Kate O'Connell (Dublin Bay South, Fine Gael) | Oireachtas source

I will follow on from Deputy Louise Reilly's point on home care and the fair deal scheme. My colleague, Deputy Bernard J. Durkan asked about the reasons for overcrowding. I know that it seems obvious, but is there evidence that the delay in discharging patients due to be discharged to a nursing home, as in normal circumstances they would not be able to return home, is due to families delaying the start of the fair deal scheme arrangement? It is my understanding the fair deal scheme arrangement only kicks in once a person enters the nursing home system. I have heard that families do not expedite the move to a nursing home because the family assets have not been transferred to a place where the HSE cannot access them. I have also heard stories on how to work the five-year clawback period to move assets out of the State's reach. A person is left in hospital for a year and then something is cobbled together to meet requirements. If there is evidence that this practice is widespread, has there been a move to extend the clawback period to seven years? Seven years would be a long time to cobble something together to try to avoid the clawback. Is this just a couple of instances of which I have heard and is it the case that the practice is not widespread?

I spoke to the Minister earlier about the expansion of the number of primary care centres from 43 to more than 100. He mentioned that there was no point in providing facilities that closed at 5 p.m. Senator John Dolan quoted Mr. O'Brien as saying, "As I stated, much of the diagnosis and prescription is contained in the Sláintecare report." One of the key aspects of the report is a reorientation to provide health services in a primary care setting. One can have all of the diagnoses and prescriptions one wants, but unless one does what one is told to do and swallows the tablets, one will not get better. We can have the prescription, but we need to implement it. A key part is the expansion of the number of primary care centres, to which Mr. O'Brien referred as primary care hubs. That is the direction taken in the Sláintecare report. We discussed diagnostic centres in the community being aligned with primary care centres in order that people would be able to find out what was wrong with them. As we are six months into the 20-month Sláintecare process, what progress has been made? Does the HSE have specific actions to expand the number of primary care centres in light of the Sláintecare report which recommends expanded opening hours and access to diagnostics to assess the impact on the level of hospital overcrowding?

With regard to the Meath Hospital community care unit, the process has been delayed by more than 18 months in the move to Mount Carmel hospital because, as I understand it, Belvilla nursing home had to be refurbished and the residents moved to the Mount Carmel hospital step-down unit. They were told they would be there for nine months, but they are still there two years later. Deputy Bernard J. Durkan spoke about blockages in the system. This is a prime example, unless, again, I am reading it incorrectly. I would be happy to receive a comprehensive response after the meeting, if the information is not to hand.

There appears to be a fee being applied to venesections by hospital management in certain hospitals. As many know, this is used as a treatment for haemochromatosis. We have quite a heavy disease burden of haemochromatosis in Ireland. I understand medical card patients are exempt from the €80 fee and people with private health insurance have their fees covered by health insurance. There is a cohort in between who do not qualify for a medical card and do not have private health insurance.

Venesection is an important part of people's treatment. I have heard from the Irish Haemochromatosis Association and various patients that people are spreading out the distance between their venesections because they cannot afford the €80 fee. Obviously, there are negative health impacts following a failure to attend for venesection when due.

Why is this policy being implemented? Is it on a hospital by hospital basis? Is it something the HSE is doing? If it is being implemented by the HSE, are there any figures on the net financial gain? I would imagine that the processing of an €80 fee costs the HSE a lot of money, based on information I have seen. Are we imposing a fee on people who require treatment? Does that have any other effect, aside from poor patient outcomes? Is there any financial benefit? Is the HSE doing anything about it?