Wednesday, 20 January 2010
Defence Forces Review.
Question 75: To ask the Minister for Defence the estimated savings expected to be made through reduced outsourcing of primary care appointments within and through the medical corps of the Defence Forces; the savings made to date; the timeframe within which he expects to make the full savings; the changes that are expected to produce these savings; and if he will make a statement on the matter. [2079/10]
Question 86: To ask the Minister for Defence his views on the conclusion of the expert panel involved the preparation of the medical services review that the Permanent Defence Force's emphasis on medical assessments is excessive and inconsistent with international defence health practice; the proposals he will make to rectify this; the timetable that will be applied to its rectification; and if he will make a statement on the matter. [2099/10]
Question 87: To ask the Minister for Defence the amount of funding provided for the implementation of the medical services review; the timetable for delivery of the recommendations in the report; the elements of the medical services review that have been implemented; if he will accept all of the recommendations in the report; and if he will make a statement on the matter. [2110/10]
I propose to takes Questions Nos. 75, 86 and 87 together.
The PA report is an important milestone in addressing the challenges to the provision of medical services in the Defence Forces. Implementation will take time and commitment. On receipt of the report in June 2009, I accepted the recommendations and asked that implementation of the recommendations proceed immediately.
The report reviewed the medical services required for the Defence Forces in light of their roles and operations, assessed the current arrangements for the provision of medical services and proposed a model for future delivery of medical services. Some of the major recommendations are focused on making better use of existing clinical resources and thereby providing a better medical service and reducing the spend on outsourcing. The savings in outsourcing are to be achieved mainly through the re-focussing of medical staff on appropriate clinical tasks with administration functions being undertaken by non-clinical personnel; a reduction in the number of doctor interventions and medical assessments; and better management of health services outsourcing.
In order to achieve the saving in outsourcing, a major restructuring of the medical corps has to be completed. A number of working groups have been established to deal with the various aspects of this restructuring and several have already made recommendations which are being considered by the steering committee overseeing the project. As regards the frequency of medical assessments, one of the working groups is currently looking at clinical issues and has made recommendations which are currently under consideration. I expect substantial progress to be made over the coming 12 months in implementing recommendations. Some issues will be resolved quickly while others will require significant consideration and will, for example, require negotiation with the representative associations.
It is difficult at this stage of implementation to estimate the savings that can be achieved through reduced outsourcing as much of our requirement depends on a number of factors. However, I expect that savings on outsourcing could be made through the implementation of the PA recommendations. Implementation of the recommendations will result in major change at both strategic and operational levels in the Defence Forces. Thankfully in these difficult times, the report shows that major additional investment is not needed to meet the medical needs of the Defence Forces. Change will be achieved mainly through better use of the available resources.
Defence Forces personnel requiring medical treatment are getting the care they need. The services of civilian medical practitioners are used to provide backup to the medical corps in ensuring that the primary health care requirements arising in barracks are met. As the Defence Forces will never be able to meet all medical requirements from internal medical personnel, outsourcing will continue to be required. However, implementation of the PA recommendations will ensure that outsourcing will be reduced for primary care and that outsourced services will be procured and managed in a more cost-effective way.
Can the Minister indicate whether any of the recommendations were implemented? Many of the major recommendations were intended for immediate implementation.
A newspaper article from last weekend reported that Defence Forces personnel had to travel to another pharmacy because a qualified chemist had not been appointed to the medical corps to dispense medication. It is not acceptable that the position of chemist is not filled. Was that report accurate?
There is a malaise in the medical corps. Its establishment figure is 46 but the most recent figures given by the Minister reveal that its staffing level is only 23. The first question I put to the Minister after he was appointed to his position was on the medical corps because the Defence Forces need to be supported by an adequate medical service. He commissioned a report and gave his commitment that urgent action would be taken. Unfortunately, I believe he is sitting on the report and I ask for a timetable for its implementation.
I will investigate the matter involving the chemist and revert to the Deputy on it. It has been widely accepted for years that the medical corps is in an unsatisfactory state for a number of reasons but we have lacked a roadmap for the solution. I decided to jump-start the process by appointing consultants and I have now received a report. I previously advised Deputy Deenihan that some of the recommendations are complex and will take time to implement because they involve radical change to the structure of the Army.
Every six weeks, the Deputy asks me what progress is being made but all I can tell him is that the changes that are being introduced cannot be measured over six week intervals. I could speed up matters by refusing to consult representative organisations because I have the power to impose change by dictat.
It is difficult to strike the correct balance. The same departmental officials who are overseeing the moratorium, a reduction of staff and decentralisation to Newbridge while preparing a value-for-money report into the Reserve Defence Force and a new White Paper are also responsible for implementing the PA report. Given the radical nature of the recommendations, we cannot expect instant action, but I expect substantial progress over the coming 12 months.
In regard to Deputy Deenihan's immediate question, one of the central recommendations of the PA report was on establishing a structure to oversee change. A programme group and a steering committee has been formed to address this recommendation. Since the last time we discussed this matter in the House, the programme group and the steering committee have held a number of meetings and five working groups have commenced work. The clinical review working group, which is designing new processes and protocols relating to the delivery of clinical services, has completed an interim report which is now being considered by the programme group. The organisation and establishment working group, which is tasked with designing a new structure for the medical corps to incorporate a non-clinical administration unit, has issued a progress report to the programme group. A future medical information system review working group has been established to analyse the information technology requirements for future medical service delivery. The group has completed an analysis of current information systems.
In regard to financial arrangements, an outsourcing review working group has been established to examine the current arrangements in the medical corps for the outsourcing of services. Based on public procurement guidelines, the review group will make recommendations by which the new central medical unit will procure its future outsourcing and services requirements. We are essentially seeking in all of this to obtain better use from existing medical staff so that we will not need as large an establishment in future. We will ensure better value for the people we are employing, which will mean less outsourcing. In tandem with that, we are reviewing the arrangements for outsourcing to ensure better value for money in that aspect.