Services for People with Disabilities

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<h3>Ceisteanna (1)</h3>
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<div class="question" id="pq_1">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Billy-Kelleher.S.1993-02-17/image/thumb" alt="Billy Kelleher"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">Billy Kelleher</a>
</h4>
</div>
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<a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/1/question/1/" data-share-text="Services for People with Disabilities" title="Share question #1 by Billy Kelleher">
<i>Roinn</i>
</a>
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<div class="content"><h4 class="from">Billy Kelleher</h4><span class="question-start">Ceist:</span>
<p id="para_663" class="">1. <strong>Deputy Billy Kelleher</strong> asked the <strong>Minister for Health</strong> the action he is taking to ensure that school leavers with disabilities who are due to finish school in 2013 will have appropriate placements and services available to them on finishing school; and if he will make a statement on the matter. [49290/12]</p>
<a class="view-answer" href="#pq-answers-1">Amharc ar fhreagra</a></div>
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<div class="sub-header" id="pq-answers-1">
<h3>Freagraí ó Béal (5 píosaí cainte) (Ceist ar Health)</h3>
</div><div class="speech" id="spk_284">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Kathleen-Lynch.D.1994-11-10/image/thumb" alt="Kathleen Lynch"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">Minister of State at the Department of Health</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/1/speech/284/" data-share-text="Services for People with Disabilities" title="Share speech #284 by Minister of State at the Department of Health"><i>Roinn</i></a></div>

<p id="para_664" class="">The HSE, through its occupational guidance service, works with schools, service providers, service users and families to identify the needs of young people with disabilities who are due to complete their second level education. The aim is to address the needs of individuals through health-funded rehabilitative - life skills - training; health-funded day services; FÁS-funded vocational training; and approval to extend education placements for a specified time.</p>
<p id="para_665" class=""> The demand for services for school-leavers continues to grow. A total of 695<strong>
</strong>school-leavers were identified as requiring supports or services in 2012 and a similar number is expected in 2013. Budgetary constraints and the moratorium on staff recruitment mean that service provision continues to be a challenge in the current environment. While the HSE makes every effort to provide day services or rehabilitative training places to school-leavers with special needs, this has always been dependent on the availability and location of appropriate places coupled with the needs of the individual school-leaver.</p>
<p id="para_666" class=""> There is evidence that an accelerated move towards a new model of individualised, person-centred service provision in the community can help to achieve efficiencies. The HSE has established an implementation project team to oversee the implementation of the recommendations in the report of the national working group for the review of HSE-funded adult day services. The report, published in February 2012 and entitled New Directions, proposes that day services take the form of a menu of 12 individualised, outcome-focused supports that will provide adults with disabilities with the support necessary to live a life of their choosing in accordance with their wishes, aspirations and needs. The guiding principle is that supports will be tailored to individual need and will be flexible, responsive and person centred.</p>
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<div class="speech" id="spk_285">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Billy-Kelleher.S.1993-02-17/image/thumb" alt="Billy Kelleher"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">Deputy Billy Kelleher</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/1/speech/285/" data-share-text="Services for People with Disabilities" title="Share speech #285 by Deputy Billy Kelleher"><i>Roinn</i></a></div>

<p id="para_667" class="">The difficulty is that there is great concern. The Minister of State met many organisations, groups and advocates who are advocating continually to have proper services available to people with disabilities. Approximately 700 people emerged from second level education this year and were afforded places. The difficulty is that the service providers are telling me time and again that they are under significant pressure trying to deliver services for 2013 and that if there are further cutbacks or a diminution of services, they will simply not be able to provide the services we expect and demand. More important, New Directions, to which the Minister referred, challenges people with disabilities to have high expectations for themselves and their communities. This is a central theme in the report. If we expect and demand that people with disabilities challenge themselves, we surely expect the Government and State to provide the resources necessary for people to fulfil their potential. The latter does not seem to be the case and there is considerable concern. People's minds must be put at ease at this stage. The service providers, clients and families are at their wits' end owing to the fear that there will be no places available next year.</p>
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<div class="speech" id="spk_286">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Kathleen-Lynch.D.1994-11-10/image/thumb" alt="Kathleen Lynch"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">Deputy Kathleen Lynch</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/1/speech/286/" data-share-text="Services for People with Disabilities" title="Share speech #286 by Deputy Kathleen Lynch"><i>Roinn</i></a></div>

<p id="para_668" class="">I fully recognise that there has always been and will continue to be fear in the community in respect of those who require the types of interventions required by people with special needs. There is a spectrum to be considered. There are those who will require very little intervention and clearly those who have very challenging needs.</p>
<p id="para_669" class=""> For the first time this year, school-leavers were dealt with by way of the services. I reiterate the gratitude not just of the Government but also of parents and those who support those with intellectual disabilities over the addressing of this issue without additional funding being made available. It was always the case that demographic funding was made available but, unfortunately, we now find ourselves in different circumstances.</p>
<p id="para_670" class=""> Groups such as Genio have sought service providers in the marketplace to offer a different type of day service for people with intellectual disabilities. It had been successful in that 184 places were made available. That is the direction we are going to go. I fully understand that service providers are very worried about the challenges faced. On the one hand, they are being hit with cuts from the Government and, on the other, they are being hit in respect of increments that are legal under the Croke Park agreement. While I understand that, I contend that even if we were not experiencing the current financial crisis, we would still be examining the provision of services in a different way and giving people the right to have a choice in how they live their lives. People will have to accept that.</p>
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<div class="speech" id="spk_287">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Billy-Kelleher.S.1993-02-17/image/thumb" alt="Billy Kelleher"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">Deputy Billy Kelleher</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/1/speech/287/" data-share-text="Services for People with Disabilities" title="Share speech #287 by Deputy Billy Kelleher"><i>Roinn</i></a></div>

<p id="para_671" class="">I accept what the Minister of State said about New Directions proposing a menu of 12 individualised, outcome-focused supports that will provide adults with disabilities with the support necessary to live a life of their choosing.</p>
<p id="para_672" class="">This is the critical issue - that the supports provided will be of the recipients' choosing and will be individualised and outcome-focused. The difficulty for individuals and service providers is that, in their experience, adequate resources are not being made available to tailor customised programmes based on the menu of 12 supports.</p>
<p id="para_673" class=""> Will the Minister of State give a commitment that the necessary funding will be put in place and where there are difficulties arising from the moratorium on staff recruitment, that those issues will be addressed in some way? We are looking potentially at an additional 700 people requiring support next year. The current level of provision to service providers is insufficient to deliver the menu of individual courses and training places. People are concerned that by this time next year, they will still be without placements.</p>
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<div class="speech" id="spk_288">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Kathleen-Lynch.D.1994-11-10/image/thumb" alt="Kathleen Lynch"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">Deputy Kathleen Lynch</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/1/speech/288/" data-share-text="Services for People with Disabilities" title="Share speech #288 by Deputy Kathleen Lynch"><i>Roinn</i></a></div>

<p id="para_674" class="">We are spending €1.4 billion per year on disability services. Given that level of expenditure, there are areas where changes simply have to be made. I am very conscious that service providers are worried. However, even though we could not do the job without them, my main concern is not for the providers. Rather, my concern is for the people who require support and to whom, in the majority of cases, those providers deliver an excellent service. I acknowledge that families are very concerned about the future of those members with whose care they are charged. We are obliged to do things differently, but I am confident that this will, in fact, ensure a better outcome for the individuals who avail of these services.</p>
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Home Help Service Provision

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<h3>Ceisteanna (2)</h3>
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<div class="question" id="pq_2">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Caoimhghín-Ó-Caoláin.D.1997-06-26/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Caoimhghín-Ó-Caoláin.D.1997-06-26/image/thumb" alt="Caoimhghín Ó Caoláin"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Caoimhghín-Ó-Caoláin.D.1997-06-26/">Caoimhghín Ó Caoláin</a>
</h4>
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<a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/2/question/2/" data-share-text="Home Help Service Provision" title="Share question #2 by Caoimhghín Ó Caoláin">
<i>Roinn</i>
</a>
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<div class="content"><h4 class="from">Caoimhghín Ó Caoláin</h4><span class="question-start">Ceist:</span>
<p id="para_675" class="">2. <strong>Deputy Caoimhghín Ó Caoláin</strong> asked the <strong>Minister for Health</strong> the steps he is taking to inform himself of the impact that the recent cuts in home help hours are having; his views on whether these cuts should be withdrawn and that services be restored to the level of support that existed prior to the latest cuts; and if he will make a statement on the matter. [49094/12]</p>
<a class="view-answer" href="#pq-answers-2">Amharc ar fhreagra</a></div>
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</div>
<div class="sub-header" id="pq-answers-2">
<h3>Freagraí ó Béal (7 píosaí cainte) (Ceist ar Health)</h3>
</div><div class="speech" id="spk_289">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Kathleen-Lynch.D.1994-11-10/image/thumb" alt="Kathleen Lynch"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">Deputy Kathleen Lynch</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/2/speech/289/" data-share-text="Home Help Service Provision" title="Share speech #289 by Deputy Kathleen Lynch"><i>Roinn</i></a></div>

<p id="para_676" class="">Government policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. This is achieved through a range of community-based services such as mainstream home help, meals-on-wheels, and respite or day care. In more complex cases, enhanced home care packages may be provided. The reductions recently introduced in respect of home help hours relate directly to the critical financial position facing the Health Service Executive towards year end and the statutory responsibility of the executive to live within the budget Voted for it by the Oireachtas.</p>
<p id="para_677" class=""> The target in the HSE service plan for 2012 was to deliver some 10.7 million home help hours to 50,000 people. In addition, just over 15,700 people were targeted to receive a home care package in 2012. As I have indicated on several occasions throughout the year, a key challenge facing the health service is how best to utilise a reduced level of resources in addressing the increasing needs of older people for health and personal social services. This means prioritising those in greatest need and accelerating reform of services overall to maximise such provision in the future. </p>
<p id="para_678" class=""> Most of the measures recently agreed with the HSE to address immediate funding pressures focus on areas that do not have a direct patient impact. It is a priority of the executive to minimise the impact on patients and clients of any spending reductions. The reduction envisaged for the mainstream home help service is €8 million, and approximately €1.2 million for enhanced home care packages. Allocation of home help hours will continue to be based on a review of individual needs and no current recipient of the service, who has an assessed need, will be without a service. The HSE has indicated that it will ensure that any alterations to supports or services will be undertaken in the context of a review of the client's assessed need, documented on client records. While the Government fully appreciates the difference high-quality home care makes to supporting vulnerable older people and their families and the impact the recent reductions will inevitably have in some cases, we must deal with the reality of funding services overall for this and subsequent years.</p>
<p id="para_679" class="">
<em>Additional information not given on the floor of the House</em>
</p>
<p id="para_680" class=""> Notwithstanding the recently announced reduction in HSE home support provision for the remainder of 2012, investment in these services remains significant, with provision in the region of €320 million expected for home help and home care packages this year. In addition, in the context of prioritising what was always a limited resource, the HSE has been developing various operational initiatives to improve its approach to all relevant aspects of its home supports services. These include various new guidelines for home care and a new procurement framework for approved agencies providing services on its behalf. While ongoing developments have been designed to standardise and maximise the use of limited resources in the face of increasing demand, they are also intended to enhance quality, safety and other relevant aspects of service for providers and care recipients alike. </p>
<p id="para_681" class=""> Services for older people are monitored on a regular basis by the Department of Health and the HSE to meet evolving circumstances in line with available resources.<strong>
</strong> The executive has been asked to furnish weekly reports to the Minister for Health on home care provision<strong>
</strong>between now and year end, in the light of recently announced measures.<strong>
</strong> The position in respect of 2013 and beyond is subject to the annual Estimates process in the light of evolving resources and services priorities for the overall health sector.</p>
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<div class="speech" id="spk_290">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Caoimhghín-Ó-Caoláin.D.1997-06-26/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Caoimhghín-Ó-Caoláin.D.1997-06-26/image/thumb" alt="Caoimhghín Ó Caoláin"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Caoimhghín-Ó-Caoláin.D.1997-06-26/">Deputy Caoimhghín Ó Caoláin</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/2/speech/290/" data-share-text="Home Help Service Provision" title="Share speech #290 by Deputy Caoimhghín Ó Caoláin"><i>Roinn</i></a></div>

<p id="para_682" class="">The position taken by the Minister, Deputy James Reilly, on this issue is absolutely untenable. He seems to have no concept of the distress and misery that has been visited on older people as a consequence of the changes he introduced. The impact of cuts in the provision of home help hours and home care packages are being felt today and every day for at least the past two weeks. People have lost precious home help hours and more are losing them every day. Almost 1 million home help hours will have been cut between last December and the end of this year, on the Minister's watch.</p>
<p id="para_683" class=""> How can the Minister of State, Deputy Kathleen Lynch, and her colleagues stand over a situation where an allocation of 15 minutes of home help is described as a service? During a short stay in Cork last week I met home help providers in Youghal and Cork city who are incensed by the cutbacks, as they demonstrated last Saturday by way of a major mobilisation which assembled at Connolly Hall in the city the Minister of State knows so well.</p>
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<div class="speech brief" id="spk_291">
<div class="c-avatar -debate -short">
<a class="c-avatar__img-link" href="/ga/members/member/Michael-P-Kitt.D.1975-03-04/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Michael-P-Kitt.D.1975-03-04/image/thumb" alt="Michael P. Kitt"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Michael-P-Kitt.D.1975-03-04/"> An Leas-Cheann Comhairle</a>
</h4>
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<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/2/speech/291/" data-share-text="Home Help Service Provision" title="Share speech #291 by An Leas-Cheann Comhairle"><i>Roinn</i></a></div>

<p id="para_684" class="">Does the Deputy have a question?</p>
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</div>
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<div class="speech" id="spk_292">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Caoimhghín-Ó-Caoláin.D.1997-06-26/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Caoimhghín-Ó-Caoláin.D.1997-06-26/image/thumb" alt="Caoimhghín Ó Caoláin"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Caoimhghín-Ó-Caoláin.D.1997-06-26/">Deputy Caoimhghín Ó Caoláin</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/2/speech/292/" data-share-text="Home Help Service Provision" title="Share speech #292 by Deputy Caoimhghín Ó Caoláin"><i>Roinn</i></a></div>

<p id="para_685" class="">How can this Government stand over the cutting of the solitary hour per week which some older people receive?</p>
<p id="para_686" class=""> Will the Minister of State clarify the figures she indicated in her reply? As I understand it, according to the figures I have been given, 50,139 people are in receipt of home help hours, which represents a reduction of 3,701 in the past 18 months. The Minister of State also gave a figure in regard to home care packages. In a reply I received to another parliamentary question yesterday, it was stated that there are 11,119 people in receipt of home care packages. I acknowledge the increase of 1,159 on the figure 18 months ago, but the net reduction in service beneficiaries across the board is 2,500. The figure of 11,119 tells only part of the story.</p>
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</div>
<div class="speech" id="spk_293">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Kathleen-Lynch.D.1994-11-10/image/thumb" alt="Kathleen Lynch"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">Deputy Kathleen Lynch</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/2/speech/293/" data-share-text="Home Help Service Provision" title="Share speech #293 by Deputy Kathleen Lynch"><i>Roinn</i></a></div>

<p id="para_687" class="">Of course the aim of the Government is to ensure that older people remain in their own communities. That is the most sensible and cost-effective solution and also the one which offers the best outcome for individuals. Unfortunately, however, we find ourselves in very straitened circumstances. We will have to make our case very trenchantly in the negotiations leading up to the budget in order to ensure those concerned have the types of supports they need.</p>
<p id="para_688" class=""> It is important to note that figures relating to home care packages can fluctuate, and for very good reasons. We are talking about an enhanced home care package system and there are times when the provision for an individual will need to be further enhanced and other times when it can be reduced. This is the beauty of a home care package, that it is operated on a continuous-assessment basis. More than 10 million home help hours are being provided this year. The number of clients benefiting is 50,000, a reduction of approximately 900 persons. We have no choice but to take a serious look at how we manage the service into the future. There is ongoing research into how we can best maintain supports for older people and others who benefit from home help hours and home care packages.</p>
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<div class="speech" id="spk_294">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Caoimhghín-Ó-Caoláin.D.1997-06-26/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Caoimhghín-Ó-Caoláin.D.1997-06-26/image/thumb" alt="Caoimhghín Ó Caoláin"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Caoimhghín-Ó-Caoláin.D.1997-06-26/">Deputy Caoimhghín Ó Caoláin</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/2/speech/294/" data-share-text="Home Help Service Provision" title="Share speech #294 by Deputy Caoimhghín Ó Caoláin"><i>Roinn</i></a></div>

<p id="para_689" class="">The Minister of State referred to a reduction of 900 in the number of individuals in receipt of home help hours. In fact, there was a reduction of 847 at the end of July as against the position last December. However, with respect to the Minister of State, over the period of her tenure in office, there has been a reduction of 3,701 in the numbers receiving this service. As I said, this is not even the worst part of the story, nor does it take into account the growing numbers who cannot access home help hours or home care packages.</p>
<p id="para_690" class=""> It is time to cut out the waffle and reverse these savage cuts to the most vulnerable people. We are talking about €8 million. Sinn Féin tabled a Private Members' proposal on this issue only a few weeks ago, the same week the Minister announced savings arising from his negotiations with the pharmaceutical sector of some €16 million before the end of this year.</p>
<p id="para_691" class="">Yet, on the back of that, he could not ringfence the cuts signalled in relation to older people. He proceeded to impose these savage cutbacks that are causing untold hardship for people in every constituency. The only answer I want to hear is that the Ministers of State will use their good offices to impact on the Minister that he will reverse these cuts, restore the home-help hours and home care packages to our citizenry who absolutely need them.</p>
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</div>
<div class="speech" id="spk_295">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Kathleen-Lynch.D.1994-11-10/image/thumb" alt="Kathleen Lynch"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">Deputy Kathleen Lynch</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/2/speech/295/" data-share-text="Home Help Service Provision" title="Share speech #295 by Deputy Kathleen Lynch"><i>Roinn</i></a></div>

<p id="para_692" class="">There is a statutory obligation on the Department of Health and the HSE to bring in a budget that lives within the Vote, which is decided in this House. There are difficulties, there are arguments to be made and there are various ways of doing things. We need to be very conscious of that. In addition, as we speak, a deficit is being run up by the HSE. It is not as if we have an expandable pot of money. Those days are gone and we must live within that budget.</p>
</div>
</div>
</div>

Services for People with Disabilities

<div class="sub-header">
<h3>Ceisteanna (3)</h3>
</div>

<div class="question" id="pq_3">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Finian-McGrath.D.2002-06-06/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Finian-McGrath.D.2002-06-06/image/thumb" alt="Finian McGrath"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Finian-McGrath.D.2002-06-06/">Finian McGrath</a>
</h4>
</div>
<div class="text">
<div class="social-share">
<a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/3/question/3/" data-share-text="Services for People with Disabilities" title="Share question #3 by Finian McGrath">
<i>Roinn</i>
</a>
</div>
<div class="content"><h4 class="from">Finian McGrath</h4><span class="question-start">Ceist:</span>
<p id="para_693" class="">3. <strong>Deputy Finian McGrath</strong> asked the <strong>Minister for Health</strong> his plans to address and take action to alleviate serious issues in our disability services as a matter of urgency. [49092/12]</p>
<a class="view-answer" href="#pq-answers-3">Amharc ar fhreagra</a></div>
</div>
</div>
<div class="sub-header" id="pq-answers-3">
<h3>Freagraí ó Béal (8 píosaí cainte) (Ceist ar Health)</h3>
</div><div class="speech" id="spk_296">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Kathleen-Lynch.D.1994-11-10/image/thumb" alt="Kathleen Lynch"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">Deputy Kathleen Lynch</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/3/speech/296/" data-share-text="Services for People with Disabilities" title="Share speech #296 by Deputy Kathleen Lynch"><i>Roinn</i></a></div>

<p id="para_694" class="">Expenditure on health services for people with a disability in 2012 will be in the region of €1.4 billion. The HSE National Service Plan 2012 provides for a 3.7% reduction in budgets but makes it clear that there is scope for achieving efficiencies of 2%, thereby limiting as much as possible the impact on front line services. Despite this reduction, which is similar to that applied across all care areas in the health sector, the HSE has undertaken to maximise the provision of services within available resources by providing for the following in 2012: some 9,100 people in residential places; 18,600 day service places; 6,300 people receiving respite residential support; and 1.64 million hours of personal assistant-home support hours.</p>
<p id="para_695" class=""> I recently published the value for money and policy review of disability services which identifies fundamental issues that need to be addressed in the way in which HSE-funded disability services are managed and operated. It lays the groundwork for the introduction of a significant restructuring of the disability services programme through first, migration from an approach which is predominantly organised around group-based service delivery towards a model of person-centred, individually chosen, supports and second, the implementation of a more effective method of assessing need, allocating resources and monitoring resource use. </p>
<p id="para_696" class=""> I must also stress that the nature of the core underlying deficit within the HSE, taken together with the requirements nationally to bring our public spending deficit down by 2015, will make the years 2013 and 2014 very challenging for all sectors, not just health. I will be doing everything possible to ensure that as much protection as possible is afforded to the disability sector and the social care area as a whole.</p>
</div>
</div>
</div>
<div class="speech" id="spk_297">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Finian-McGrath.D.2002-06-06/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Finian-McGrath.D.2002-06-06/image/thumb" alt="Finian McGrath"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Finian-McGrath.D.2002-06-06/">Deputy Finian McGrath</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/3/speech/297/" data-share-text="Services for People with Disabilities" title="Share speech #297 by Deputy Finian McGrath"><i>Roinn</i></a></div>

<p id="para_697" class="">Is the Minister of State aware of the urgent need for, and the crisis going on in, disability services? I will refer to two such services. First, there are major concerns at Prosper Fingal in Swords that if more cuts are implemented they will have to reduce transport and respite facilities. Second, St. Michael's House has 1,663 service users and 454 residential service users. These are very concerned because since 2008 they have taken cuts in the region of €11.2 million. In the context of the forthcoming budget, is the Minister of State aware that St. Michael's House will have to consider intermittent closure of day, residential and respite services? In addition, there will be a reduction in transport, support and clinical services, as well as closures.</p>
<p id="para_698" class=""> There is a huge problem there at the moment. Hundreds of families across the northside of Dublin have lobbied me about these services in recent days. They are very frightened about potential cuts. There are major issues facing elderly parents of adults with an intellectual disability who are in their mid-40s or 50s. These families are very worried. Such parents in their 80s and 90s are scared of what lies ahead.</p>
</div>
</div>
</div>
<div class="speech brief" id="spk_298">
<div class="c-avatar -debate -short">
<a class="c-avatar__img-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Kathleen-Lynch.D.1994-11-10/image/thumb" alt="Kathleen Lynch"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">Deputy Kathleen Lynch</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/3/speech/298/" data-share-text="Services for People with Disabilities" title="Share speech #298 by Deputy Kathleen Lynch"><i>Roinn</i></a></div>

<p id="para_699" class="">While I do not wish to pick out one service in particular, St. Michael's House is one of the exceptionally good ones.</p>
</div>
</div>
</div>
<div class="speech brief" id="spk_299">
<div class="c-avatar -debate -short">
<a class="c-avatar__img-link" href="/ga/members/member/Finian-McGrath.D.2002-06-06/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Finian-McGrath.D.2002-06-06/image/thumb" alt="Finian McGrath"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Finian-McGrath.D.2002-06-06/">Deputy Finian McGrath</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/3/speech/299/" data-share-text="Services for People with Disabilities" title="Share speech #299 by Deputy Finian McGrath"><i>Roinn</i></a></div>

<p id="para_700" class="">That is right.</p>
</div>
</div>
</div>
<div class="speech" id="spk_300">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Kathleen-Lynch.D.1994-11-10/image/thumb" alt="Kathleen Lynch"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">Deputy Kathleen Lynch</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/3/speech/300/" data-share-text="Services for People with Disabilities" title="Share speech #300 by Deputy Kathleen Lynch"><i>Roinn</i></a></div>

<p id="para_701" class="">Those involved are innovative, imaginative and have done all the things we would like other services to do as well, such as reducing absenteeism and having a better skills mix. I am very conscious of the waiting list they have whereby older parents are awaiting residential spaces for their adult children. I do not want to dismiss or minimise any of the arguments that have been made concerning pressures on services. Deputy Kelleher made the same point earlier. I am not saying that arguments about anxiety over the prospect of what might happen in the budget are misjudged. Neither am I saying that there is no need to be concerned, because nothing is so protected that it cannot be cut. That sort of "worried well" argument may be just that but, nevertheless, we will do our very best.</p>
</div>
</div>
</div>
<div class="speech" id="spk_301">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Finian-McGrath.D.2002-06-06/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Finian-McGrath.D.2002-06-06/image/thumb" alt="Finian McGrath"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Finian-McGrath.D.2002-06-06/">Deputy Finian McGrath</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/3/speech/301/" data-share-text="Services for People with Disabilities" title="Share speech #301 by Deputy Finian McGrath"><i>Roinn</i></a></div>

<p id="para_702" class="">I welcome the Minister of State's comments on St. Michael's House which has done an excellent job in getting absenteeism down from 6.5% to 3.5%. It has also had a reduction in administration costs of approximately 34%. St. Michael's therefore has delivered in terms of fairness and efficiency. However, the Minister of State will have to fight her corner in this budget because this is a very serious issue. If one is to protect the vulnerable, one must target those with an intellectual disability. All people with disabilities have to be top of the list. If it means bringing in extra taxation and tapping the rich people in this State to pay for such services, the Minister of State should do it. She will have my support. We must focus our priorities on those with an intellectual disability.</p>
</div>
</div>
</div>
<div class="speech brief" id="spk_302">
<div class="c-avatar -debate -short">
<a class="c-avatar__img-link" href="/ga/members/member/Michael-P-Kitt.D.1975-03-04/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Michael-P-Kitt.D.1975-03-04/image/thumb" alt="Michael P. Kitt"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Michael-P-Kitt.D.1975-03-04/"> An Leas-Cheann Comhairle</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/3/speech/302/" data-share-text="Services for People with Disabilities" title="Share speech #302 by An Leas-Cheann Comhairle"><i>Roinn</i></a></div>

<p id="para_703" class="">I call on the Minister of State for a final reply.</p>
</div>
</div>
</div>
<div class="speech" id="spk_303">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Kathleen-Lynch.D.1994-11-10/image/thumb" alt="Kathleen Lynch"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Kathleen-Lynch.D.1994-11-10/">Deputy Kathleen Lynch</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/3/speech/303/" data-share-text="Services for People with Disabilities" title="Share speech #303 by Deputy Kathleen Lynch"><i>Roinn</i></a></div>

<p id="para_704" class="">I agree with the Deputy. Unfortunately, however, every other group approaching us feels that it should be top of the priority list. That is the balancing act that one is constantly trying to achieve in order to ensure a degree of fairness. That is the difficulty. St. Michael's House has done all the things we would expect other service providers to do and, in fairness, a lot of them have done so. Last year, there was speculation - and the Deputy was one of those speculating in public - that we were going to have cuts of between 5% and 7% in disability services, yet we managed to bring it in at 3.7%. I will fight my corner and have always done so. I am charged with looking after people with disabilities. That is my specific responsibility and I will do my very best on their behalf.</p>
</div>
</div>
</div>

Medicinal Products Availability

<div class="sub-header">
<h3>Ceisteanna (4)</h3>
</div>

<div class="question" id="pq_4">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Billy-Kelleher.S.1993-02-17/image/thumb" alt="Billy Kelleher"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">Billy Kelleher</a>
</h4>
</div>
<div class="text">
<div class="social-share">
<a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/4/question/4/" data-share-text="Medicinal Products Availability" title="Share question #4 by Billy Kelleher">
<i>Roinn</i>
</a>
</div>
<div class="content"><h4 class="from">Billy Kelleher</h4><span class="question-start">Ceist:</span>
<p id="para_705" class="">4. <strong>Deputy Billy Kelleher</strong> asked the <strong>Minister for Health</strong> if he will provide details of medicines and patient products that have been removed from the medical card and drug reimbursement schemes to date in 2012; and if he will make a statement on the matter. [49291/12]</p>
<a class="view-answer" href="#pq-answers-4">Amharc ar fhreagra</a></div>
</div>
</div>
<div class="sub-header" id="pq-answers-4">
<h3>Freagraí ó Béal (13 píosaí cainte) (Ceist ar Health)</h3>
</div><div class="speech" id="spk_304">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Alex-White.S.2007-07-23/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Alex-White.S.2007-07-23/image/thumb" alt="Alex White"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Alex-White.S.2007-07-23/">Minister of State at the Department of Health (Deputy Alex White)</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/4/speech/304/" data-share-text="Medicinal Products Availability" title="Share speech #304 by Minister of State at the Department of Health (Deputy Alex White)"><i>Roinn</i></a></div>

<p id="para_706" class="">I thank Deputy Kelleher for having raised this question. In the current financial environment the Health Service Executive is facing a challenge to deliver services in a way that will minimise any adverse impact on patients and continue to protect, as far as possible, the most vulnerable citizens. Unfortunately, it has become necessary for the HSE to suspend certain products from its list of reimbursable items. These include glucosamine, omega-3 triglyceride products, orlistat, and gluten-free products.</p>
<p id="para_707" class=""> Glucosamine is indicated for the management of symptoms of osteoarthritis. The National Centre for Pharmoeconomics has assessed the cost-effectiveness of glucosamine on two occasions and concluded that it did not offer value for money to the HSE. However, it should be noted that glucosamine products are available over the counter without prescription.</p>
<p id="para_708" class=""> Omega-3 triglyceride products - for example, omacor - have been identified both nationally and internationally as not being cost-effective or being of lesser benefit to patients. However, these products are also available over the counter without prescription, as is orlistat.</p>
<p id="para_709" class=""> Gluten-free products have become more widely available in supermarkets in recent years and tend to be significantly cheaper than products sold through community pharmacies. A supplementary welfare allowance adult diet supplement may be awarded by the Department of Social Protection to eligible persons. Persons wishing to apply for this allowance can do so by completing an application form which can be downloaded at <em>http://www.welfare.ie/EN/Forms/Documents/swa9.pdf</em><em>.</em> Separate application forms are available for children on that site. For persons who are not awarded a diet supplement, moneys spent on gluten-free foods can be taken into account for tax purposes.</p>
<p id="para_710" class="">A full list of items available under the community drug schemes is available on the HSE's primary care reimbursement service website, <em>www.pcrs.ie</em>. If one goes on to that site, one should choose the "List of Reimbursable Items" option. In addition, the monthly updates, additions and deletions, to the product list are provided at the same location under "Updates to the List of Reimbursable Items and High Tech Scheme List".</p>
</div>
</div>
</div>
<div class="speech" id="spk_305">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Billy-Kelleher.S.1993-02-17/image/thumb" alt="Billy Kelleher"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">Deputy Billy Kelleher</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/4/speech/305/" data-share-text="Medicinal Products Availability" title="Share speech #305 by Deputy Billy Kelleher"><i>Roinn</i></a></div>

<p id="para_711" class="">Briefly, I accept that savings must be made in certain areas. However, I am very concerned about a particular inclusion on the list, namely, xenical, which is the trade name for orlistat, an anti-obesity drug. This is a life-saving drug and is not something a person can do without. It is an anti-obesity drug and many people with disabilities who have different syndromes need this drug to ensure that diet is suppressed and that they do not overeat and cause difficulties with obesity. One family in particular has contacted me and stated the first they heard of it was when they visited their pharmacist, only to be told the drug no longer is available under the medical card scheme. As it has been withdrawn, it will cost the family in question €64 per month to keep their daughter alive basically, because without this drug, she potentially could eat herself to death by virtue of not being able to suppress her diet. While I am fair in respect of what a Government can do, of all the drugs included in the withdrawal, I ask the Minister of State to consider orlistat, the anti-obesity drug with the trade name of xenical, given the serious nature of the difficulties its withdrawal is causing.</p>
</div>
</div>
</div>
<div class="speech" id="spk_306">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Alex-White.S.2007-07-23/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Alex-White.S.2007-07-23/image/thumb" alt="Alex White"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Alex-White.S.2007-07-23/">Deputy Alex White</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/4/speech/306/" data-share-text="Medicinal Products Availability" title="Share speech #306 by Deputy Alex White"><i>Roinn</i></a></div>

<p id="para_712" class="">I certainly will take a look at the particular item to which the Deputy refers. In fairness, the Deputy asked a general question on the items that have been removed from the list and orlistat is one such item. As for the other item to which the Deputy referred, I certainly will ascertain what information is available on it and will relate that to the Deputy. I must state that my clear advice with regard to orlistat is that it is an adjunct to diet in obese patients and is available over the counter. As to whether it is necessary at the level suggested by the Deputy, I simply cannot comment on that. He puts the point very strongly with regard to it being a drug he states essentially is a life-saving drug. That is quite a claim and I cannot respond to the specifics of that point. It was not contained in the question but I certainly will have a look at it and will relay any information on it back to the Deputy.</p>
</div>
</div>
</div>
<div class="speech" id="spk_307">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Billy-Kelleher.S.1993-02-17/image/thumb" alt="Billy Kelleher"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">Deputy Billy Kelleher</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/4/speech/307/" data-share-text="Medicinal Products Availability" title="Share speech #307 by Deputy Billy Kelleher"><i>Roinn</i></a></div>

<p id="para_713" class="">I do not expect the Minister of State to have to hand the knowledge on the individual query that I have available to me via e-mail on my iPhone here. However, the family contacted me and asked me to raise this matter specifically when they saw this particular question had been tabled. They are very concerned, primarily with this particular drug, orlistat, the trade name of which is xenical.</p>
</div>
</div>
</div>
<div class="speech brief" id="spk_308">
<div class="c-avatar -debate -short">
<a class="c-avatar__img-link" href="/ga/members/member/Alex-White.S.2007-07-23/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Alex-White.S.2007-07-23/image/thumb" alt="Alex White"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Alex-White.S.2007-07-23/">Deputy Alex White</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/4/speech/308/" data-share-text="Medicinal Products Availability" title="Share speech #308 by Deputy Alex White"><i>Roinn</i></a></div>

<p id="para_714" class="">If the Deputy makes a specific point to me, I will address it.</p>
</div>
</div>
</div>
<div class="speech brief" id="spk_309">
<div class="c-avatar -debate -short">
<a class="c-avatar__img-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Billy-Kelleher.S.1993-02-17/image/thumb" alt="Billy Kelleher"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">Deputy Billy Kelleher</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/4/speech/309/" data-share-text="Medicinal Products Availability" title="Share speech #309 by Deputy Billy Kelleher"><i>Roinn</i></a></div>

<p id="para_715" class="">I am specifically naming this particular drug about which, as I stated, I am very concerned. It is an appetite suppressant and some people with various syndromes need this suppressant to ensure they do not overeat and have the difficulties associated with obesity.</p>
</div>
</div>
</div>
<div class="speech brief" id="spk_310">
<div class="c-avatar -debate -short">
<a class="c-avatar__img-link" href="/ga/members/member/Alex-White.S.2007-07-23/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Alex-White.S.2007-07-23/image/thumb" alt="Alex White"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Alex-White.S.2007-07-23/">Deputy Alex White</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/4/speech/310/" data-share-text="Medicinal Products Availability" title="Share speech #310 by Deputy Alex White"><i>Roinn</i></a></div>

<p id="para_716" class="">While I do not believe it is a suppressant-----</p>
</div>
</div>
</div>
<div class="speech brief" id="spk_311">
<div class="c-avatar -debate -short">
<a class="c-avatar__img-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Billy-Kelleher.S.1993-02-17/image/thumb" alt="Billy Kelleher"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">Deputy Billy Kelleher</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/4/speech/311/" data-share-text="Medicinal Products Availability" title="Share speech #311 by Deputy Billy Kelleher"><i>Roinn</i></a></div>

<p id="para_717" class="">It is an anti-obesity drug.</p>
</div>
</div>
</div>
<div class="speech brief" id="spk_312">
<div class="c-avatar -debate -short">
<a class="c-avatar__img-link" href="/ga/members/member/Alex-White.S.2007-07-23/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Alex-White.S.2007-07-23/image/thumb" alt="Alex White"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Alex-White.S.2007-07-23/">Deputy Alex White</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/4/speech/312/" data-share-text="Medicinal Products Availability" title="Share speech #312 by Deputy Alex White"><i>Roinn</i></a></div>

<p id="para_718" class="">-----as the Deputy has the details on his telephone, it probably would be better to have a specific question related to a specific item. Were it committed to paper and sent to me, I certainly can address it for the Deputy-----</p>
</div>
</div>
</div>
<div class="speech brief" id="spk_313">
<div class="c-avatar -debate -short">
<a class="c-avatar__img-link" href="/ga/members/member/James-Reilly.D.2007-06-14/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/James-Reilly.D.2007-06-14/image/thumb" alt="James Reilly"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/James-Reilly.D.2007-06-14/">Deputy James Reilly</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/4/speech/313/" data-share-text="Medicinal Products Availability" title="Share speech #313 by Deputy James Reilly"><i>Roinn</i></a></div>

<p id="para_719" class="">It is not a suppressant.</p>
</div>
</div>
</div>
<div class="speech brief" id="spk_314">
<div class="c-avatar -debate -short">
<a class="c-avatar__img-link" href="/ga/members/member/Alex-White.S.2007-07-23/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Alex-White.S.2007-07-23/image/thumb" alt="Alex White"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Alex-White.S.2007-07-23/">Deputy Alex White</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/4/speech/314/" data-share-text="Medicinal Products Availability" title="Share speech #314 by Deputy Alex White"><i>Roinn</i></a></div>

<p id="para_720" class="">-----and, if necessary, refer it to the experts I have available to me. I cannot take it any further.</p>
</div>
</div>
</div>
<div class="speech brief" id="spk_315">
<div class="c-avatar -debate -short">
<a class="c-avatar__img-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Billy-Kelleher.S.1993-02-17/image/thumb" alt="Billy Kelleher"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Billy-Kelleher.S.1993-02-17/">Deputy Billy Kelleher</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/4/speech/315/" data-share-text="Medicinal Products Availability" title="Share speech #315 by Deputy Billy Kelleher"><i>Roinn</i></a></div>

<p id="para_721" class="">For clarity, it is an anti-obesity drug.</p>
</div>
</div>
</div>
<div class="speech brief" id="spk_316">
<div class="c-avatar -debate -short">
<a class="c-avatar__img-link" href="/ga/members/member/Alex-White.S.2007-07-23/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Alex-White.S.2007-07-23/image/thumb" alt="Alex White"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Alex-White.S.2007-07-23/">Deputy Alex White</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/4/speech/316/" data-share-text="Medicinal Products Availability" title="Share speech #316 by Deputy Alex White"><i>Roinn</i></a></div>

<p id="para_722" class="">Perhaps if that was committed to paper and relayed to me, it could be dealt with in that way.</p>
</div>
</div>
</div>

Health Services Reform

<div class="sub-header">
<h3>Ceisteanna (5)</h3>
</div>

<div class="question" id="pq_5">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Caoimhghín-Ó-Caoláin.D.1997-06-26/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Caoimhghín-Ó-Caoláin.D.1997-06-26/image/thumb" alt="Caoimhghín Ó Caoláin"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Caoimhghín-Ó-Caoláin.D.1997-06-26/">Caoimhghín Ó Caoláin</a>
</h4>
</div>
<div class="text">
<div class="social-share">
<a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/5/question/5/" data-share-text="Health Services Reform" title="Share question #5 by Caoimhghín Ó Caoláin">
<i>Roinn</i>
</a>
</div>
<div class="content"><h4 class="from">Caoimhghín Ó Caoláin</h4><span class="question-start">Ceist:</span>
<p id="para_723" class="">5. <strong>Deputy Caoimhghín Ó Caoláin</strong> asked the <strong>Minister for Health</strong> the position regarding the Health Service Executive negotiations with representatives of hospital consultants and on the proposed new working arrangements; and if he will make a statement on the matter. [49095/12]</p>
<a class="view-answer" href="#pq-answers-5">Amharc ar fhreagra</a></div>
</div>
</div>
<div class="sub-header" id="pq-answers-5">
<h3>Freagraí ó Béal (6 píosaí cainte) (Ceist ar Health)</h3>
</div><div class="speech" id="spk_317">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/James-Reilly.D.2007-06-14/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/James-Reilly.D.2007-06-14/image/thumb" alt="James Reilly"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/James-Reilly.D.2007-06-14/">Minister for Health</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/5/speech/317/" data-share-text="Health Services Reform" title="Share speech #317 by Minister for Health"><i>Roinn</i></a></div>

<p id="para_724" class="">The measures agreed between health service management and the consultant representative bodies at the Labour Relations Commission, LRC, in September will allow for very significant reforms in how services are delivered and ultimately will lead to improved outcomes for users of the services. The agreement encompasses a range of flexibilities centred on enhancing productivity and efficiency on an ongoing basis and on maximising the availability of consultants, as key clinical decision-makers. Health service managers are proceeding with implementation of these measures as appropriate to each site and service, with effect from 5 November, that is, last Monday, in line with the procedures provided for in the public service agreement.</p>
<p id="para_725" class=""> On 6 November, the Labour Court issued its recommendations regarding three matters which had been referred to it. These concern consultants' current “rest day” arrangements, the fee to consultant psychiatrists for giving a second opinion under the Mental Health Act 2001 and the issue of “historic rest days”. Health service management will take the necessary steps over the coming weeks to give effect to the court's recommendations.</p>
<p id="para_726" class=""> I look forward to all consultants embracing the changes agreed at the LRC and complying with the terms of the Labour Court recommendations in the interests of providing the most appropriate and cost-effective services to patients.</p>
</div>
</div>
</div>
<div class="speech" id="spk_318">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Caoimhghín-Ó-Caoláin.D.1997-06-26/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Caoimhghín-Ó-Caoláin.D.1997-06-26/image/thumb" alt="Caoimhghín Ó Caoláin"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Caoimhghín-Ó-Caoláin.D.1997-06-26/">Deputy Caoimhghín Ó Caoláin</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/5/speech/318/" data-share-text="Health Services Reform" title="Share speech #318 by Deputy Caoimhghín Ó Caoláin"><i>Roinn</i></a></div>

<p id="para_727" class="">Will the Minister outline the improved work practices that have been achieved thus far arising from the engagement between the Department of Health, the HSE and the consultants? What improved work practices can the Minister outline for Members this afternoon that actually are being delivered on the ground in hospitals? Are there any? In respect of the Irish Hospital Consultants Association, IHCA, will the Minister clarify whether it has been or is now engaging fully, given the association's earlier position of refusing to participate in the industrial relations mechanism of the State? The Minister made reference to the Labour Court. Does the Minister echo the call of the Labour Court, as do I, for consultants to forego so-called historic entitlements, which allows many of them to receive double pay when they choose to work the final year before retirement? Does the Minister agree it is perverse that psychiatrists, who already are in receipt of very high salaries from the HSE, are being paid €500 a time for second opinions? There are so many examples of inappropriate payments and unacceptable practices associated with the consultants down through the years but most certainly, in these times when savage cuts are being imposed on older people, it is absolutely unacceptable and must be addressed properly.</p>
</div>
</div>
</div>
<div class="speech" id="spk_319">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/James-Reilly.D.2007-06-14/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/James-Reilly.D.2007-06-14/image/thumb" alt="James Reilly"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/James-Reilly.D.2007-06-14/">Deputy James Reilly</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/5/speech/319/" data-share-text="Health Services Reform" title="Share speech #319 by Deputy James Reilly"><i>Roinn</i></a></div>

<p id="para_728" class="">I first will outline what were the measures agreed at the Labour Relations Commission, LRC, after which I wish to make a few other comments, if possible. Consultants will be available for rostering for any five days out of seven, as opposed to weekdays only at present There can be rostering of consultants, where required, on a 16-hour, seven-day basis from 8 a.m. to midnight, or on a 24-hour, seven-day basis where this is required. Consequently, clinical directors will have a much strengthened management role in respect of consultants. Heretofore, consultants have co-operated, in the main, around their holidays, when they would take their leave and so on but from henceforth, the new clinical director will have the authority to actually dictate when people go on holidays and it can be done only in consultation with him or her. Consultants will co-operate with a range of measures to support community and mental health services Consultants will comply with contractual requirements regarding private practice. Consultants have committed to expeditious processing and signing of claims for submission to private health insurers and there will be more cost-effective arrangements for funding of continuing medical education. I should point out to the Deputy that the IHCA did engage with the Labour Relations Commission but failed to engage with the Labour Court.</p>
<p id="para_729" class=""> I wish to point out something which it is important to state and I will be as brief as I can. Many of these practices to which I have alluded here as being now agreed at the LRC already have been taking place on the ground. I have commended consultants on this and their change in work practices with regard to the new clinical programmes and teams led last year to €63 million in savings through the saving of 70,000 bed days. As I often have stated, it is not so much the money saved as the fact that more patients can be treated more quickly that really is the point in this regard. Through the LRC, I sought to push this<em> pro bono</em> arrangement, with which consultants have co-operated, into a formalised contractual arrangement because one cannot run the health service on a <em>pro bono</em> basis and that is what this is about. I am sure the Deputy will have a further supplementary question.</p>
</div>
</div>
</div>
<div class="speech brief" id="spk_320">
<div class="c-avatar -debate -short">
<a class="c-avatar__img-link" href="/ga/members/member/Michael-P-Kitt.D.1975-03-04/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Michael-P-Kitt.D.1975-03-04/image/thumb" alt="Michael P. Kitt"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Michael-P-Kitt.D.1975-03-04/"> An Leas-Cheann Comhairle</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/5/speech/320/" data-share-text="Health Services Reform" title="Share speech #320 by An Leas-Cheann Comhairle"><i>Roinn</i></a></div>

<p id="para_730" class="">Hopefully, if we have time.</p>
</div>
</div>
</div>
<div class="speech" id="spk_321">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/Caoimhghín-Ó-Caoláin.D.1997-06-26/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/Caoimhghín-Ó-Caoláin.D.1997-06-26/image/thumb" alt="Caoimhghín Ó Caoláin"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/Caoimhghín-Ó-Caoláin.D.1997-06-26/">Deputy Caoimhghín Ó Caoláin</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/5/speech/321/" data-share-text="Health Services Reform" title="Share speech #321 by Deputy Caoimhghín Ó Caoláin"><i>Roinn</i></a></div>

<p id="para_731" class="">The Minister has read out a list of specifics that were addressed in the LRC. However, as my question first posed sought, can the Minister tell Members what improved work practices are currently in place now thus far from among those measures? This is what I am particularly interested to hear, rather than what actually is intended or what will happen. On a related matter, what action is the Government taking to ensure there are sufficient hospital doctors, either consultants as we know them or the new category of hospital doctor that has been talked about in the past, to provide the necessary care for patients?</p>
<p id="para_732" class="">Does the Minister agree that it is not only an issue regarding pay but, rather critically, it is about staffing and such needs for the varying services that we all depend upon at some time?</p>
</div>
</div>
</div>
<div class="speech" id="spk_322">
<div class="c-avatar -debate">
<a class="c-avatar__img-link" href="/ga/members/member/James-Reilly.D.2007-06-14/">
<img class="c-avatar__img" src="https://data.oireachtas.ie/ie/oireachtas/member/id/James-Reilly.D.2007-06-14/image/thumb" alt="James Reilly"/>
</a>
<h4 class="c-avatar__name">
<a class="c-avatar__name-link" href="/ga/members/member/James-Reilly.D.2007-06-14/">Deputy James Reilly</a>
</h4>
</div>
<div class="text">
<div class="content"><div class="social-share"><a href="#" class="share-trigger" data-share-url="https://www.oireachtas.ie/ga/debates/question/2012-11-08/5/speech/322/" data-share-text="Health Services Reform" title="Share speech #322 by Deputy James Reilly"><i>Roinn</i></a></div>

<p id="para_733" class="">I will have great pleasure in answering those specific questions. Many consultants are doing excellent work, although many of them feel there has been much "consultant bashing". As with all groups in Irish society there are always some who deserve a good bashing but the vast bulk of people working as consultants in this country do an extraordinary job, going way beyond the hours they are contracted to provide.</p>
<p id="para_734" class=""> To answer the direct question of what is being done now that was not done before, in the past year or 18 months consultants have been coming in on Saturdays and Sundays, although they are not contracted to do so. They are doing ward rounds and discharging patients, as well as examining X-rays and other diagnostics in order to allow diagnoses to be made and patients to be discharged. Those initiatives alone have brought about improvements and saved 70,000 bed days, allowing many more patients to be treated much more quickly.</p>
<p id="para_735" class=""> The Deputy knows about the new stroke care programme that is saving one life per week and preventing three other Irish citizens per week from going into long-term care. He asked about ensuring there are sufficient hospital doctors and I again allude to a previous comment made in the debate on the national paediatric hospital: this is not so much about input but rather outcomes for patients. We can improve outcomes for patients by ensuring consultant specialists are doing the sort of work only they can, with work that can be done by other doctors and nurses done by those doctors and nurses. If health care assistants can do some of the work of nurses, they will do so. With regard to physiotherapy and speech and language therapy, the addition of allied health professionals to the stroke units have made a significant difference.</p>
<p id="para_736" class=""> It is about the right person treating the patient at the right time and with the right cost, and the new arrangements for consultants are a key part of that. They will open the way for many other groups within the health service changing work practices, as they can no longer point to consultants as leaders who do not lead the way. We can significantly improve the care we give in the health service in a far more cost-effective fashion.</p>
</div>
</div>
</div>