Written Answers Nos. 624-642
625. Deputy Finian McGrath asked the Minister for Health the reason for the refusal of a medical card in respect of a person (details supplied) in County Galway; and if he will make a statement on the matter. [30817/13]
Amharc ar fhreagraThe Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible.
The Health Service Executive operates the General Medical Services scheme, which includes medical cards and GP visit cards, under the Health Act 1970, as amended. It has established a dedicated contact service for members of the Oireachtas specifically for queries relating to medical cards and GP visit cards, which the Deputy may wish to use for an earlier response. Contact information has recently reissued to Oireachtas members.
626. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the resources available to his Department remains adequate to meet the full range of services at hospital and community level envisaged at budget time; and if he will make a statement on the matter. [30820/13]
Amharc ar fhreagraThe Health Estimates for 2013 continue to be very challenging and further cost reductions had to be made to ensure the most vulnerable were protected and frontline services maintained to the greatest extent possible. The Health Services have already made significant progress in "doing more with less" with significantly reduced financial and human resources.
In order to mitigate the impact on services at hospital and community level due to the reduction in employment numbers, the priority is to reform how health services are delivered in order to ensure a more productive and cost effective health system. The additional working hours and other cost-saving measures provided for in the Haddington Road Agreement are a pivotal element in this regard.
The rebalancing of hospital budgets in 2013 has ensured that hospitals have been given budgets which are related more closely to their costs in 2012. The HSE will be required to address any slippage in Cost Containment Plans and to ensure that additional measures are identified and safely implemented to bridge any projected deficits which are within HSE direct control, while engaging with my Department on a continuing basis.
627. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the number of medical cards has fluctuated in each of the past five years to date; and if he will make a statement on the matter. [30821/13]
Amharc ar fhreagraThe information sought by the Deputy is outlined below. The medical card service is demand led and the number of cards at any given time reflects those persons who have met the eligibility criteria governing the scheme.
|
Date |
National Population |
Number of Medical Cards |
Medical Cards as % of National Population |
Medical Cards Numbers - % increase year over year |
|
End 2008 |
4,422,100 |
1,352,120 |
30.6% |
- |
|
End 2009 |
4,459,300 |
1,478,560 |
33.2% |
9.4% |
|
End 2010 |
4,470,700 |
1,615,809 |
36.1% |
9.3% |
|
End 2011 |
4,581,269 |
1,694,063 |
37.0% |
4,8% |
|
End 2012 |
4,585,400 |
1,853,877 |
40.4% |
9.4% |
628. Deputy Bernard J. Durkan asked the Minister for Health if adequate resources remain available to ensure the retention of the maximum number of public nursing homes having particular regard to the projected needs in this sector; the extent to which any evaluation has been done to examine the prospect of increasing the capacity of such nursing homes; and if he will make a statement on the matter. [30822/13]
Amharc ar fhreagraBoth myself and my colleague, Dr. James Reilly, Minister for Health, are committed to the provision of a quality public nursing home service. Our overall objective is to protect the viability of as many units as possible within the funding and staffing resources available. My Department is working closely with the HSE to develop an overall plan regarding future public provision for the Minister’s consideration. The plan will reflect regional need and have regard to the current severe financial constraints, restrictions on public sector staffing and recruitment and the ongoing need to meet service and safety standards, all of which pose challenges for community nursing units across the country.
As the Deputy is aware the over-65 population recorded in Census 2011 was 535,393, an increase of 14.4% from 2006. Compared to population growth of 8.2% in the State as a whole, this is one of the age groups which experienced greatest growth over the period. The funding available for services for older people cannot increase at the same rate as the relevant population, and we will therefore have to ensure that the funds that are available are used to best effect for our older people.
The Nursing Homes Support Scheme provides financial support for those in long term nursing home care in accordance with their means. This Scheme is currently being reviewed. The terms of reference for the review are:
Taking account of Government policy, demographic trends and the fiscal situation-
1. To examine the on-going sustainability of the Nursing Homes Support Scheme,
2. To examine the overall cost of long term residential care in public and private nursing homes and the effectiveness of the current methods of negotiating/setting prices,
3. Having regard to 1 and 2 above, to consider the balance of funding between long-term residential care and community based services,
4. To consider the extension of the scheme to community based services and to other sectors (Disability and Mental Health), and
5. To make recommendations for the future operation and management of the Scheme.
Work will continue on the review in the coming months with a view to completion by end 2013-early 2014.
629. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he expects to have sufficient junior hospital doctors to meet requirements throughout the hospital service in the coming years; if he sees any requirement for policy changes in this regard in view of the experience of previous years; and if he will make a statement on the matter. [30823/13]
Amharc ar fhreagraUnder the provisions of the Medical Practitioners Act 2007 it is the responsibility of the Health Service Executive (HSE) in co-operation with the medical training bodies and after consultation with the Higher Education Authority, to undertake appropriate medical workforce planning for the purpose of meeting specialist medical staffing and training needs of the health service on an ongoing basis, and to assess on an annual basis the number of intern training posts and the number and type of specialist medical training posts required by the health service.
Following implementation of the recommendations of the Report of the Undergraduate Medical Education and Training Group (Fottrell 2006) a significant increase in the intake of Irish and EU students into Irish medical schools was phased in over the period 2006 to 2011. The objective of the increase was to achieve self-sufficiency in terms of medical staffing. This initiative has resulted in an increased number of Irish/EU medical graduates from Irish medical schools and projections indicate that the number of graduates will continue to increase up to 2016, providing a greater supply of junior hospital doctors for the health service.
630. Deputy Bernard J. Durkan asked the Minister for Health the extent to which sufficient nursing staff are readily available in line with requirements over the next three years; and if he will make a statement on the matter. [30824/13]
Amharc ar fhreagraA workforce planning exercise carried out in 2012 to forecast future staffing requirements as part of the Review of the Undergraduate Nursing and Midwifery Degree Programmes has indicated that the overall number of trainee nurses and midwives currently undertaking the programmes, 1,570 places in total, is considered to be sufficient to meet demand.
631. Deputy Bernard J. Durkan asked the Minister for Health the extent to which waiting lists have been reduced in all public hospitals throughout the country; the extent to which this compares favourably or otherwise with the private sector; and if he will make a statement on the matter. [30825/13]
Amharc ar fhreagraImproving access to hospital services for patients is a priority in the Programme for Government. In July 2011, I established the Special Delivery Unit (SDU) as set out in the Programme for Government, with the aim of unblocking access to acute services by improving the flow of patients through the system. Since then, the number of adults waiting over nine months has fallen by 25%, the number of children waiting over three months has fallen by 47% and the number of people waiting over three months for GI endoscopy is down by 89%.
By the end of 2012, the SDU had made significant progress in achieving the maximum waiting time targets of nine months for adults and 20 weeks for children awaiting inpatient or daycase treatment, and 13 weeks for those awaiting a routine GI endoscopy. By December, 86 adults and 89 children were waiting longer than the maximum waiting time targets, while 36 patients were waiting longer than 13 weeks for routine endoscopy.
For 2013, the maximum wait time for adults has been further reduced to eight months. However, the early months of the year brought severe pressures on Emergency Departments which impacted on waiting times and figures at 2 May show:
- A total of 39,064 (88% of total ) adults waiting less than 8 months;
- 5,392 adults waiting longer than eight months;
- 3,725 adults waiting longer than nine months;
- 717 adults waiting longer 12 months;
- A total of 2,889 (80% of total) children waiting less than 20 weeks;
- 716 children waiting longer than 20 weeks;
- A total of 7,876 (90% of total) waiting less than 13 weeks;
- 917 patients waiting longer than 13 weeks.
The SDU together with the NTPF and the HSE is undertaking a range of measures to work towards the 2013 maximum wait times. This involves working closely with hospitals to analyse performance, to agree action plans and extra support as necessary and to ensure hospital capacity is being optimised.
Neither my Department nor the HSE has a function in relation to the gathering of waiting list data for the private hospital sector. Therefore, a comparison between public and private waiting lists is not available. However, I can assure the Deputy that my Department will continue to focus its resources on reducing waiting lists in line with the Government’s commitment to deliver rapid and equitable access to health services.
632. Deputy Bernard J. Durkan asked the Minister for Health the extent to which savings and efficiencies have been achieved throughout all sectors in the health services; and if he will make a statement on the matter. [30826/13]
Amharc ar fhreagraIn 2013 the health sector continues to face the dual challenge of reducing costs while at the same time improving outcomes for patients. The financial challenges to be addressed this year are significant and a total cost reduction requirement of €721m was identified in the National Service Plan approved in January.
Based on a review of financial data to date, the HSE is not flagging any new concerns or risks beyond those which were set out within the National Service Plan 2013 (NSP). These risks remain and principally include:
- Savings of €353m within the Primary Care Reimbursement Service;
- Pay and pay related savings under the Croke Park Agreement and the Haddington Road Agreement;
- Private Health Insurance Income;
- The general scale of the overall challenge within the remainder of the community and in particular hospital services.
The rebalancing of hospital budgets in 2013 has ensured that hospitals have been given budgets which are related more closely to their costs in 2012 - however as indicated in the Service Plan it has not been possible to provide for the full amount of 2012 costs. The HSE will be required to address any slippage in Cost Containment Plans and to ensure that additional measures are identified and safely implemented to bridge any projected deficits which are within HSE direct control, while engaging with my Department on a continuing basis.
There is ongoing and intensive engagement each month between officials from my Department and the HSE in the context of regular monitoring of expenditure. My Department also provides detailed analysis each month on expenditure trends to the Department of Public Expenditure and Reform, and there is regular engagement between officials from that Department, my own Department and the HSE. The HSE's Performance Report, which is published every month, provides an overall analysis of key performance data from Finance, HR, Hospital and Primary & Community Services. The activity data reported is based on Performance Activity and Key Performance Indicators outlined in the HSE National Service Plan. The April Performance Report is available to view on the HSEs website - www.hse.ie
633. Deputy Bernard J. Durkan asked the Minister for Health the extent to which agency nursing staff continue to be replaced by part-time, temporary or whole-time staff throughout the public health sector; and if he will make a statement on the matter. [30827/13]
Amharc ar fhreagra638. Deputy Bernard J. Durkan asked the Minister for Health the extent to which graduate nurses are likely to be offered positions over the next two years; and if he will make a statement on the matter. [30832/13]
Amharc ar fhreagraI propose to take Questions Nos. 633 and 638 together.
Government policy requires that by the end of 2013 the health service achieves a workforce of 98,955 wholetime equivalents (WTEs), a gross reduction of almost 4,000 WTE in the current year. Given the requirement on the HSE to reduce numbers employed and to achieve savings of over €700m this year, there is very limited scope to offer new nursing posts, part-time, temporary or full-time, at present.
The Public Service Stability Agreement 2013-2016 (The Haddington Road Agreement) contains a number of provisions that will deliver additional hours and which will allow the HSE to reduce the use of agency staff. Among these provisions are an increase in the working week of nurses and midwives to 39 hours per week and the Graduate Nurse Placement Initiative.
The Minister for Public Expenditure and Reform approved the Graduate Nurse Placement Initiative on the basis that participants would not be counted in health service staff numbers and that it would contribute to savings on unsustainable levels of agency and overtime expenditure. This Initiative will enable the health services to offer 1,000 graduate nurses with positions for two years. It will support the retention of recently qualified graduate nurses and midwives within the Irish health system and enable them to gain valuable work experience and development opportunities post-graduation, at a time when job opportunities in the public service are very limited.
634. Deputy Bernard J. Durkan asked the Minister for Health arising from recent announcements by health insurers, the extent to which his Department continues to monitor the health insurance sector with a view to ensuring that the public continue to have access to competitive rates of health insurance and that an urgent evaluation is carried out into the basis for increases in such health insurance over the past five years in view of the fact the commitment to community rating and the need to ensure that cherry picking by health insurers is discouraged or the penalisation of families traditionally provided for by private health insurance needs over a long period of years do not find themselves disadvantaged which tends to discourage participation in private health insurance; and if he will make a statement on the matter. [30828/13]
Amharc ar fhreagraMy Department oversees the maintenance of a competitive and sustainable private health insurance market, under the provisions of the Health Insurance Acts 1994 to 2012, and monitors developments on an ongoing basis, to ensure that the market is regulated appropriately in the transition to a market-based Universal Health Insurance system.
I have consistently raised the issue of managing costs with health insurers and am determined to address rising costs in the sector in the interests of consumers. I want insurers to address the base cost of each element of claims which they pay. This is the real issue as costs are becoming unsustainable at present. Last year, I established the Consultative Forum on Health Insurance to generate ideas to address health insurance costs, while always respecting the requirements of competition law. I have made it clear to the health insurers that I believe significant savings can be made, ultimately reducing the impact of rising health costs on health insurance premiums for the consumer. Last week I announced the appointment of an independent Chairperson to work with my Department and the insurers under the auspices of the Consultative Forum on Health Insurance. The Chairperson will oversee a process of review to give effect to real cost reductions in the private health insurance market. Specific areas that I have asked insurers to address include:
- Audit - of the volume of procedures;
- Clinical audit - to determine the appropriateness of procedures being claimed for;
- Procedure based payments - in particular with a view to their extension to the public health sector; and
- Benchmarking - to determine the underlying basis for the cost of specific procedures, with a view to driving costs downwards.
I am strongly of the view that all procedures should be provided at an appropriate setting that is safe and provides value for money for consumers.
Given VHI’s very significant share of overall costs in the market, I will continue to focus strongly on the need for the VHI to address its costs. At my instruction, the VHI recently compiled a detailed cost containment plan, which sets out savings targets for 2013 and for the 2014-2016 period, so as to minimise the need for any future premium increases. The savings targets over this period are to be achieved through a combination of initiatives including rate reductions with private hospitals and consultants, utilisation management, expansion of clinical audit, reductions in high cost drugs and prosthesis, provider reviews and the continued transition of procedures to lower cost, medically appropriate settings.
The Deputy has also raised concerns about the need to ensure that cherry-picking by health insurers is discouraged. In this regard, the Health Insurance (Amendment) Act, 2012 provides for the introduction of a permanent Risk Equalisation Scheme (RES) in the private health insurance market, with effect from 1 January, 2013. This new scheme puts in place, for the first time in this country, a permanent and robust system of Risk Equalisation. The scheme is budget neutral and has no overall impact on the costs in the market. It supports competition by encouraging insurers to move their focus away from avoiding older, less healthy customers and towards innovation, achieving greater efficiencies and improved customer service. This is the kind of competition which is best for consumers and is intended to support the Government’s efforts to maintain community rating in the Irish health insurance market.
The revised rates for 2013 will, from 31 March onwards, increase the support levels in respect of older and less healthy customers, so that health insurance will be made more affordable for them. Without this support, health insurers have a strong financial incentive to ‘segment’ the market by offering policies targeted at younger, healthier people. I will continue to focus strongly on this issue, as part of measures to ensure the sustainability of the private health insurance market in the transition to a Universal Health Insurance system.
635. Deputy Bernard J. Durkan asked the Minister for Health the extent to which central procurement in terms of medicine, drugs or services in the health sector is organised in order to give maximum benefit and efficiency to the taxpayer when possible and that local indigenous providers have ample opportunity to compete for the provision of all such goods and services; and if he will make a statement on the matter. [30829/13]
Amharc ar fhreagraAll Government Departments and Agencies funded by the Exchequer must comply with EU Directives and national guidelines on procurement.
Procurement of medicine, drugs or services in the health care sector which supports the delivery of health care is a service matter. Therefore your question has been referred to the HSE for direct reply.
636. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the cost of prescription drugs to the Exchequer has fluctuated over the past four years to date; and if he will make a statement on the matter. [30830/13]
Amharc ar fhreagraThe cost to the HSE of drugs and medicines supplied under the GMS, Drug Payment and Long Term Illness schemes between 2008 and 2012 are set out below:
|
Year |
Exchequer Costs |
|
2012 |
€1.53 billion |
|
2011 |
€1.46 billion |
|
2010 |
€1.53 billion |
|
2009 |
€1.65 billion |
|
2008 |
€1.59 billion |
The figures above include dispensing fees and mark-ups paid to pharmacists.
In recent years, a number of changes to the pricing and reimbursement system have been successfully introduced in Ireland. These have resulted in reductions in the prices of thousands of medicines.
Between 2009 and 2013 price reductions of the order of 30% per item reimbursed have been achieved. The average cost per item on the GMS Scheme has reduced from a peak of €18.97 in 2009 to €13.43 in January/February 2013, a 29% reduction in cost per item. The average cost per item reimbursed is now running at 2001/2002 levels.
637. Deputy Bernard J. Durkan asked the Minister for Health the total number of consultant, non-consultant doctor and nursing posts currently vacant; those likely to be filled in the foreseeable future; and if he will make a statement on the matter. [30831/13]
Amharc ar fhreagraThe Government has decided that the numbers employed across the public service must be reduced, in order to meet fiscal and budgetary targets. As a major employer, the health sector must make a significant contribution to this reduction. This policy requires that, by the end of 2013, the health service achieves a workforce of 98,955 wholetime equivalents (WTEs).
The HSE may continue to recruit staff in exceptional circumstances, where it has been established that there is an urgent service requirement and that this can be accommodated within the budgetary constraints and overall employment ceiling. In addition development posts in a range of disciplines are being filled in accordance with priorities determined by Government. The number of consultant posts has increased significantly in recent years and NCHD numbers, for the most part, have been maintained.
I have asked the Executive to compile the information in relation the number of Consultant, NCHD and Nursing posts that are currently deemed vacant and reply directly to the Deputy.
639. Deputy Bernard J. Durkan asked the Minister for Health the extent to which nursing assistant posts have been filled in line with requirements in each of the past four years to date; the likely development in this regard in the future; and if he will make a statement on the matter. [30833/13]
Amharc ar fhreagraThe Government has decided that the numbers employed across the public service must be reduced, in order to meet fiscal and budgetary targets. As a major employer, the health sector must make a significant contribution to this reduction. This policy requires that by the end of 2013, the health service achieves a workforce of 98,955 wholetime equivalents (WTEs).
The HSE may continue to recruit staff in exceptional circumstances, where it has been established that there is an urgent service requirement and that this can be accommodated within the budgetary constraints and its overall employment ceiling.
I have asked the Executive to compile the information in relation the number of Nursing Assistant posts that have been filled in each of the past four years and reply directly to the Deputy.
640. Deputy Bernard J. Durkan asked the Minister for Health if his attention has been drawn to the need to ensure the retention of the widest possible network of local health centres throughout County Kildare with particular reference to all rural and urban areas dependent on such services; and if he will make a statement on the matter. [30834/13]
Amharc ar fhreagraAs the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive for direct reply to the Deputy.
641. Deputy Bernard J. Durkan asked the Minister for Health the extent to which hospice beds are available to patients throughout north Kildare; the extent to which this number is sufficient to meet requirements; if he or his Department has received any submissions in this regard requesting extra bed accommodation; and if he will make a statement on the matter. [30835/13]
Amharc ar fhreagraAs the issues raised relate to service matters, the question has been referred to the Health Service Executive for direct reply. This Department has not received any recent submissions regarding hospice beds in North Kildare.
642. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he and his Department continues to monitor developments at St Bridget’s Nursing Home, Crooksling; if any changes have taken place in policy or administration which might affect the future of the hospital, its capacity to accommodate the needs of the indigenous community and the scale of services provided there; and if he will make a statement on the matter. [30836/13]
Amharc ar fhreagraBoth myself and my colleague, Dr James Reilly, Minister for Health, are committed to the provision of a quality public nursing home service. Our overall objective is to protect the viability of as many units as possible, within the funding and staffing resources available. My Department is working closely with the HSE to develop an overall plan regarding future public provision for the Minister’s consideration. The plan will reflect regional need and have regard to the current severe financial constraints, restrictions on public sector staffing and recruitment and the ongoing need to meet service and safety standards; all of which pose challenges for community nursing units across the country. The question has been referred to the HSE for direct reply in relation to the specific operational matters raised by the Deputy.
