Dáil Éireann Debate, Thursday - 28 October 2004
162 Mr. Durkan asked the Tánaiste and Minister for Health and Children if she has satisfied herself that the general public have adequate and unimpeded access to the health services; if she proposes to address the issue; and if she will make a statement on the matter. [26607/04]
Amharc ar fhreagra172 Mr. Durkan asked the Tánaiste and Minister for Health and Children if she has identified the reason for the poor delivery of health services with particular reference to access to hospitals; and if she will make a statement on the matter. [26620/04]
Amharc ar fhreagraI propose to take Questions Nos. 162 and 172 together.
A core objective of the health strategy is that all people should have access to high quality services. Priority will be given to supporting those who need to access the health service they require and I will address the provision of health services from this perspective with particular emphasis on the implementation of the current reform programme.
As regards general eligibility for health services, it is the case that under the Health Act 1970, the determination of eligibility for health services is based on residency and means and is primarily the responsibility of the chief executive officer of the appropriate health board.
Persons in category 1 are medical card holders and they are entitled to a full range of services including general practitioner services, prescribed drugs and medicines, all in-patient public hospital services in public wards including consultants services, all out-patient public hospital services including consultants services, dental, ophthalmic and aural services and appliances and a maternity and infant care service. Persons in category 2, non-medical card holders, are entitled, subject to certain charges, to all in-patient public hospital services in public wards including consultants services and out-patient public hospital services including consultants services. The current public hospital statutory in-patient charge is €45 per night, up to a maximum of €450 in any 12 consecutive months. Attendance at accident and emergency departments is subject to a charge of €45 where the patient does not have a referral note from his or her doctor. This charge applies only to the first visit in any episode of care.
In regard to acute hospital services, the target set out in the national health strategy states that by the end of 2004 all public patients requiring admission to hospital will be scheduled to commence treatment within a maximum of three months of referral from an out-patient department. Intermediate targets have been set to achieve this aim to ensure that the focus is being turned towards those patients waiting longest for treatment. In accordance with health strategy objectives, the Government's immediate focus is on the reduction of waiting lists and waiting times for in-patient and day case treatments in acute hospitals. This is being particularly facilitated by the National Treatment Purchase Fund, NTPF.
The NTPF has reported that waiting times have fallen significantly with 37% of patients now waiting between three and six months and 43% waiting between six and 12 months for surgery. Some 80% of patients now wait less than one year for surgical treatment. This represents a major reduction in the length of time patients have to wait. The NTPF has been successful in arranging treatments for approximately 19,000 patients up to the end of September 2004. It is now the case that, in most instances, anyone waiting more than three months will be facilitated by the fund.
Many of the difficulties and delays experienced in emergency medicine departments reflect the system-wide issues. Therefore, in tackling the problems in emergency medicine departments it is necessary to take a whole system approach involving primary care, acute care and sub-acute and community care. Following a submission from the Eastern Regional Health Authority, ERHA, in June 2004 my Department approved proposals for short and medium term actions to be taken to address the problems associated with emergency departments in the Dublin Academic Teaching Hospitals, DATHS. The cost of these new initiatives is €2.4 million in a full year. Areas covered include the appointment of specialist nurses, the establishment of rapid assessment teams, a clinical decisions unit and the provision of multi-disciplinary teams to assess patients.
Pressures on the hospital system, particularly in the eastern region, arise from demands on emergency departments and on difficulties associated with patients who no longer require acute treatment but are still dependent. Funding of €16.8 million has been made available to the ERHA which has resulted in some 520 patients being discharged and work is ongoing to facilitate the discharge of a further 80 patients. Increasing acute bed capacity will also have an impact on the delivery of emergency services. As a result of the bed capacity initiative and the commissioning of new units, which was announced in September, funding is now in place for an additional 900 beds in the acute hospital system.
In line with the objective set out in the health strategy to broaden the eligibility framework, the Government is fully committed to the extension of medical card coverage. This will focus on people on low incomes. The timing of the introduction of the extension will be decided having regard to the prevailing budgetary position. For those who do not qualify for a medical card there are a number of schemes that provide assistance towards the cost of medication. Under the long-term illness scheme persons suffering from a number of conditions can obtain the drugs and medicines required for the treatment of that condition, free of charge. Under the drug payments scheme, a person and his or her dependants will not have to pay more than €78 in any calendar month for approved prescribed drugs and medicines.
Health board chief executive officers have discretion in relation to the issuing of medical cards and a range of income sources are excluded by the health boards when assessing medical card eligibility. Despite someone having an income that exceeds the guidelines, a medical card may still be awarded if the chief executive officer considers that a person's medical needs or other circumstances would justify this. It is open to all persons to apply to the chief executive officer of the appropriate health board for health services if they are unable to provide these services for themselves or their dependants without hardship.
The health strategy includes a whole series of initiatives to clarify and expand the existing arrangements for eligibility for health services, including recommendations arising from the review of the medical card scheme carried out by the health board CEOs under the PPF which include: streamlining applications and improving the standardisation of the medical card applications process to ensure better fairness and transparency; providing clearer information to people about how and where to apply for medical cards; proactively seeking out those who should have medical cards to ensure they have access to the services that are available.
In addition, my Department is committed to the preparation of new legislation to update and codify the whole legal framework for eligibility and entitlements in regard to health services. Since the publication of Primary Care: A new Direction, significant progress has been achieved on many fronts in the development of an integrated, multi-disciplinary and team based approach to the delivery of primary care services. Initiatives included the establishment of a primary care task force, national primary care steering group, primary care implementation projects, further research and wider implementation of the strategy.
In June 2003 the Government introduced thehealth service reform programme, HSRP,based on system reviews which identified various needs, such as clear focus on service and management, less fragmentation, more accountability and better information, for modernisation in line with the health strategy. The work currently underway to implement the reform programme will combine to enhance nationwide access to health services with the overarching objective of providing higher quality delivery aimed at ensuring a healthier community.
