On behalf of the select committee I welcome the Minister for Health and Children, Deputy Harney, and her officials. We are meeting to consider the Supplementary Estimate for the Health Service Executive, Vote 40. A proposed timetable has been circulated for the meeting allowing for an opening statement by the Minister and brief statements by Opposition spokespersons, followed by an open discussion and a question and answer session. Is the timetable agreed? Agreed.
Vote 40 — Health Service Executive (Supplementary).
Thank you. I thank the committee for facilitating the meeting. Its purpose is to agree a Supplementary Estimate for the repayment scheme. The 2008 Estimates provided for €150 million towards the cost of the repayments but that sum has been exceeded by approximately €77 million. Currently the HSE has 841 cases where agreement has been reached and we want to make the payments.
Some 40,000 of claims have been processed under the scheme and 19,167, or just under 50%, are valid. Some 8,693 of those are in respect of people who are still alive while 10,474 are in respect of the estates of deceased persons. To date, 18,053 have been offered compensation and 13,597 claims have been completed. The total cost of the scheme will now be €391 million, of which €366 million goes to the individuals and €25 million are overheads. Some €15 million goes to the scheme administrator and the balance to advertising, the appeals office, staff and administration.
The average payment is €20,000 per claim and I would be very grateful to the committee if it were to agree the Supplementary Estimate so that payments can be made. All claims will be concluded in 2008 and approximately €23 million will fall due to be paid next year and will be provided for in the 2009 Estimates to be published next week in conjunction with the budget.
The Fine Gael spokesman is delayed and I will not presume to speak on his behalf but I do not think there will be any problem in passing this.
I welcome the Minister. The Labour Party does not have a problem with this Estimate either, as it is money which is due to people and needs to be paid. I will, however, ask a few questions. The Minister said there was €25 million in overheads, including €15 million to the scheme administrator, which I presume from the briefing document is KPMG-McCann Fitzgerald. It seems a great deal of money to pay to a body outside the HSE when there are already many administrative people within the HSE. Why was it necessary to engage an outside firm at a significant cost to the taxpayer to administer the scheme? The Minister said recently that there have been too many people in the administrative layers of the upper levels of the HSE since the 11 health boards were combined. Was it not possible to do this from within the HSE, rather than spending extra money that could have been used in a variety of areas? People say that their home help hours have been cut and there are a variety of areas in the health service in which this €15 million would have been very useful.
Did we get value for money in this case? I tabled a question to the Minister when there was a — possibly erroneous — report that somebody had been telephoned directly by KPMG and put under pressure regarding the fund. KPMG seems to have been involved in only limited administration as much of the work was done by HSE staff. What did KPMG do for that money and why was it necessary to employ the company?
We are now agreeing a Supplementary Estimate of €77 million. A sum in excess of that relating to the fair deal scheme money was taken back from the Department in the cuts earlier in the summer. I am delighted to see another €77 million coming into the Department of Health and Children and I hope the Minister will secure as much as possible for health services in the forthcoming budget. The Department suffered the biggest cuts earlier in the summer. Was it not possible to see that this money would be needed and to hold on to the fair deal scheme money for this purpose?
I take it the Chairman will not allow us to stray into wider issues.
Certainly not.
I thank the Minister for outlining how things stand. I fully support the Supplementary Estimate but wish to raise two small points about the scheme. There is sometimes need for more clarity for claimants who were transferred from a public hospital to a private nursing home by the area health board. There is some confusion on the part of relatives as to their entitlement in such cases.
Public representatives received a stereotyped letter telling us that the data commission had ruled we were not entitled to information about the scheme. In a complex scheme such as this, if the immediate next of kin comes to us as the claimant there is a case for giving more information to Oireachtas Members, though I understand there are good reasons for denying information when another person, such as a neighbour, asks for it.
I want to raise the same points as Deputy O'Hanlon. People who were in a private nursing home but whose financial position was exhausted and were moved to a public nursing home are now being refused repayment on the basis that they are not entitled to it. The administrators are not providing the next of kin with any detailed information as to why that is the case.
The Committee on Procedure and Privileges invited the Data Protection Commissioner before it. He made it clear to members that once a public representative made representation there was an inference that the confidentiality aspect was looked after. We discussed replies we received from the Health Service Executive at the time and the Data Protection Commissioner clearly stated that we, as public representatives, were entitled to the information because if we were making representations there was a clear inference that we were asked to do so. That point seems to have been missed by the committee and, as Deputy O'Hanlon indicated, we receive a stock reply that the matter is none of our business and that the information is confidential. We raise more confidential issues with Ministers and the Health Service Executive to which we receive detailed replies that are of great assistance to our constituents.
I do not wish to be repetitive and to waste time. However, like previous speakers I find it difficult to deal with the administrators of the scheme. Many letters come back without a signature. I raised the matter by way of parliamentary question and I wrote to the Minister's office about the fact that there is a scribble and then "scheme administrator" is printed under that with no contact details. In other Departments that is in breach of regulation. Despite the fact that I raised the matter as outlined, the practice continued up to recently. The most recent letter I received had a signature. In addition, the response indicated that the information was of a confidential nature.
Recently, an individual was informed that his claim had been rejected but even with my familiarity with departmental correspondence I found it difficult to understand the reasons the claim was rejected. There is a lack of transparency. As Chairman of the Committee of Public Accounts, and like Deputy O'Sullivan I have reservations about the fact that we hear many people at senior level in the Health Service Executive do not know what their job is. It is beyond comprehension that they are being paid while €15 million is allocated to a private company to administer a scheme.
I will not go back over what has already been said. My point has already been made by Deputy Allen, that people found it very difficult to understand the reasons they were refused. That is why numerous people came to our offices, yet even when we tried to get information, we were not able to ascertain the reasons for the claim refusal or to help them. There is a need for more clarity.
Deputy O'Hanlon referred to patients who were transferred to private facilities through no fault of their own and not by choice, as no bed was available for them, yet those people seem to be in limbo. I welcome the fact that the claims process is to be concluded as quickly as possible because that money is quite rightly being returned to the individuals concerned or the families of deceased individuals. I have no difficultly in supporting the Minister this morning. I am pleased to be able to do so.
We all join in congratulating the Minister and everyone involved in the disbursal of the funds to date. We look forward to seeing the balance of the money paid as speedily as possible.
To echo the points made by members, at the Committee on Procedure and Privileges the Data Protection Commissioner made it very clear that he saw no role for his office in interfering in the normal representational role of Members of this House. It is problematic for all of us if other agencies effectively seek to use the Data Protection Act against Members.
I echo the point raised by Deputies O'Hanlon and Conlon because I am minded of a case in my constituency where a family went to visit an elderly relative at a public hospital, not in my constituency, to find that the relative was no longer there but had been transferred to a private nursing home. In those circumstances it is normal that such families would wonder why they cannot benefit from the scheme.
I will take the last issue first. I know from many public nursing homes that many residents in nursing homes were not known to have relatives until the issue arose, which I suppose is not surprising. Equally, it was predicted here and elsewhere that the cost of the scheme would be approximately €1 billion, and it will come in at approximately 40% of that. One of the reasons is that many people did not claim. I know of people who did not claim because they felt their loved one got very good care. Because of a legal technicality they could have availed of the repayment but decided not to opt for it. We should acknowledge the significant number of people who are happy to support the care they got and not look for their legal entitlements.
It is true that the Data Protection Commissioner does not interfere in representations but his advice was sought and he said that where representations are made the scheme administrator must respond to the person and not to the public representative. The administrators must take on board what the public representative says but they must respond directly to the resident or to the family of the resident. That is not unusual. As Minister for Health and Children I frequently get queries on the medical care of patients. It would be highly improper of any doctor to discuss with me his or her patient. Sometimes it is difficult for people who come to my constituency clinic to understand that I cannot ring their consultant, GP or whoever it may be, to discuss their particular issues. It is important to remember there are difficult issues at stake such as those relating to patient confidentiality in terms of the doctor-patient relationship and wider data protection issues as far as the scheme is concerned.
The administration of the scheme is coming in at 3.75%. I regard that as extraordinarily good value. If the HSE were to do this it would be on an overtime basis, the cost would be substantially higher and it would have clogged up the system.
Can I ask——
Questions have been asked and the Minister is replying to them.
Nothing like this has ever been done before. Huge legal issues are involved. Probate had to be sought in regard to deceased persons. A major legal input was involved as well as an accounting and administration input. The Health Service Executive did not have the wherewithal to do that without securing additional staff or working on an overtime basis. Moreover, I am certain we would not be concluding the scheme this year otherwise. Repayments were made in regard to a different matter a couple of years ago and it clogged up the health boards for a considerable length of time. That is why I asked the Health Service Executive to consider outsourcing some of the support for the scheme. To be fair, it has worked incredibly well.
Regarding the issues raised by Deputy O'Hanlon, on the face of it, the person concerned seems to me to qualify but I am not competent to say that in regard to the individual circumstances. The people who qualify are those who were in public nursing homes, beds contracted by the public health system or those who were in public nursing homes where for whatever reason the nursing home had to close or reduce the number of beds and moved those patients to a private facility. The persons concerned would all seem to me to be covered by the scheme. However, if the Deputy would like to bring the individual case or cases to my attention we would be happy to pursue them.
Everybody who is refused is informed of his or her right to appeal. Of those who appealed, in 82% of cases the appeals officer upheld the view of the administrator. A total of 18% of appeals have been successful. Approximately 5,000 applications were in respect of people who were in private nursing homes under subvention and they do not qualify under the scheme.
In regard to the Fair Deal scheme and the €144 million, the legislation on the Fair Deal scheme will be published tomorrow. The Fair Deal will, hopefully, be passed through the Oireachtas quickly. However, realistically there are time issues to consider given the Finance Bill 2008, which will be debated early because of the early budget, and the Social Welfare Bill 2008. The Fair Deal will be operational next year and when it is in place we will end the inequity between those in public and private facilities. As I have said previously, those in public care had 90% of care paid for and contribute approximately 10%. Those in private facilities paid, on average, in excess of 50% of the cost of their care. This was a highly inequitable situation, it was very unfair and a significant burden for many families. The Fair Deal will deliver equity between public and private care. The support will be based on an individual's means and not based on whether the institution is financed from the public purse, through taxation, or through private investment.
I appreciate the support of the committee for the Supplementary Estimate. It is not the final Supplementary Estimate for the Department of Health and Children this year. The new consultant's contract will be the subject of a Supplementary Estimate later in 2008 when we know the number of people who have signed on for it. I say this in case there is any misunderstanding that this is the end of the issue.
The Minister has concluded.
I welcome that the Minister has announced that the Fair Deal will be published tomorrow. Will it be introduced in the Dáil or the Seanad?
In the Dáil.
I thank the Minister, Deputy Harney, and her officials for attending and for the prompt way in which business has been transacted.