James Reilly (Dublin North, Fine Gael)
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I have a real concern about the assessment tool, a point raised by Deputy Ó Caoláin. With the fair deal, not alone did we find funding was difficult to follow once it went below the regional director of organisation level, but even though we had a supposedly uniform process for assessing people for long-term care, it was not uniformly applied. There were different professionals in different areas applying it in different ways. The consequence of this was that some people who did need long-term care urgently were behind those who did not need it that much. This is being addressed not just for long-term care but for all services for elderly people.

Up to €200 million is spent on home help and home care. When we review the fair deal process, I believe the emphasis should be further back. People tend to follow where the resources are and they know there are moneys available for long-term care to which they gravitate. Subsequently, we find people ending up in long-term care before they need or want to be there.

Deputy Ciara Conway referred to outstanding moneys owed by health insurers. There is certainly a couple of hundred million euro outstanding but €125 million will be collected before Christmas. That means there is €100 million owed which we will pursue next year aggressively.

Deputy Dowds raised the point about agency workers and how it would be more suitable in some cases to appoint permanent staff. We are in talks with the Department of Public Expenditure and Reform about taking on recently graduated nurses for a nursing bank. It would be somewhat like the JobBridge programme. Negotiations need to take place with the INMO, Irish Nurses and Midwives Organisation, on this too. It will mean we will have more nurses we can use instead of agency nurses. While agency nurses are very fine people, the reality is they cannot be trained in specialised areas because they are moving and changing all the time.

I referred earlier to hospital group managers and Galway because of its success. It would have had 9,901 people waiting for nine months or longer if they had not been treated by September. They were all treated. The hospital had on average 27 people on trolleys each day, regularly up to 50. That number is now an average of seven people with none on some days. This has been achieved through the group hospital scheme. It gives the chief executive officer of the group hospitals the opportunity to re-orient staff. The other good point out of this is that Roscommon hospital, which is part of that group, is now busier than ever doing work that is safe. It now does plastic surgery, as well as dealing with rheumatology and has a sleep apnoea clinic. The future of that hospital is secure, delivering a wider range of services to people than it did before and doing so safely. These managers should not just have control over their budgets but over their recruitment. They know whether it is another nurse they need or a new physiotherapist. We also have to give them some power over procurement even though central procurement can give us greater savings. Sometimes procuring locally can ensure better deals.

An example was given of four different items procured by four different hospitals. One hospital was charged €66 for one item while another hospital was charged €25. The stunning point about this was they were all purchased from the same wholesaler. There is much money to be saved in many ways. Another issue surrounds the amount of stock kept by hospitals. The larger hospitals would keep €20 million in stock while in Germany this is used as the parameter for stocking a hospital of 10,000 beds. Our whole health system has only 11,000 beds so there are significant one-offs to be made.

Deputy Mitchell O’Connor spoke about charities, such as LauraLynn House, providing great care across a range of areas. There are 3,500 of these agencies. We have a real issue with some of them in that they will not tell us how much they are paying their chief executive officers, how many staff they have and how much goes on salaries. If we are going to do a service level agreement with any of these groups, all of this information will have to be supplied or we are not signing up with them.

The Chairman asked if we have gone beyond the level at which reductions become dangerous. The OECD report states the safest lowest health spend is 3% of gross domestic product but once below that then there will be trouble. He referred to the disability sector and specifically to the COPE organisation which believes it cannot take much more. Will its provision be ring-fenced? Last year, every sector got a 5% cut while disability got a 3.5% cut. The problem with ring fencing is that the more one does it, the less one has to deal with it and then the cuts elsewhere become really difficult. I do not want to be cutting services but the cost of services. That comes through many different ways such as increased productivity and working in different ways.

Organisations involved in disability will have to change the way they operate. In the past, they received moneys from government to look after the people with whom they are charged. We want to move to the money-follows-the-patient model in the disability area which will mean individualised and personalised budgets. That empowers the person with the disability and they will choose the service they want from the various providers. This will change the dynamic and I believe this is the right and moral thing to do.