Other Questions
6Deputy Micheál Martin asked the Minister for Health the consultations he has held with general practitioners regarding the extension of free care to those with long term illnesses; the expected cost of this scheme; and if he will make a statement on the matter. [24288/12]
Amharc ar fhreagra37Deputy Charlie McConalogue asked the Minister for Health if he has consulted with the Irish Medical Organisation regarding the provision of universal general practitioner care; and if he will make a statement on the matter. [24290/12]
Amharc ar fhreagraI propose to take Questions Nos. 6 and 37 together.
The programme for Government commits to reforming the current public health system by introducing universal health insurance with equal access to care for all. As part of this reform programme the Government is committed to introducing universal GP care within the term of office of this Government. I have established the universal primary care project team which has been tasked with working through the issues relating to the introduction of this commitment. Officials from the Department and the HSE are represented on this project team. The project team has been meeting regularly, approximately fortnightly since February.
The Government has given its approval to the preparation of heads of a Bill to progress the phased introduction of free GP care in line with the programme for Government. I intend that this Bill will be published and enacted prior to the summer recess. It is envisaged that the first phase in the programme will provide for the extension of access to GP services without fees to persons with illnesses or disabilities to be prescribed by regulations under the new legislation. A provision of €15 million was made available in the 2012 Estimates for the first phase of the programme.
I have had preliminary discussions with the IMO and the Irish College of General Practitioners to outline policy in this area. I expect to engage in further discussions with GPs and the IMO at the appropriate time.
This will involve a contractual change in terms of how the Department assesses medical card qualification because up until now it was based on means, not on illness. This change will involve contractual discussions with GPs. The GPs represent the front line in the delivery of care, as the Minister for Health, Deputy Reilly, more than anybody else, will be aware. We are talking about the establishment of primary care units and primary care teams, and the GP will be the focus.
If the legislation is to be published in the middle of this year and enacted thereon, surely there must be some form of discussions and contractual changes with GPs in the country to deliver this new service because it will impact on their contracts.
Would the Deputy raise a question?
I apologise for interrupting. There is a lot of noise coming from the background and I cannot hear the speakers.
Could we get clarity as to whether the Minister intends to sit down on a formalised basis with the IMO and others to tease out the issue of the contractual changes that will be required in the implementation of the first phase of free primary GP care?
In terms of the funding of this roll-out and the fact the Minister is talking about having free GP care available to everybody by the end of the term of the Government, has he analysed the charge on the Exchequer? While we are talking about free GP care for everybody, we are currently, in Kilkenny and Carlow, counting the number of incontinence pads being given to persons in nursing homes. As we speak, they are rationing incontinence pads. I am in favour of trying to make GP care available to as many people as possible, but in the meantime that is what we are doing to the elderly in nursing homes in the State.
That issue of a limit being placed on incontinence pads should never have arisen and that decision has been reversed. It is no longer the case. It was unfortunate it happened, it should not have happened, and it has been dealt with.
On contractual changes, it is not envisaged there will need to be a change to the GP contract to begin the process of introducing free GP care. It is true what Deputy Kelleher stated, that the existing system operates on a means basis. That is why we are introducing legislation to enable us to provide by regulation for certain categories of person to be given a doctor visit card. That is the purpose of the legislation.
We do not foresee that causing difficulties with or any concerns about the contract. What we have seen over recent years with the recession is a big increase in the number of medical cards issued and GPs have taken on that additional work. There is no reason the extension of the doctor visit card should cause any difficulty. I do not foresee that being a problem.
I have had informal discussions. I made it clear to the ICGP from the beginning. I outlined Government policy, the plans we are making and the preparatory work that is under way through the universal primary care project team. I also met the IMO on a couple of occasions recently to outline the preparatory work that is going on. We will be engaging more closely as the legislation develops. We are applying a good deal of pressure to get it through before the summer.
In the context of long-term illness, as far as I can ascertain in research, there has been no long-term illnesses added to the scheme since the mid-1970s. Will there be an extension of the illnesses that will qualify as long-term illness? Motor neurone disease, asthma, bipolar disorder and many others are not part of the long-term illness scheme. In the context of the roll-out of free GP care for those who are on the long-term illness scheme, will there also be an extension?
I have a slight difficulty when the Government talks about free GP care for everybody. Free GP care for everybody sounds great, but the difficulty is there are many who should be entitled to free GP care who are not getting it and the Government is talking about this grand design and plan of rolling it out to everybody. In the meantime, there are people dying of motor neurone disease or many other major long-term illnesses who will not qualify. Will the Minister of State carry out a review of the long-term illnesses and diseases that will qualify for same?
As I outlined, in situations where people are dying, special arrangements are in place to provide medical card cover, details of which have been circulated to all Members of this House.
I accept that.
The Minister of State, please.
Let us be clear about that.
Qualification of diseases.
The Government is committed to introducing free GP care within its term and it will be over a four-year period. The issue is the phasing of that and identifying the best way in order that we can do it in a controlled way to ensure the budget does not run out of control and the system is geared up. We are aware that primary care is underdeveloped. We want to see more GPs involved and more practice nurses and other allied health professionals. We must gear up. That is why it is being phased over a number of years.
There are different ways of dealing with the issue of category of person but we are trying to do it logically and within the budget provided. I accept the point the long-term illness scheme is problematic. It is far from ideal. In phasing in free GP care, we are trying to look at how we can target those not covered currently by a medical card but who are the most sick, and those within the long-term illness scheme are part of that. We will look then at other groups to whom we will extend the free GP care. That is why we are talking about enabling legislation and it is why we will look in greater detail at the nature of the regulations we will introduce, which will enable us to include the greatest number of persons in the greatest need within the budget available to us.
When will the promised costing structure of the proposed health reforms based on health insurance be available? This has been signalled for some time. Can the Minister of State give Members an indication as to when that will be available?
Will the Minister of State clarify the step approach to the roll-out of GP care for all? Is it on a two-step basis - those who currently hold the long-term illness card and then all citizens - or on a category-by-category phased basis? Can she give the House some sense of how many steps there will be towards the ultimate roll-out? Is there a timeframe in which she expects that to be concluded?
On the bigger questions about funding and the model, as Deputy Ó Caoláin will be aware, the Minister, Deputy Reilly, established the UHI implementation group earlier this year. That expert group, drawn from a wide range of expertise in different fields, has been tasked with drawing up a White Paper on UHI, and the aim is to have that White Paper before the end of the year.
Separately, I established the universal primary care project team, which is working through all of the issues involved in developing primary care. It is not only about the introduction of free GP care. It is about all the other elements as well - ensuring there are sufficient allied health professionals in the right places and there is decent accommodation for primary care centres. Work is also being done in respect of the contract. Many different issues are being addressed and one of the most important of these is ring-fencing the budget relating to primary care. The budget in respect of such care has never previously been ring-fenced.
We are going to phase in the introduction of free GP care this year, starting with the category of people to whom I already referred. The budget for this year is €15 million and we expect to have a similar amount next year. We are working through how we might devise the regulations in order to ensure the phasing-in process is done in the most appropriate way. We do not want to become involved in the expensive business of means testing. We are, therefore, taking the approach of identifying different categories, namely, those which contain people who are most sick, and ensuring they will be included in the initiative at as early a stage as possible. The overall timescale will be four years. Everyone will eventually be covered by then.
So it will be more than a two-step process.
It will be a four-step process at least.
7Deputy Brian Stanley asked the Minister for Health if he will provide a guarantee that the decision to close Abbeyleix Hospital, County Laois, will be reversed, that the hospital will be retained and maintained by the Health Service Executive as a facility for older persons in the midlands; and if he will make a statement on the matter. [24202/12]
Amharc ar fhreagraI wish to reassure the Deputy and, more importantly, the residents of Abbeyleix community nursing unit, and their families, that no decision has been made to close the unit. During 2011 the Health Service Executive was considering a proposal to close Abbeyleix community nursing unit. However, following the instigation of court proceedings, it became clear that it was not appropriate for the HSE to make a decision to close the unit without a prior consultation process.
On Friday, 27 April 2012 the HSE issued a statement confirming that it will commence consultation on the planning and provision of services for older people in the midland counties of Laois, Longford, Offaly and Westmeath. I have been advised this consultation process will commence shortly. I understand this will include a proposal to consolidate nine of the community nursing units in the region into seven such units, with the possible closure of Abbeyleix community nursing unit and St. Brigid's Hospital, Shaen. This will involve engaging with residents, relatives, staff, public representatives and other stakeholders. The process will be completed within a period of three months from commencement. Should the HSE conclude that full closure of any unit is necessary, a recommendation to this effect will then be made.
The Minister of State is clearly aware that as recently as Monday last the HSE was still stating that the promised consultation process relating to Abbeyleix community nursing unit and the care of older people in the midlands has not yet commenced. This process was promised last year and it is now May 2012. Nothing has been heard about the process in all of the months that have passed. As the Minister of State indicated, on 27 April last, two days before a second major rally in support of the unit, the HSE advised the process would be commencing soon. We have heard this before and I am of the view that greater certainty is required in respect of this matter. I would also like an assurance to the effect that the process will take place.
Will the Minister of State admit that the policy of downgrading public nursing homes and of closing some is completely wrong and that it must be reversed? When addressing the annual conference of the Irish Nurses and Midwives Organisation, INMO, the Minister, Deputy Reilly, stated that not a single acute hospital bed that has been closed will be reopened any time soon. What is the position with regard to closing public nursing homes? Where are people who are being displaced to go? We are heading for a calamitous situation in the context of the closure of beds in acute hospital settings and also, perhaps, with regard to the imminent closure of public nursing homes in some circumstances. Ultimately, the position will become impossible.
I have always been of the view that when one is discussing people who are easily convinced of the doomsday situation, one must be very careful with regard to the language one uses. I refer here to the use of words such as "disastrous" and "calamitous" and to asking where people should go. We have not reached that point and I do not believe we will reach it. Families and communities in this country are extremely caring.
A recommendation has not yet been made. The consultation process will take three months to complete and if a recommendation is made at that point, then HIQA will have to be given six months notice in respect of it. It is all in Abbeyleix community nursing unit's favour that the process involved is slow. Neither the relevant files nor the consultations in which I have engaged with the Department have indicated there is a foregone conclusion in respect of this matter. When discussing older people who always feel a degree of insecurity with regard to their position, we must be very careful with regard to what we say. I appeal to the Deputy to allow the process to take its course. The process will take as long as it takes.
There is no policy in respect of the downgrading of public facilities. The Government is committed to ensuring there will be a sufficient number of public beds to cater for people who require long-stay care. In the context of two areas, namely, mental health and disability, I have been charged with removing people from institutions. There is a rush to place older people into institutions and I am of the view that we need to consider a different way to do things.
I sincerely hope that the situation at Abbeyleix will not present as being calamitous at any time in the future. However, the situation for older people across the State who are awaiting discharge from hospital settings and who cannot access nursing home beds is indeed calamitous for them and their families. I make no apology for using that language.
A question please, Deputy.
I am not trying to incite fear at all, I am merely attempting to spell out to the Minister of State and her colleagues in the Chamber the fact that we are dealing with a very serious situation. The Minister of State indicated that there is no policy. Will she impress that fact upon the HSE? In respect of the service plans that were announced earlier this year, the HSE stated there will be reductions in bed numbers at different locations throughout the State, including in the HSE area in which I live.
The Deputy should be aware that we have set aside a substantial sum of money, €28 million, in order to ensure that a programme relating to frail elderly people will be put in place. Such individuals are those who will require respite care when they come out of hospital and also access to physiotherapy services. They will also require to be assessed and it is important that assessments in respect of long-stay care patients be performed outside the hospital setting and in more familiar surroundings. In the past, such assessments were carried out in surroundings with which older people were not familiar and, as a result, they became quite confused. Half of the 40% of people who are in long-stay care settings and who do not need to be there could be accounted for in this way. We are definitely considering other ways of operating.
Not everything relates to long-stay care. However, I wish to reassure those who require such care that the necessary funds are available. I also wish to reassure those who will need a different type of care, namely, that which will facilitate them in the context of transitioning back into their own communities, that the relevant service will be available within the next few weeks. That is a good thing. This is a different way of operating and I know the Deputy will agree with me in this regard.
I put it to the Minister of State that in the case of Abbeyleix community nursing unit, the HSE is operating in the context of a preordained policy of closure and that the consultation process is no more than window dressing. Will she outline exactly what is meant by a consultation process which will involve public representatives? As a long-standing public representative for the county in which Abbeyleix community nursing home is situated, will the Minister of State indicate precisely how the consultation with public representatives will proceed and what will be the outcome of it?
As a long-standing public representative, I have great faith in the democratic process and I would never downgrade public representatives. The essential aspect is that families, residents and support workers within communities will be the priority. Consultation with the public representatives will be just one part of that.
It has not happened, however.
If we wish for something to happen long enough, then sometimes our wish will come true. The Health Service Executive is not preordained in this instance. I am convinced the best possible outcome that we could wish for will occur in this case. We need to reassure those with loved ones in nursing homes, not just Abbeyleix, that their best interests, as well as their will and preference, must be taken into account. The process will begin and all stakeholders, including public representatives, will be contacted and consulted on this. We all wish that at the end of this consultation process the best possible outcome will be achieved for those whose home it is.
I hope that model will apply to all homes.
It will apply in this case.
8Deputy Michael Colreavy asked the Minister for Health if he will fulfil his commitment to abolish prescription charges for medical card patients; and if he will make a statement on the matter. [24201/12]
Amharc ar fhreagraMedical cardholders are required to pay a 50 cent charge for medicines and other prescription items supplied to them by community pharmacists, subject to a cap of €10 per month for each person or family. Charges are not payable in respect of items supplied under the long-term illness scheme. Prescription charges do not apply to children in the care of the HSE or to methadone supplied to patients participating in the methadone treatment scheme.
Prescription charges result in savings to the HSE of approximately €27 million annually. I regret that, due to the current financial climate, I am not in a position to remove the 50 cent prescription charge, one of my goals on entering office. However, despite the very difficult budgetary situation, the Government has ruled out an increase in prescription charges.
At the time prescription charges for medical cardholders were introduced by the then Minister, Mary Harney, in 2010, the then Fine Gael spokesperson on health - I wonder who that would have been - described them as "aimed at the most vulnerable, sickest and weakest in our society". He pointed to international research showing that "any disincentive for people to take medicine should be avoided as certain patients will inevitable end up in hospital." He went on to point out that the cost of a single day in hospital would wipe out any supposed savings from the charges for prescriptions.
What has changed with the Minister? Why has his response changed from the position he articulated quite correctly in 2010? Why are we seeing the continuation of prescription charges for medical cardholders?
Thank you, Deputy.
The Government's policy was to repeal the imposition of prescription charges but it has never been given effect. Recently, I presented a Bill to repeal this charge to the respective office in the Oireachtas for consideration but it was rejected on the basis that the repeal of a charge by an Opposition Deputy would represent a charge on the Exchequer. Every obstacle is put in our way as Opposition voices to try to have this outrageous charge not only addressed but reversed.
Thank you, Deputy. I must call the Minister.
I thought my answer was clear on how the situation had changed. However, the old saying comes to mind, "There are none so blind as those who will not see and none so deaf as those who will not listen." The reality is that not alone were the coffers empty when we arrived in government but there was a stack of IOUs in them as well. The money is not there to do what I wanted to, as already stated in my original reply. It was also one of the first actions I wanted to take on first becoming Minister. I still believe any barrier to someone taking their medicines is to be avoided.
There are many other ways, which we are investigating, for reducing the drugs bill and the amount of drugs prescribed, which are sometimes hoarded by people of which I had personal experience as a GP. This can be done with the aid of pharmacists monitoring what is prescribed and double-checking whether a person has used his or her full amount of medication. Some medications are prescribed on a PRN, pro re nata, basis. Much work can be done in this regard.
It is clear with the difficult financial situation in which this country finds itself and with €2.5 billion gone out of the €16 billion health budget in the past three years, we are not able to do many of the things we would like to do. That does not mean that sometime in the future we will not be able to achieve that goal of repealing these charges.
The Minister knows best about those who do not want to hear because he does not want to hear what he said himself when he was in opposition. He will be reminded of it time and again.
The Minister would have the support of all voices in this House if he proceeded with Mary Harney's promise of reference pricing and generic substitution. Legislation was promised to address that. These are critical points. For all her failures, which were legion, at least she identified an area that needed to be addressed and which we could support. Although this Bill was promised, it has yet to be published. What is happening in the Minister's Department that there is not significant progress at least to signal the intent to bring in this legislation?
Thank you, Deputy. I must call the Minister.
Will the Minister address that matter? Will the Minister indicate to the House his intention to repeal this charge on medical cardholders that is an impediment to access to essential medication?
I have just signalled very clearly that in the future I hope to be able to introduce the repeal of these charges as the economy improves and we make savings in health as we have done to date. Last year, through the new clinical programmes and the special delivery unit in conjunction with front-line services, we saved 70,000 bed days at a value of €63 million to the State. That money has been reinvested in health to ensure more patients can be treated more quickly. Similarly, in a pilot money-follows-the-patient scheme in orthopaedics, it was insisted patients be admitted on the day of the procedure rather than the night before, as long as there was no co-existing morbidity. We saved €6 million in this move. We hope to do much better this year.
The costs of drugs are a major issue, as was addressed by my colleague, Deputy Shortall, earlier. It remains a bone of contention between us and the pharmaceutical industry. Nonetheless, the industry has to come to the party. There is a limited pot. If we have to make room for new drugs, then older drugs have to fall in price to accommodate that. There must be some risk-sharing by the pharmaceutical industry and more involvement with patients and patient groups in this area. It has already been successfully done by the Irish Haemophilia Society, in conjunction with the Department, in acquiring blood products. Through the pressure it brought to bear considerable savings were ensured.
Drug reference pricing legislation is a key priority and it is out for consultation. It has elicited an alarmed response from the pharmaceutical industry. The industry must acknowledge, however, this country can ill afford, much less than many other countries, the high prices we are charged for drugs.
The Minister made a statement some time ago about the abolition of prescription charges. The first parliamentary question I tabled to this Government was to the Minister for Finance. He informed me Government members were fully aware and briefed in advance of the programme for Government of the difficult circumstances in every Department. Yet, the Minister for Health still made a statement on the abolition of the charges after taking up office. He looked into the cupboards, knew they were bare, saw the IOUs but still made the promise. It is not factually correct for the Minister to claim he was unaware of the difficulties. He was fully aware of them and he still insisted on making the commitment to abolish the prescription charges.
As we are having a little history lesson, may I remind the Deputy that I was only in the door as Minister for Health when I gave that interview on prescription charges and that I had not had the opportunity to examine every cupboard? I certainly was not given the opportunity to check behind all the radiators where certain other reports had been lost. The Deputy might ask his leader about those.
I stand and acknowledge fully that I sought to get rid of the prescription charge because I believed it could have been a barrier to some people maintaining medical care. It may have been to their detriment and at greater cost to the State. I hold that belief still but I am not in a position to repeal the charge because I do not have the extra €27 million. I need not remind the Deputy of the reasons for this.
The Minister maintained it would be budget neutral.
It is not budget neutral at all. It brings in €27 million per annum, and I would dearly love to find that money elsewhere. I will continue to seek it elsewhere so that I can fulfil that promise. I, along with many other people in the country, was not aware of the depth of the destruction the Deputy's Government wreaked on the country until we got a complete look at what was going on in individual Departments. One might have an overview, but it is only when we get to the nitty-gritty of each Department that we can see the true extent of the damage and disaster that resulted from the Fianna Fáil and Progressive Democrats Government.
I call the next question in the name of Deputy Brendan Smith.
What about the Greens?
Exactly. Who are the Greens?
What about the builders?
9Deputy Brendan Smith asked the Minister for Health if his attention has been drawn to the fact that nine hospitals have amended criteria for categorising patients on trolleys as a way of reducing the appearance of overcrowding in accident and emergency; and if he will make a statement on the matter. [24271/12]
Amharc ar fhreagraI am aware that Deputy Kelleher has claimed there may be some issues with trolley counts in some hospitals. I draw the Deputy's attention to the statement issued by the Irish Nurses and Midwives Organisation, INMO, acknowledging and confirming the reduction by 17% overall in the numbers of people on trolleys in accident and emergency departments in the first four months of 2012 compared with the first four months of 2011. This overall reduction reflects a 23% reduction in the Dublin area and a 13% reduction for the rest of the country. This follows from a 27% reduction nationally in 2011.
Reduction of trolley numbers was a key priority initiative for the special delivery unit, SDU, in my Department for 2011. Building on the achievements of 2011 and the first four months of 2012, the SDU will work with the National Treatment Purchase Fund, the HSE clinical programmes and hospitals to minimise patient waiting times in accident and emergency departments further. There are still too many people on trolleys but the next phase of work by the SDU will include the introduction of an unscheduled care target to be introduced in 2012 and a change of focus in accident and emergency departments to patient journey time monitoring, in addition to trolley waits, as part of the new national scorecard for measuring performance. The ultimate aim is to ensure 95% of all attendees at accident and emergency departments are discharged or admitted within six hours of registration and those who need to be admitted through the department wait no more than nine hours from registration.
Selective quotations are in vogue. At the same conference, the secretary of the INMO stated the management at up to ten hospitals were putting pressure on nursing staff to move patients from the accident and emergency departments to inpatient wards. Does the Minister accept the veracity of that statement and if it is the case, would it not put significant pressure on people to take shortcuts with patient safety? Does the Minister agree that if we are to benchmark quality of care and patient safety, the idea that people would be forced or requested by hospital management to comply with the guidelines of the Department and SDU to move to inpatient wards is against all the protocols, as that should only happen when full-capacity protocols are enacted in a hospital?
I am glad the Deputy qualified his statement. If there is a question, as has been suggested by some, that patients are being hidden around hospitals, it will be fully investigated. I would be pleased to deal with anybody engaging in that practice. There is absolutely no question that international information shows very clearly the patient is better off in a ward than in an accident and emergency department. A problem is better spread through a hospital rather than focused in an accident and emergency department. That argument has been well discussed and it is over.
There have been suggestions that people have not been waiting for full protocols to be in place and I am very happy to examine any area where that has happened. I know we now have consultants coming in on Saturdays and Sundays to do ward rounds. I know diagnostics are being read at weekends and patients are being discharged seven days a week rather than the five days a week that was true in the past. We want the measures that have been put in place on the ground formalised through the Croke Park process, and talks will begin imminently to achieve that.
Ultimately, we do not want to see discussions about inputs but rather outcomes for patients. We are discussing the patient experience and journey as well as how to improve incomes and ensure recovery is quicker and more complete.
If I could-----
I cannot even allow Deputy Kelleher ask a supplementary question as we are out of time. It is his question.
This is Question Time.
It finishes at 3.45 p.m. and it is already 3.46 p.m.
The clock is fast.
I have five clocks in front of me and they all read the same. We will get back to those issues.
Written Answers follow Adjournment.
