James Reilly (Dublin North, Fine Gael) | Oireachtas source

Senator van Turnhout raised the issue of palliative care, as did Deputy Mitchell O'Connor. A substantial budget is directed at it but it is true that much additional money is spent on end-of-life care. Most of us would like to see people being able to end their lives at home and, if not, at least in a hospice. Mr. Ian Carter, the director of acute hospitals, has taken an interest in this and has plans to address it. Mr. O'Brien will address this matter further.

Mr. O'Brien will discuss the issues the Senator raised with regard to children in care and mental health. Many psychiatric nurses retire at the age of 55, as they are entitled to do. This is younger than the average nurse retirement age, so more people have left the mental health services as a proportion of the number over all elements of the service. We have been playing catch-up. Through A Vision For Change there has been a need for a change in the type of person working in our health service. We have much more need for allied health care professionals such as psychologists and counsellors as well as nurses. We are moving away from the old model to the new model. An element of change in this regard is happening also.

The Senator asked whether child and family services will carry any deficit forward into the new agency. They certainly will bring their proportion of it because otherwise other elements, such as disability and the HSE, would have to take it. I do not mean Senator van Turnhout, but people have a tendency to ask for something to be ring-fenced. This means twice as much must come from what is left, so a 2% drop overall becomes a 4%, 5% or 6% drop in certain areas because other areas do not have to take any of the load. The Child and Family Agency is hugely important and is a big part of the commitment of the Government towards children. We want to see it fare well but we are not in a position to take the entire deficit. A proportional amount was left with the services and much was taken back by the HSE centrally.

Deputy Fitzpatrick spoke about the cost of the addition of children under six to the medical card scheme. A total of 240,000 additional children will be covered as a consequence of this initiative, at a cost of €37 million. He also mentioned medical cards. A total of 60,000 additional medical cards will be provided for. The long-term future for the medical card for those aged over 70 is universal health insurance. This is how it will be addressed, obviously not in this term of government but in the next, if we are re-elected by the people to carry through on the reforms on which we have made major progress and continue to do so.

I do not believe there has been a change in the number of home help hours from 2013 to 2014. I will ask Ms Laverne to address this question and that about respite services. A number of committee members raised the issue of the Fair Deal scheme. When people can see a large pot of money they tend to go for the resources. The consequence is that many people have ended up in long-term care before they needed to be there and without full and proper assessment. We are developing a single assessment tool which will be rolled out this year in 50% of cases and rolled out fully next year. This has taken quite a long time to develop and we must train all of the people involved who will use it. It is about transparency and fairness. It has not been fair in the past. In some parts of the country people went into long-term care long before they required it while in other parts people waited for long periods, long after they needed the care and should have had it.

Several people raised the issue of obesity. We take it very seriously and as part of our Presidency of the Council of the European Union we debated it during the ministerial meeting which I and the Minister for Children and Youth Affairs, Deputy Fitzgerald, chaired. We have a special action group on obesity. It is a preventable cause of chronic illness and death and there is no doubt that if we do not address it we may very well be the first generation to bury the generation behind us. Consequent on the obesity epidemic will come a diabetes epidemic. When I started as a doctor one never saw a type II diabetic under the age of 30, but now we regularly see teenagers with type II diabetes, which is appalling. We need to address this. Dr. Stephanie O'Keeffe might say a few words on health and well-being. This is a cross-Government initiative and does not only involve health. It must also involve the Departments with responsibility for education, the environment, justice and finance, the latter with regard to VAT on certain products which are healthy, calorie-free or low in calories compared to others. We are the first Government to put in place at principal officer level in the Departments of Health, Children and Youth Affairs and Education and Skills an individual responsible for co-ordinating services and preventing childhood obesity.

Deputy Mitchell O'Connor mentioned organ transplants. I am pleased that we can put more money into the project, particularly rapidly developing live transplants. We all acknowledge that the procedure saves lives, leads to a better quality of life and saves a large amount of money.
Senator Colm Burke mentioned a step-down facility issue. I discussed the improvement in the number of intermittent care facilities as late as yesterday with Members in the Department. In the past an older, frail person would enter hospital suffering pneumonia that would be treated within 72 hours but unfortunately other problems would ensue. Therefore, a person would have to remain in bed for a prolonged period and end up having to go into long-term care. Had such that person received an aggressive programme of physiotherapy or occupational therapy from 48 hours onwards he or she may not have had to enter long-term care. We are examining the matter and are thinking outside of the box. We are considering some of the NAMA hotels which have en suitefacilities, gymnasia, canteen facilities and, in some cases, swimming pools, as possible locations for a new type of intermittent care. We are considering more cost-effective methods and better solutions for patients. People want to retain their independence for as long as possible and, as a doctor and a politician, we should support that wish in every way we can.