When one considers the overall budget for the health system, it does not appear that there is much scope to develop additional services. The additional increase of 7% does not represent a great deal of extra spending power in 2007 when inflation and wage increases are taken into account. Where has the Department made savings and where does it plan to make savings in order to provide the additional services?
How are home help hours being measured? I received an answer from the HSE to the effect that it had no way to provide me with an accurate figure on the home help hours provided under the old health board structure. Do we have an accurate measurement of home help hours? We were always given the impression that the Minister knew how many home help hours were being provided when we asked these questions at committee two years ago. We have now found out that the health boards were not really sure.
I have looked at the annual Output Statement from the Department of Health and Children on the care of older people. What has gone wrong with nursing home repayments? Why is it taking so long to make the repayments? The Department gave the contract to a private company to speed up the repayments, but it has been over a year since the HSE identified at least 10,000 living people who were entitled to the repayments. I have no doubt that people have written to the Department in significant numbers to inform it of their entitlement to repayment for illegally imposed nursing home charges. People have made contact with me to say that they have twice written to the private organisation appointed by the Department and received no response.
Why are repayments being made into separate accounts? They are not necessarily paid directly to people. It seems an account has been opened which is also in the name of the KPMG consortium. It seems incredibly bureaucratic and has slowed the repayments process significantly. Can the Minister of State explain what has gone wrong? My impression was that KPMG was retained to speed up repayments, which is not what has happened.
Programme 4 relates to care for people with disabilities. One of the output targets for the Disability Act 2005 is the commencement of Part 2 for children from birth to five years of age. I was taken aback by the Taoiseach's speech at the recent Ard-Fheis. He made a commitment that every child under five would receive speech and language and occupational therapy within three months, the standard period set out in the promises the Government is making nowadays. Does the Minister of State agree that to make such a commitment at an Ard-Fheis is to promise the impossible? It is reminiscent of the promise on a children's referendum which the Taoiseach made last November.
Even if therapy were to be provided under the National Treatment Purchase Fund, it would be impossible to fulfil the Taoiseach's commitment within three months. According to a parliamentary reply I have received, there are at least 5,000 children in the Dublin area who are waiting for occupational therapy assessment. Most people will not have understood as they listened to the Taoiseach what exactly he meant. The Minister of State and I know that any child seeking special assistance at school or at home must have a complete assessment carried out before his or her needs can be met.
One of the greatest stumbling blocks to proper assessment is a lack of occupational therapists nationally. If 5,000 children and 3,000 adults are waiting for occupational therapy assessment in the greater Dublin area, the figures when the rest of the country is taken into account may approach 20,000. I have received a number of representations from parents who have become extremely frustrated with the process and the inability to have their children's needs assessed due to the lack of occupational therapy provision. Can the Minister of State make it clear that the Taoiseach's commitment is not achievable within three months no matter what happens?
The HSE is attempting to employ occupational therapists from abroad to make up the deficit, but the problem is also faced by local authorities. Any elderly person seeking a disability grant or a grant for house renovations must also undergo assessment by an occupational therapist. Even where local authorities have sought to have assessments carried out by private occupational therapists, an applicant may still have to wait between three and six months. I would like to know what the Minister of State's thoughts are on the unachievable goal and current provision? Does the Minister of State consider the output target under the Disability Act 2005 to be achievable or realistic?
Programme 5 relates to mental health services. No real additional funding has been provided for mental health services according to the figures before us. An increase of 6% will quickly be consumed in pay and non-pay issues. When Bodywhys came before the committee a few weeks ago, it hit on some of the issues. The Revised Estimates refer to completion of the initial development of eight community adolescent mental health teams and the development of a further eight five-person child and adolescent mental health teams. Reference is also made to the provision of an additional 12 beds for persons aged under 16 years, an initial 24 to 32 beds for those aged 16 and 17 years, the completion of the development of 18 multidisciplinary teams and the enhancement of the existing 16 teams. There is also a requirement for an additional 3,000 mental health tribunals under the provisions of the recent Mental Health Act. How will the Department achieve all that development when the money in the Vote is insufficient? Providing such services costs a great deal, and realistic funding has not been made available.
Programme 6 deals with primary care, which on the basis of these figures is probably worse off. The Minister is not being particularly straightforward regarding a great deal of what is happening. Has anyone ever left the Minister's office to inquire at the HSE regarding the 100 extra primary care teams promised on top of those already supposed to have been developed? I do not believe the development of an additional 100 such teams is really happening. The 100 primary care teams supposed to have been developed are also unrealistic. They are not the primary care centres envisaged under the primary care strategy. They are simply virtual teams whereby people are supposed to remain in close contact by means of ICT and regular meetings.
I would like the departmental officials to give us a proper report on what the HSE is doing. Someone is seriously misleading the Minister regarding those primary care teams, which are not a presence on the ground. In my constituency I certainly cannot find the sorts of close connections about which the Minister is talking. There are a few, and even the Taoiseach has admitted that there are only ten primary care centres to show for a five-year strategy. Based on those figures, it seems that development of the primary care teams of which the Minister speaks will simply not happen.
Another interesting issue is that of acute hospitals and associated services. It is quite clear that running acute hospital services costs €4.9 billion per year. I found that interesting, since the Minister will know that I have always been concerned at her plans to co-locate private hospitals. However, I am also concerned about the National Treatment Purchase Fund, NTPF. It is impossible to get any information on it, since although we are suppose to scrutinise services provided by the Department of Health and Children, whenever we ask serious questions regarding the NTPF, we are fobbed off with the excuse that the information is commercially sensitive.
What the Department of Health and Children provides for the acute hospital sector, €4.9 billion, gives a good indication that the NTPF is not providing great value for money. Public hospitals are caring for 600,000 inpatients per year, and almost 600,000 day-case discharges. They are also dealing with 2.7 million outpatient attendances. There are also 1.2 million attendances at accident and emergency departments.
Let us take the budget of €4.9 billion and compare it with the €80 million spent on the NTPF. For every €1 spent by the latter, some €60 is spent on the public health service. The Minister always says that the public health service is not particularly efficient. However, if the NTPF were as efficient as public hospital services, it would care for 10,000 inpatients, 10,000 day cases, and 40,000 outpatients, while dealing with perhaps half that number of accident and emergency department attendances. It is quite clear that the NTPF does nothing of the sort.
Since the Minister will not give us the information on what is her baby, there is a need for someone to conduct a cost-benefit analysis or value for money audit of the NTPF. I know the Minister has tried to portray me as denying the 55,000 who have used the NTPF. However, it becomes apparent that some 80,000 extra people might have been seen in the public health sector at the same cost if the Minister had taken the reforms seriously. Looking through some of the services it provides, one sees such procedures as the removal of moles. Removing lesions or moles is a basic, day-case dermatology procedure, all relatively straightforward. They are certainly not all complex orthopaedic or other major operations. A quite significant proportion of work done under the NTPF is relatively low-cost, and that is what concerns me when I examine these figures. Perhaps the NTPF is not really securing value for money.
I do not have the figures to which the Minister has access, but there are serious concerns. Since one of the highest paid Government-appointed advisers also chairs the NTPF, the Minister should have a serious discussion with that person regarding the value for money that the fund provides. I know the Minister has been responsible for a great deal of publicity in this regard in recent years, but it does not seem to provide the value for money we might have expected. It should be seriously examined, since that is the matter in hand.
Perhaps the Minister might contact me this week with the sort of information she can access quickly. Someone queried me regarding the HSE, which seems now also to pay for cosmetic surgery. Can the Minister tell me how many cases of cosmetic surgery are being dealt with by the HSE and the reason for that?
This is a briefing note for the select committee. It is for the Department of Health and Children. In drawing up the Medical Practitioners Bill 2007, the Minister has changed the way in which postgraduate medical and dental training is administered. The Postgraduate Medical and Dental Board has been subsumed into the HSE, and the Minister has also granted the new Medical Council, over which she exerts considerable influence, control over medical training. I wonder why the Minister should subsume the board into the HSE.
In the list she gave us, a range of other organisations seem to have been reconstituted. For instance, the National Council for the Professional Development of Nursing and Midwifery was established by the Minister for Health and Children in 1999. Will that too be subsumed into the HSE? It seems to have much the same function as the Postgraduate Medical and Dental Board, except that it applies to nursing. The Pre-Hospital Emergency Care Council deals with the training of paramedics and also provides similar services. Will that be subsumed into the HSE? The Minister has established the National Cancer Screening Service Board, but is there a need for it, or should it also come under the HSE?
Like the Minister, I am against setting up new organisations. The only new organisation that I propose for the health service is a patient safety authority. When I speak in that regard, I mean amalgamating the social services inspectorate with the Mental Health Commission, which would give the two more authority than at present and help protect patients. I cannot see any clear reasoning behind some of the moves the Minister has made in recent years or in what she has done when it comes to establishing new organisations while subsuming others into the HSE. There is some concern that medical and dental training might suffer from the relevant budgets now being part of overall HSE funding.
Subhead G2 concerns payments to persons claiming to have been damaged by vaccination. The Minister has provided an estimate of €1,000, but the issue has been with us for some time. The heading covers the payment of compensation to persons permanently damaged by whooping cough vaccination as decided by an expert group established by the Minister in 1977. I have asked the Minister about this on several occasions. She repeatedly tells me that an expert group will report on whether these people are entitled to compensation. The expert group was established in 1977, however. I am not even sure who was Minister for Health and Children at that time, it may have been Charlie Haughey.