
On GP services in north Dublin, the HSE told me yesterday the relevant services will be up and running on 1 September. It is very optimistic that this deadline will be met. I hope we have moved on from the experience of the Deputy when the service was established in his region.
I hope so.
Additional palliative care beds were opened recently at Our Lady's Hospice, as were other services, which I opened. Six additional beds were opened at Blackrock Hospice, which was part of the ten-point plan. The HSE has made provision for direct access by general practitioners to diagnostic services and this is being enhanced this year.
I asked three questions which the Minister has not broached. No reference was made to future general practitioner numbers or the consultant contract talks of 2001. Michael Kelly remarked that the extended working day would not be feasible.
I do not know about those talks but if we had a blank cheque to hand every group to meet their wishes, we would never have difficulties sorting anything out.
The Minister should be honest. It transpired that this committee supported the extended working day and a change to the consultants' contract. The Irish Hospital Consultants Association said this was tangential and it was rejected by the Secretary General of the Department of Health and Children. I presume this was in the presence of a Minister but, if not, a Minister would at least have been informed. If the proposal is to be pursued, with the support of this committee, we at least have a right to know if it was considered and rejected by the Department, without our receiving a statement about throwing money at people. There is no point in my supporting the Minister in negotiating the consultants' contract if the proposal has already been discussed and rejected by the Department.
The Estimate pertaining to BreastCheck in 2006 is 30% greater than that for 2005. Is the roll-out of BreastCheck in the west on track for the early part of 2007?
Yes.
I am not familiar with the discussions that took place between the former Secretary General at the Department of Health and Children and representatives of the Irish Hospital Consultants Association but if a good offer had been on the table it would not have been rejected. There would have to have been very good reasons for rejecting it. I am not familiar with the details of the proposal in question and, in fairness to the then Secretary General, the matter would have been cleared by the then Minister for Health and Children.
I would love there to be more training for general practitioners but the college was not in a position to provide more training places. Unfortunately, it could only provide 17 additional places this year. If the trainers cannot provide the training, we must consider other options.
The last time I appeared before this committee, Professor Drumm mentioned that a number of qualified general practitioners are not in a position to get a general medical service contract because of an agreement reached in the past. This must be revisited. I have met three different doctors in the Dublin area who are available but who are precluded under the current agreement from participating in the general medical service. This does not make sense when there is a shortage.
Is that part of the negotiations?
I am sure it would be but I do not even know whether——
I do not believe it is.
We promised to conclude by 11 a.m. and therefore we must adjourn.
I thank the committee.
I thank the Minister and her officials for attending.