Kieran O'Donnell (Limerick City, Fine Gael)
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I shall return to a point raised by Deputy Mary Lou McDonald on the clinical director's allowance. Mr. Tony O'Brien referred to the fact that he was also in the management service of a modern HSE. I raised the question previously and I have put the representatives on notice that I would probably raise the issue. Within the consultants area, €74 million in private fee income remains unbilled to insurance companies. I was told on 9 October that there were specific problems with some consultants in terms of completion of forms. On the previous occasion the HSE appeared before the committee we were informed that €8 million was outstanding for more than a year. I am looking at this in the context of front-line cuts of the order of €58 million before the end of the year. It is ironic that €8 million of that relates to home help hours and €8 million of the €74 million is the amount that is outstanding for more than 12 months. For me the issue is simple.

Does the clinical director's role involve examining whether the forms are signed and is that the only reason the claims have not been put in? Is there a specific person in each hospital designated by the HSE to ensure forms are completed by consultants and claims submitted? I commend the HSE on the fact it got €125 million in accelerated payments from the insurance companies. I see no reason the same cannot happen in respect of the €74 million unclaimed private fee income. It could be looked at in the form of an accelerated payment from the insurance companies. This is about management.

What is the clinical director's role in interacting with consultants? Is there a specific person in place in the HSE at administration level to ensure the forms are signed? I understand that in many cases patient files are not presented to consultants to sign-off on insurance claims. Given that €74 million has not been claimed in fee income, in the context of the HSE being required to make front-line cuts of €58 million, €8 million of which relates to home help hours, something is not right.

I do not fully accept that it is tied in with the Labour Court. This is an administrative issue. Somebody should be put on the job full time to lug the files to the consultants to sign them because a submission cannot be made to the insurance companies unless the form is signed off by the consultant. Is there a requirement for a change in legislation to the effect that it could be signed off by a senior house doctor rather than a consultant? Is it all about management? Will Mr. O'Brien give me an update on the role of the clinical director, the allowances paid and where that stands? At this time the HSE is having to make adjustments in home help hours which are impacting on people.

Clearly, the HSE is doing it because it is in very difficult circumstances but on behalf of the people we represent, we are looking for angles whereby the HSE can pull in money and not have to make adjustments such as these. In that context, this €74 million is sticking out like a sore thumb. I have had time to reflect on this and I simply cannot understand why the claims have not been sent to the insurance companies. It is totally unacceptable and I ask Mr. O'Brien to deal with that issue.