Seanad debates
Tuesday, 14 February 2012
HSE National Service Plan: Statements, Questions and Answers
4:00 am
James Reilly (Dublin North, Fine Gael)
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I am pleased to have the opportunity to discuss the HSE national service plan for 2012 and our health reform priorities. My overriding commitment to the people is to introduce a better and more efficient health system which will have improved services for everyone. With this in mind, the Government and I are committed to introducing a single tier service that will deliver equal access to care based on need, not income. There will be a number of important stepping stones along the way and each will play a critical role in improving our health service in advance of the introduction of universal health insurance.
I wish to update the House on the HSE national service plan for 2012 and, in particular, to outline the steps taken by my Department and the executive to mitigate the impact of budget cuts on front-line services and to set out my health reform priorities for the year. The HSE plan, which I approved in January, sets out the health and personal social services that will be delivered by the executive within its current budget of €13.317 billion. This year will be the latest in a series of hugely challenging years for the health service. The €750 million savings target for 2012 follows savings of €1.75 billion over the past two years, giving a total of €2.5 billion. As I advised the Dáil recently, approval of the plan followed extensive work undertaken by my Department and the HSE, including a rigorous examination of budget allocations across the services aimed at minimising the impact on front-line services and identifying where efficiencies will be driven.
This is to ensure there will not be a straight line reduction in services. In other words, it is not business as usual.
The targets for service delivery set out in the plan are very demanding. The plan commits the HSE to minimising the impact on services by fast-tracking new, innovative and more efficient ways of using reduced resources. Reform initiatives set out in the plan include the development of proposals to protect the viability of community nursing home units and to increase the intermediate care capacity for older people, and I will continue to work with the Minister of State, Deputy Kathleen Lynch, on this; a significant strengthening of primary care services, including issuing GP visit cards to long-term illness claimants - the Minister of State, Deputy Róisín Shortall, and I will ensure the delivery of this significant step on the road to universal health insurance and free GP care for all; an additional €35 million to be targeted at improving child, adolescent and adult community mental health teams as well as suicide prevention and counselling services; a more tailored approach to disability services; commencement of the roll-out of the colorectal screening programme; and progression of the clinical care programmes, including the roll-out of a national chronic disease management programme for diabetes. This underscores our commitment to both prevention and chronic illness management, or secondary prevention as it is better known.
More than 2,000 people have retired since September and another 2,000 will have retired by the end of the month. This still leaves more than 100,000 people working in our health services. Planning on this issue began last year. Contingency plans continue to be refined to address the impact of retirements and to ensure patient safety and service at the front line. This will include measures under the public service agreement to achieve increased flexibility in regard to work practices and rosters, redeployment and other changes to achieve more efficient delivery of services. Some management structures and services will be amalgamated and streamlined and cross-over arrangements will be put in place wherever possible and where clinical management numbers have been reduced.
I have acknowledged that pressure points will emerge which, in fact, have already been identified by local hospital and community managers in the HSE and are now being worked on by the health transition team. The HSE is seeking to mitigate the impact of these retirements through targeted investment and recruitment. Some key posts will be filled and planned investment in this regard includes €20 million to enable the replacement of front-line primary care staff and €35 million in mental health for the recruitment of an additional 400 whole-time equivalents.
I intend to review the service plan once the full impact of staff leaving at the end of the 29 February grace period is known. I made it clear during the course of the national service plan statements in the Dáil that this will be a dynamic process. There will be a number of reviews and as the situation changes, we will modify the plan. The service plan is a key signpost, however, for how our health services will be delivered in 2012.
In addition, the programme for Government has set out a major agenda of reform of our health care system which will lead to universal health insurance. I have identified four key reform priorities for 2012: delivering on the special delivery unit agenda; further overhaul of health system governance; reforming the model of care; and reforming the health insurance sector.
First, significant reform of the acute hospital system is planned. Last year I established a special delivery unit to reduce waiting times for patients for both scheduled and unscheduled care. The special delivery unit has delivered on the two key priorities which I set for it in 2011. In the area of unscheduled care delivered in emergency departments, the cumulative number of patients waiting on trolleys at 8 a.m. across the country for the first 16 days of January 2012 was reduced by 27% compared with the same period last year. I am glad to say that reduction continues.
In regard to scheduled care, I directed that all public hospitals ensure they had no patients waiting more than 12 months by the end of 2011. The National Treatment Purchase Fund reported that at the end of 2011, only two hospitals, both in Galway - Merlin Park and University College Hospital Galway - had people waiting more than 12 months for treatment on the active list.
That compares with 28 hospitals at the end of 2010 that had patients waiting over 12 months. I recently announced new ambitious targets for scheduled and unscheduled care by the end of 2012 or earlier.
Another critical aspect of reform of the acute hospital system is implementation of a new, more efficient funding system for hospital care. Under a "money follows the patient" funding system, hospitals will be paid per patient seen. This is a more efficient financing mechanism which incentivises acute hospitals to treat more patients, an incentive absent from the current arrangements. To achieve this a number of initiatives are already under way including a patient level costing project, which involves tracing resources actually used by individual patients from the time of entry and admission to hospital until the time of discharge. The Health Service Executive has also implemented a pilot project in regard to prospective funding for certain elective orthopaedic procedures. That has yielded a saving of nearly €6 million in its first year. Where hip and knee orthopaedic procedures were being paid for under the money follows the patient system, the hospitals were reimbursed immediately on submission of the bill as long as the patient was admitted on the day of surgery. That had a dramatic effect in both Navan hospital, Cappagh hospital and elsewhere.
Further reform in the hospital sector will see public hospitals become independent, not for profit trusts. In progressing this, I recently announced my intention to organise every acute hospital into hospital groups. Each group will have a consolidated management team headed by a group chief executive with responsibility for performance and outcomes, operating within clearly defined budgets and employment limits. This initiative will build on the groups already announced in Galway and Limerick and ensure that the smaller hospitals are managed as part of a group, and that their role is protected. I have said time and again in the past that notwithstanding the difficulties we have had with removing some services from smaller hospitals because of safety concerns that is nothing to the row that will result when we start moving the less complex procedures from the bigger hospitals back to the smaller hospitals but we are determined to do it, and it will be done. The future of smaller hospitals is guaranteed.
It is clear that the system of health governance must be radically overhauled also. To this end, I will be bringing forward legislation to bring about significant changes in the governance of the HSE. The legislation will abolish the board of the HSE and replace the board structure with a directorate structure. This new governance structure will be a transitional arrangement, pending the eventual dissolution of the HSE as the health care reform programme advances.
In tandem with the proposed transitional governance structures, I intend to put in place new administrative arrangements for greater operational management focus on the delivery of key services. I believe that new arrangements will facilitate greater transparency, accountability and efficiency, and will be a key component in the move towards universal health insurance.
The strengthening of primary care planned in the programme for Government and the HSE National Service Plan 2012 reflects the need to move to new models of care across all service areas, which will treat patients at the lowest level of complexity that is safe, timely, efficient and as close to home as possible. An example of that is a focus on the provision, where appropriate, of intermediate care for older people rather than long-term residential care. In that respect I want to see a chain of intermediate care facilities across the country to ensure that nobody goes into long-term care from an acute hospital without having passed through the intermediate care assessment and had the best possible chance at recovery through convalescence and rehabilitation and a full assessment done as to how their needs are to be best met.
The reform agenda also involves enhancing and expanding our capacity in the primary care sector to deliver universal general practitioner care, with the removal of cost as a barrier to access for patients. This commitment will be achieved on a phased basis to allow for the recruitment of additional doctors, nurses and other primary care professionals. Taking this step will allow us to move away from the old hospital-centric model, where health care was episodic, reactive and fragmented, and to deliver a more proactive, joined-up approach to the management of our nation's health. A project team of officials from the Department and the HSE has been established to oversee the implementation of universal primary care. The project team held its first meeting on 24 January.
Under universal health insurance, everyone will be insured for health care and the current unfair discrimination between public and private patients will be removed. In the meantime, I am focusing on addressing the problems of the current private health insurance market where insurers have a considerable financial incentive to cover younger, better risks rather than older, poorer risks. I emphasise that the levy that was put in place in regard to achieving this goal is not about class but about young people supporting old people. That is what community rating is about and I believe it is supported by all Members of this House. It is important to point out, however, that this is the last year of that levy as full risk equalisation will come in with effect from 2013.
I am strongly committed to protecting community rating and within the next few months I will introduce legislation for a new risk equalisation scheme. This will ensure that a company such as VHI, which has the most of the older and less healthy customers, will be better able to compete on a level playing field. In the meantime an interim scheme of age-related tax credits and community rating levy has been in existence since 2009 and has been providing significant support to community rating. I extended the interim scheme for 2012, under the Health Insurance (Miscellaneous Provisions) Act 2011.
I have previously expressed my views on the VHI in the public arena on many occasions and the programme for Government provides for the VHI to remain in State ownership. For the benefit of clarity, the current position in respect of the VHI is that the Government has decided, on foot of my recommendations, that the VHI should make an application for authorisation by the Central Bank, subject to further Government decisions to be made relating to capitalisation. My Department and the VHI have been working for some time in preparation for this. When the foregoing fundamental building blocks are in place, we will be ready to proceed with the introduction of universal health insurance. This system will give patients a choice of health insurer and will guarantee that everyone has equal access to a comprehensive range of curative services.
The Government has recently given approval for an implementation group on universal health insurance. This group will assist in developing detailed and costed implementation plans for universal health insurance and will also help to drive the implementation of various elements of the reform programme. I have recently finalised details of the implementation group, which will be announced shortly, and the group will meet before the end of the month.
The HSE service plan 2012 is underpinned by the Government's requirement for reform, innovation and efficiency. The reforms that I am proposing are different from those tried before in a number of ways. They are comprehensive rather than incremental, they are led by innovation as opposed to dictated by resources and, most importantly, they are patient-focused instead of system-focused. The special delivery unit approach has succeeded in significantly improving services in regard to emergency departments and scheduled care. Equally, I was pleased to launch a new electronic GP referral initiative recently, on behalf of the national cancer control programme, for patients with lung, prostate and breast cancer. This simple, effective referral guarantees patients that they will see the first available expert in one of the eight cancer service centres - the one nearest to them - and that a record of the referral is made and available to them as well as a confirmation of their appointment. This will obviate the types of problems we had in Tallaght last year.
The commonality between these two improvements for patients has been that all the stakeholders have been involved. In the case of the special delivery unit, people on the front line came forward with innovative ideas, the special delivery unit did the analysis and the clinical programmes put in place the protocols to ensure they were safe. It delivered improvements in our trolley numbers; they are measurable and there for all to see. Similarly, the national cancer control programme, working with the Irish College of General Practitioners and with the IT providers, brought about the improvement of the electronic referral.
The reforms are working. We can see real evidence of progress. This proves that it is possible, even during these times of financial constraint, to drive improvements and ultimately to provide a health system that is more efficient, of higher quality and delivers better outcomes for our patients.
While we have made some progress, we have much more to do. We need to continue on the road we have taken. I am pleased that those who work in the health service have joined us in working toward this aim. The changes we have made which have primarily involved listening to them and what they have to say have given power back to the system and those on the front line a sense that they can in a real way influence the system that should be serving them to serve patients.
Michael Mullins (Fine Gael)
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The procedure is that group spokespersons will have five minutes and that a Sinn Féin Senator will have two minutes. All other Senators will have one minute each to ask questions.
Darragh O'Brien (Fianna Fail)
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I welcome the Minister. I do not think I have had an opportunity before now to congratulate him publicly, although I have done so personally, on his elevation, as one north County Dublin man to another. He now understands how difficult it is to be Minister for Health and perhaps he has some sympathy for his predecessor, Mary Harney, on whom he was particularly hard from time to time, although it was sometimes justified. He should always bear this in mind.
I have some questions for the Minister. However, I would like to start on a positive note. I very much welcome the additional €35 million and 400 staff in the mental health sector, an issue we discussed with the Minister of State, Deputy Kathleen Lynch. This is crucially important. I am glad to say that, as the Minister will agree, the former Minister of State, John Moloney, did good work in this regard; it is important to highlight this fact. There is also €20 million for primary care services and €15 million to continue the GP visit card system which is a good initiative, as well as €25 million for further progression of the national clinical programmes. These are positive steps. I understand the Minister's job is a difficult one, as there is no silver bullet for the health service.
The Minister has mentioned the €750 million reduction in his budget and that the number of retirements from September up to the end of this month will total 4,000. He has said he will reassess the position at the end of February, which is probably the right thing to do, but I am concerned about the effect on front-line services. We must consider being more targeted in protecting front-line services, although I know the Croke Park agreement does not allow this. It was the Minister's mantra when he was in opposition - I consider that he was correct - but I would like to see more action from him in government.
One striking aspect of the Minister's statement is the lack of a mention of private hospital consultants and the issue of consultants' fees. That is a nettle that needs to be grasped. The lack of 24 hour, seven day a week coverage in hospitals is the elephant in the room. The Minister and I both know the number who remain in our local hospital, Beaumont Hospital, at the weekend because there is not enough cover to allow them through the system. The special delivery unit will deal with only one element of the problem, the accident and emergency unit side. If we are treating the health service seriously, as we all are, we must grapple with the issue of hospital consultants' fees and, more generally, the issue of private fees.
I fundamentally disagree with the Minister on the issue of a universal health system - not necessarily with what he is trying to do but with what is being achieved. Effectively, middle Ireland can no longer afford private health insurance. We all know this and the figures bear it out. We will have a one tier system much sooner than the Minister might believe. We all aspire to this, but we will have a one tier system on the basis of the thousands of people who continue to leave the private health system. I put it to the Minister that the public health system is not fit for purpose in taking on the additional procedures. I would like to hear his view on how we will manage this. More than 140,000 people who cannot afford private health insurance are moving away from that system. How will the public health system deal with this?
We previously considered matters such as elective surgery. The Minister has said much about the SDU and I agree it has done good work on the issue of trolleys, but the NTPF previously had an average waiting time of three months for elective surgeries and that is now being pushed out to nine months under the service plan.
What was the difference between the service plan the Minister rejected on 5 January and this service plan? Were there fundamental differences? Fergal Bowers might have been a little unkind in describing it as somebody writing a letter to themselves to complain about themselves when commenting of the rejection of the service plan on 5 January, but we need to know if there were fundamental differences in the plans.
The Minister has given a commitment time and again that the smaller community hospitals will remain. Throughout the country, however, there is a different sense about what is happening. Under the plan a maximum of 898 beds could be closed this year in community nursing homes. That is an 11% cut in public residential beds. We need more clarity on this. Every week, another figure is blowing around.
I know the Minister is aware of the issue but I am also concerned about the further downgrading of HSE nursing homes and the services they provide. Specifically, there is a proposal that all cooking facilities will be off-site at Lusk nursing home. Food will be delivered the day before for elderly patients and reheated in the nursing home. This is a grave concern. The Minister, as a doctor, is aware of the importance of nutrition for sick and elderly people. I hope this proposal is not the thin end of the wedge with regard to moving food preparation and cookery services out of HSE nursing homes altogether and centralising them through mass-produced products. I do not expect the Minister to comment specifically on that today but I ask him to use his good offices to assist in the case of Lusk nursing home.
It appears we are facing another 100,000 applications for medical cards over the next year or so. It is a fact - and none of us believes the HSE - that the applications are not being processed within eight weeks. The system is not working and we know it. I was sick to my back teeth asking the previous Minister about this. The review and renewal of medical cards is absolute nonsense. People have ailments that everybody knows will not be cured, yet in many instances their medical cards are being reviewed every 12 months. That is adding to the paperwork within the section. It makes no sense and is slowing down the approval of new medical cards. There have been some awful cases, and I am sure the Minister has encountered some in his constituency office and has views in that regard. Can he confirm whether he believes the HSE's claim of a four to six week turnaround on new medical card applications? It is not happening.
Colm Burke (Fine Gael)
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I welcome the Minister. I thank him for his detailed summary of the service plan for 2012. It is a difficult area. Last year we spent €13.416 billion on health care and the total income tax collected in the country was €13.317 billion. In other words, we spent more on health care than we collected in income tax. It is a frightening figure when one puts it in that context but it points to the fact that we are giving priority to health. This year I note that we will spend €13.317 billion on health care, which is the same amount we collected in income tax last year. It demonstrates the cost of health care.
Health care covers a broad area ranging from elderly care, mental health and hospital services to the front-line services being provided in the community. It is a huge budget and a comprehensive service is being provided. I agree there are difficulties in this area, but the Minister has faced up to dealing with them and is very proactive in creating efficiencies, which is what we must achieve. The Minister said that in real terms there is a cut of €750 million in the budget. It is a huge cut for any Department to face. The Minister is facing that challenge and dealing with it.
There will be staff cuts. Approximately 2,044 staff retired between September and January and another 1,770 will leave by the end of February. A substantial number are leaving the service and this must be catered for. We must consider the issue of staff who are retiring but who are prepared to continue to provide services until new staff can be put in place. I raised one of these issues with the Minister last week. Where a replacement is not immediately available, a person who is retiring should be allowed to carry on doing the work. A service should continue on that basis rather than have it close down. Not everything can be done by the rule book. Sometimes we must bend the rules a little in order to maintain services at all cost.
I welcome the serious effort being made to reduce the number of agency staff being employed. It is unfortunate that this practice has used up a huge proportion of the budget of many hospitals in the past 12 months or two years. I am pleased, therefore, that a serious effort is being made to cut out this practice and get value for money, which is what taxpayers and the Minister want.
Despite all the difficulties the Minister faces, he is dealing with the reform of the service to make it more efficient and reconfiguring services. I give him one warning in this regard. Reconfiguration cannot be set in black and white. There may be an ambitious programme, but reconfiguration cannot be done overnight. In this regard, I will bring a case to the Minister's attention privately later. There is a need to set up an implementation team to oversee the reconfiguration process. Rather than proceeding in a straight line and closing a particular unit on a particular day, we need to ensure the proper transfer of services is provided for. There needs to be give and take in this process. In bringing forward reform and reconfiguration not all decisions should be taken by one person. There should be a joint approach by nursing and medical staff and administrators.
There is a need for more competition in private health care in certain areas of the country, which could fill a niche. I have referred one matter to the Competition Authority on which I am waiting for a decision. I hope the net result will be the creation of more competition in the private health care sector which will, in turn, bring down the cost of health care for the ordinary person, which is what we all want to see. It should be our priority to bring down the cost for everyone in the country while providing a very good service.
I thank the Minister for coming to the House and presenting the health service plan for 2012. With my colleagues, I wish him well in the implementation of the programme. I hope we will continue to maintain and reform the services in place.
David Cullinane (Sinn Fein)
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I welcome the Minister who mentioned the pressure points in the health service because of the cut of €750 million, mostly in acute hospitals. That figure is not a true reflection of the savings that will be made in hospitals.
I bring the issue back to a local level. Sometimes when we deal in global terms, it is hard to understand the impact of cuts on local acute hospitals. This morning we were briefed by the Health Service Executive. Senior management staff, including the CEO, Mr. Cathal Magee, were present for what was a very good briefing session on the regional plan for the southern region and the impact of cuts on Waterford Regional Hospital. It is not only the percentage cut. The regional hospital budget was cut by 3.7%, but there is an overrun on last year, so the total loss in spending this year at the hospital will be 10%. We will lose three theatres. One was closed last year. Two surgical theatres will be closed this year and we will go from eight to five. A total of 25 inpatient beds in the regional hospital will be lost. We will lose two inpatient beds in paediatric services. We lost six inpatient beds last year. We will see a 50% reduction in spending on medicines in rheumatology. We will see a reduction on spending on medicines for people with asthma. We are told that people will no longer get drugs administered on an individual basis, but that the hospital will do it on a group basis. This raises fears. Someone may need a drug on Tuesday but could be told to wait until Friday or the following Friday when enough people will need the same medicines.
The problem is not so much about the money following the patient. The problem is that the money is simply not going into our hospital services. We have to look at the corporate governance issues. We have fragmentation of many services across the region. For example, we do not have 24 hour cardiology care at Waterford Regional Hospital. We need to make sure that regional hospitals specialising in acute services operate as regional hospitals and provide those services. That is not happening at the moment due to cutbacks. I ask the Minister to take that on board.
I welcome some of what is being done by the Government. However, the impact these cuts will have on front line services and on patient care this year in our acute hospitals will be immense. That is simply wrong. It is not what the Minister's party promised when it was in opposition and when it said it would deal with the real waste in the system, such as the money being spent by the taxpayer subsidising private health care. That is what needs to be dealt with; not these one size fits all cuts.
John Kelly (Labour)
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I welcome the Minister to the House. When the former Deputy Mary Harney took over at health, I sent her a letter to the effect that she had taken the poisoned chalice. I was proved right. I would nearly say the same to this Minister, although I hope that, like the priest who drinks the wine at Sunday mass, he puts a good gloss on the chalice. I wish the Minister well in doing that.
I welcome the extra €35 million provided for the psychiatric services in the national service plan. I know that front line services right across the country are being run at skeletal levels. Even at this stage, nurses feel threatened and afraid to go to work. I welcome the extension of medical cards to long-term illness patients, but the Minister should consider including people with cancer. They should have a medical card without having to undergo a means test. I say this from my years of experience as a community welfare officer, when anyone with cancer who ever applied for a medical card was granted it.
I have a couple of questions. Is the National Treatment Purchase Fund gone by the wayside, or is it still in place? What are the plans for Roscommon County Hospital? The Minister said that the future of smaller hospitals is guaranteed. Once the accident and emergency department in Roscommon was closed, a group came together to try to salvage something for the health service in the county. The group has promoted the opening of an ambulance base for west Roscommon. I hope the Minister will work with us on this issue and when the ambulance base is proposed for west Roscommon that it will go to west Roscommon. What is the update on the provision of advance paramedics following the closure of the accident and emergency unit at Roscommon hospital? Perhaps he would help dispel rumours circulating in the media on the urgent care centre in Roscommon that it will be further downgraded to five days per week.
On the issue of the 600 community nursing home beds that it is proposed will be lost, I urge the Minister, by virtue of the debacle with Roscommon hospital, to ensure no nursing home in Roscommon is lost as a result of the reduction in bed numbers. I am concerned that we may be going down the privatisation road. I have worked in the health service for many years and have visited all the community nursing homes. The residents in those community nursing homes need 100% care, as distinct from many of those in private nursing homes who may not need to be there, as stated by the Minister. The main issue is that we do our best to keep people out of nursing homes. In seeking to do that a reduction of 4% in home help hours will not help the position. However, I have a proposal for the Minster which I have mentioned previously, namely, that consideration be given to the opening up of home help hours through the community employment scheme. There are many unemployed persons who are well able to provide care as home helps and perform such tasks as bringing in turf, sweeping floors, taking out ashes, doing the shopping and so on, the net cost of which to the Exchequer is €1.70 per hour given that they will still receive the social welfare payment. For an extra €1.70 per hour a home help service can be provided. That is an issue that should be dealt with.
The fail deal scheme, as I said previously, is in many cases an unfair deal. When a person applies for the fair deal he or she is put on a waiting list. That person may be in the nursing home for four to five weeks but subsequent to that the HSE will write to him or her and authorise that the fair deal is in place but it will not be retrospective to the date of entering the nursing home.
John Kelly (Labour)
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I was always critical of HSE staff down through the years who received bonuses because I considered the bonus was in place to keep within a budget. However, when keeping to a budget someone is deprived of an important service. The Minister mentioned efficiencies in the services. I would have no problem with giving bonuses to people who can bring about efficiencies. I understand €6 million was saving in orthopaedic procedures. If that was an initiative undertaken by somebody that person deserves to be given a bonus.
John Kelly (Labour)
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There is also the issue of the amount of money the hospitals are not collecting by way of health insurance. There are plenty of senior HSE employees who are not needed and are doing nothing. There is a job for one of them to ensure that each hospital claims back the money from the health insurers.
Terry Leyden (Fianna Fail)
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There are many in County Roscommon who would like to have the opportunity I have today to put a few questions to the Minister. Does the Minister feel any sense of shame or embarrassment that he misled the people of Roscommon before the general election of 2011? He gave a clear unambiguous commitment as a senior qualified doctor, former president of the IMO, that the accident and emergency department in Roscommon hospital was safe and if it was closed he would reopen it and would keep acute surgery and acute medicine. They have all gone and the hospital is down to a skeleton service. Is the endoscopy unit promised by the Minister and one Fine Gael Deputy at a cost of €1.9 million going ahead? Can the Minister confirm whether six nurses are leaving the old accident and emergency section, now called the medical urgent care centre? Will they be replaced? It is vital that staff in a small hospital are replaced and it should be a priority to replace those that avail of the early retirement package. The Minister mentioned in his speech that he will review the matter at the end of February. It is important that we hold on to what we have and develop it.
Has the Minister made a decision on the provision of a helicopter service for emergency cases, or an "eye in the sky", that will be based at Roscommon County Hospital? He has received a submission on it and I would like to hear his views.
Marie Moloney (Labour)
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I welcome the Minister to the House and thank him for his presentation. Unfortunately, I have only one minute to speak. I could speak about many things but I shall stick to the point.
I welcome the significant strengthening of the primary care services in the plan, including the GP visit card for long-term illness claimants. My only misgiving is that rich people suffer long-term illnesses too and some very wealthy people will now receive a medical card. The Minister could have extended the medical card to people with asthma, for example, or increased the guildelines or thresholds before adopting the measure.
As the Minister will know, there will a large amount of applications submitted under this scheme. We are not coping with the current amount of applications. The HSE may tell the Minister that there is a 15-day turnaround of applications but it is not happening. I understand that there is one deciding officer to deal with all of the appeals which are not linked with the primary care reimbursement centre. As a result it takes many months to link an appeal with an application. I know that I am beginning to sound like a broken record in the House by going on about this issue but it is one that causes a lot of problems. Some people must wait over 12 months for a medical card and that is unacceptable. I would appreciate it if the Minister could spend a few minutes telling us how he proposes to deal with the matter.
Imelda Henry (Fine Gael)
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We must conclude the debate by 5.15 p.m. If members want the Minister to respond they will have to stick to one minute each.
Trevor Ó Clochartaigh (Sinn Fein)
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Go raibh míle maith agat an tAire. I would like to ask the Minister a number of questions, if possible. I would have liked to have asked him how the essential organ transplant programme will function in the Galway area if Galway Airport closes down. I would like to ask him about the medical card debacle. How does he intend to sort the matter, as outlined by Senator Moloney? There are 158 people leaving the Galway west HSE through the redundancy programme, 50% of whom are nurses. How will the system function? Public health nurses and mental health nurses comprise 50% of the 158 that are leaving.
If I had more time I would have asked him about the pulling of dental services in the Connemara area, pardon the pun. How will the primary care strategy be rolled out when we have not enough people on those care teams? The most pressing question I have is on the St. Francis Nursing Home in Galway. Before Christmas a delegation from Galway met the Minister to discuss it. He listened intently and promised to carry out a review and that nothing would happen until it was finished. We have now been told that a decision has been made and the nursing home will close in May which contradicts the promise he made to the delegation. Who is telling the truth? Is it his Department or HSE Galway west? What is happening to the nursing home?
Mary Moran (Labour)
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I welcome the extension of the long-term illness scheme. Will the Minister consider including patients that suffer stress or mental issues in the scheme? As I have mentioned to him before, the cost of prescriptions to such people can be astronomical.
I also welcome the increase in funding of €35 million for mental health services for children, adolescents and adults. I ask the Minister to examine the services that are provided for young people again because some of the hospitals are totally unsuitable. The wards are unsuitable and can have a mix of elderly people with mental problems and younger people. I ask that he takes this into consideration when allocating the money and services. I refer to the closure of the laboratory in the Louth hospital and the fact that, as a result, all blood tests are being sent to Drogheda which is 24 miles away. I was recently contacted by constituents who have long-term conditions and need their blood test results on the same day, and this is not happening. The lab closed only yesterday but it is already posing a problem.
Michael Mullins (Fine Gael)
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I welcome the Minister to the House. My local hospital is Portiuncula hospital in Ballinasloe. It has been indicated to me that phsyician services are under severe pressure due to staffing levels and the significantly increased number of patients from the Roscommon area being treated. Some consultants are reducing their outpatient clinics by as much as 30% because of the workload. The physicians fear that the department of medicine will become an 8 a.m. to 8 p.m. service and there is a fear that the accident and emergency department will also become an 8 a.m. to 8 p.m. service. I ask for an assurance from the Minister that the necessary staffing will be provided to ensure the physician services can continue to give a 24-hour service. Will the acute medical assessment units be staffed independently and separately?
Jimmy Harte (Labour)
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I welcome the Minister to the House. I commend him on his statement yesterday with regard to autism and the comments by Dr. Humphreys. I have experience of autism in my family. What he said was very hurtful and many people appreciate what the Minister said publicly.
In the Letterkenny area, the parents of children with paediatric type one diabetes are fearful that the service will not be focused in Letterkenny and will instead go to Sligo which would be unfair in their view. Donegal has a high number of people with type one diabetes compared to the rest of the country and to travel from Carndonagh or Buncrana, for example, to Sligo, would be a long journey, whereas a person in Sligo could go to Galway which is less of a journey. The service is good as it stands but these parents are concerned that they may be pushed aside in favour of Sligo. I ask the Minister for clarification in this regard.
The Minister is familiar with the situation in Lifford community hospital. I was born in that hospital and I know the area very well. When I visited it recently I met many of the patients, one of whom asked me to please ensure they were not moved out of their home because they regard the hospital as their home. Even though they may be moved to a more modern facility they like the familiarity of their own chairs and their own television. I ask that these considerations be addressed.
Imelda Henry (Fine Gael)
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I call Senator Crown who has five minutes.
John Crown (Independent)
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I thank the Minister. That means I have about three minutes to think of what I am going to say for the other two minutes. I am sorry but I did not realise I had such generous speaking time.
I compliment the Minister on his vision for reform of the health service and I wish him well with its implementation. The challenge of implementation will be very difficult and, as I have said to him on many occasions, he will have my support in pushing towards a reform of the system to create an insurance model based on a mixture of public and private insurance in competition, which in my view is the right way to do it. This is my understanding of the synthesised programme of the two coalition parties. I ask also for an acknowledgement that the system which will maximise efficiency, equity and quality is the move towards a single tier of health care where there is a linkage at all levels between activity and payment, in order to provide the appropriately policed incentives for activity.
I would like to bring the Minister's attention to one area which is probably not as high on the agenda but of which I know the Minister has been made aware and which he has had a chance to consider in detail, namely, the question of the integration of research into the activities of the health service. Historically, in Ireland we have tended to regard ourselves as a small, poor, peripheral, investigationally irrelevant society where research was that activity which bright young Irish doctors did when they were abroad to train to build up their curriculum vitae before coming home and becoming rich ex-researchers. Unfortunately, that was the way the career path ultimately ended up developing for many people because they came back to a system that was so desperately and unprecedentedly short of specialist doctors that any notion of attempting to roll up their sleeves and do research when they already had truly unsustainable clinical loads would, I believe, have been considered bordering on immature by many of the more established people who were present in the country. Things are changing. We now have a cohort across the specialties in medicine, including family practice and the hospital-based specialties, of people who have developed major reputations in research.
As I had occasion to point out to the Minister recently, the arguments for doing research in the health service are multiple. The first is that research itself may yield results which are of importance to the advance of the field. Ireland should not regard itself as a country which is in isolation from the worldwide research initiative. Second, while my colleagues in the Seanad might not be aware of this, patients who are being treated on research programmes tend to have better outcomes than patients who are getting identical or similar treatments outside of the discipline and rigour of a research programme. While this may be counter-intuitive, the reality is that the discipline and level of oversight which go into structuring treatments, which have been designed in many cases by teams of truly international experts, mean that the average patient in Dublin, Letterkenny, Cork, Galway or Belfast can get access to research protocols which have been designed by such truly international leaders. This has happened in the case of the All-Ireland Co-operative Oncology Research Group , which now has patients on trolleys in every acute hospital throughout the island of Ireland.
The third reason is the bizarre career structure here. I am delighted we finally have a Minister who understands the issues involved in this. If we are to keep people in this country, we must enable them to continue to spend meaningful portions of their research time in international centres of excellence, of which I am in favour and which has been very good for Ireland, and then ensure they return here. To achieve this, we need to have some research input into their training structures while they are in Ireland. People who will look at the curriculum vitae of young Irish graduates who are seeking jobs in, say, cardiac surgery in a Cleveland clinic, oncology in Memorial Sloan-Kettering or some branch of paediatrics in Sydney or Melbourne, will wonder what the person has done in research to date and whether the person has publications and a track record. This enhances the reputation and recognition of the training which our graduates will receive here.
I support the Minister's notion of introducing an additional level in the career grade which acknowledges the reality that we have many doctors in this country who are completely trained, and the only reason they are not employed as specialists is that we have had a highly restrictive national contract for specialists, which makes no sense. My one gentle criticism of the Minister is that, having come into a new job, he needs to let those around him in the Department know exactly who is boss - I believe he is beginning to do this. The need for change is fundamental. We need to dispense with the notion of a solitary national contract for hospital-based specialists. It makes no sense that somebody who works in the university environment in a teaching hospital in a large centre like Cork would be on the same contract as somebody who is doing very busy but primarily service-orientated work. With the new model of a single-tier insurance base, there will be different models of reimbursement. There may be doctors who set up practices in general surgery or in obstetrics affiliated to hospitals where they will bill insurance companies for their services.
5:00 am
James Reilly (Dublin North, Fine Gael)
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Given the day that is in it, the metaphors regarding honeymoons and marriage may be appropriate. However, I will leave that well alone. I thank Senators for their contributions and will endeavour to answer their questions as best I can. I do not have every answer, but the information will be conveyed to Members. Where it is not available today, I will seek it out and get back to them in writing. I am reminded of my time in opposition when I was wont to fire a barrage of questions at the Minister at the Oireachtas committee. Members will understand if I inadvertently omit any question that was asked.
I thank Senator Darragh O'Brien, who has had to leave the Chamber, for his questions. He referred to the reduction of €750 million in real terms in the health budget, the loss of 4,000 staff and our undertaking to protect the front line. Protecting the front line is what we have undertaken to do, in so far as we can. It is about front line services as much as front line numbers. The Senator said there was no mention in my opening statement of the issue of consultants' private fees. I have made the point numerous times that it might give us a warm political feeling to give consultants a whack over the head and take €50 million from them, but the question is whether that will lead to more patients being treated more quickly.
I draw Members' attention to the various initiatives we have taken through the clinical programme, supported by the special delivery unit. For example, the assessment of the medical admissions unit in Cork has, in a six-month period, saved 11,000 bed days by avoiding admissions for patients who would otherwise have ended up in hospital. That would translate to 22,000 bed days in a year and a saving of somewhere between €15 million and €17 million. That is the type of progress being made in just one hospital. The productive theatre initiative is being carried out in five units, representing only 2.5% of all theatres, and has saved €2.5 million in one year. Transposing that across the system would give potential savings of €100 million. In addition, the money follows the patient initiative in regard to orthopaedic procedures, whereby patients are admitted on the day of surgery rather than the night before, has led to savings of €6 million thus far.
There is more than one way to achieve our goal. To clarify, my target is not savings but ensuring more patients are treated more quickly. If I can achieve that by way of negotiations with consultants on changes to work practices, that would be a good day's work. My main concern is the cost of private beds and private fees. I am concerned that there is a willingness on the part of VHI and others to accept a 9% cost inflator year on year. I do not accept that. VHI has shown a willingness to deal with the matter through its engagement of Milliman to help it examine its cost base. Furthermore, having had a meeting with the three insurers and having established the health insurance consultative forum, which will meet again later this week, I made clear that cost is a major issue and that they must examine why they pay what they pay for different procedures.
I am certainly seeking serious discounting of consultant fees where they are carrying out procedures in hospitals that could and should be carried out in primary care. What is at issue is not whether those procedures are carried out by consultants or GPs but the fact that they are attracting utterly unnecessary hospital side room fees. In regard to the cost of care in private hospitals, VHI has taken on board that our clinical programmes have been quite successful in reducing costs in public hospitals. VHI is now engaging with Barry White, the Health Service Executive's national director of clinical strategy, to see how similar cost reductions can be achieved in private hospitals.
Senator Colm Burke referred to competition in private health care. I have made very clear to VHI that it is not its role to determine its market. If there is a private facility available that is open and competitive, then VHI should be covering it. Certain people on the board of VHI may have a different view, but there are four new appointments to be made in the coming week. Those appointees will carry my message loud and clear that the objective is to secure more, not less, competition for the benefit of patients.
Senator O'Brien claimed that waiting times under the National Treatment Purchase Fund, NTPF, have increased from three months. That is a little disingenuous. The reality is that many people waited six months or more before they even got on to the NTPF. I can prove it if the Senator needs me to. We had patients waiting up to three years for treatment. Is it more equitable to have everybody treated within a year or to have a select group treated within three months while others wait for years? Nobody should wait longer than a year for treatment, a target we have achieved throughout the country, with the exception of Galway. The specific reasons for that have been addressed with a new management now in place. It has control over the university hospital, Merlin Park, Roscommon and Portiuncula hospitals as a group, with clear riding instructions in terms of what is required of the smaller hospitals. That will cause some friction, but it is an argument we are determined to win.
On nursing home care, I have made clear that the policy of this Government is to maintain a public provision capacity for nursing home care and community nursing units. However, I have made equally clear that we cannot have a situation where it is costing anywhere between 50% to 100% more to provide that care through the public health system as opposed to the private system. People will say there has been cherry-picking by private nursing homes and so on, and we are addressing that in a clear fashion. The NTPF has been asked to draw up, in conjunction with clinicians, a score card incorporating boxes that must be ticked in terms of the services available in a nursing home. When provision is agreed in terms of the price the nursing home will receive to care for a patient, if it does not tick all of these boxes, a discount will be applied. There is some evidence that nursing homes in the private sector do not provide the same complexity and high dependency of care as their counterparts in the public sector. This is only anecdotal and not across the board by any means.
Community nursing units are not being downgraded. Some may very well have to close, but we should try to keep as many as possible open and where they are not necessarily economically viable alternatives should be considered in terms of local fund-raising, being taken into a local trust and so on. I am wide open to all such options. What I cannot do is tell a person that his or her mother cannot get the care required because another patient is in a facility that costs twice as much as it should. There is an equity issue here. I have made clear in the past that it is not always about money. It is also about changing work practices and rosters.
Several Senators referred to delays in processing medical card applications and disputed the Health Service Executive's claim that its primary care reimbursement service, PCRS, is turning around new applications within 15 working days provided all the necessary information is submitted. I had a meeting with Mr. Paddy Burke, director of the PCRS, only two weeks ago, at which we reached agreement on several matters. First, anybody who responds to the PCRS's contact will keep his or her medical card until the review is complete. Heretofore, applicants' cards were being withheld until all correspondence was complete. This change takes a large number of people out of the equation. Second, there is now cross-referencing with the Department of Social Protection to ensure that anybody on social welfare keeps their card. Third, as I said in the House last week, there are people who have not responded and have not had any activity on their card in the past two years. It is reasonable that a card is revoked when there is no response to a third attempt at contact. Otherwise Mr. Burke would be in front of the Committee of Public Accounts trying to explain why he is still paying GPs to service cards for people who have not used them for two years and have not responded to his inquiries on three separate occasions. It is safe to assume that those people have probably left the country and, as such, we should not waste public money in providing medical cards for them.
I fully accept that there was not sufficient regard given in the past to the need to process medical card applications in a timely fashion. Mr. Burke has apologised for that and the position has improved. However, in case anybody should take false succour from that, including the staff of the PCRS, a delegation from the Oireachtas Joint Committee on Health and Children will visit the facility in Finglas before the end of the month. There should be no doubt about the tremendous interest in this House in ensuring minimum inconvenience for people applying for or renewing medical cards.
Senator Colm Burke raised the issue of retirees returning to work in the health service. He is absolutely right that we must maintain flexibility within the system so that we can maintain services. If we find ourselves with a highly specialised vacancy, such as a CNA II in a paediatric intensive care unit, for example, we need to be sensible. To clarify, it is not my intention that retirees will return to the service in droves. Not all of the positions will be filled because they will not be necessary. However, those which are necessary to fill will be given to new people. We want to give young people a chance at a job instead of bringing back people who have already had their lump sum and pension. That is not what this is about. It would be very much the exception that somebody who has retired will be back in their old job. We are doing something that has not been done anywhere else in the western world, as far as I am aware, namely, seeking to improve quality and service against a backdrop of seriously declining budgets. I commend all of those involved.
Senator David Cullinane referred to a reduction in the number of theatres and beds in Waterford. I already mentioned the productive theatre initiative. It is not about the number of theatres but how one uses them and how many patients are treated. The number in Waterford has reduced from eight to five, but I am assured that the productivity of the remainder can be improved under this initiative to ensure that patients receive the service they require. The same applies in regard to reductions in bed numbers.
Regarding drug treatments, I do not accept that any patient would be left without treatment because of a delay in accessing drugs. Drugs will be secured if patients need them in urgently. It would be very strange if it were otherwise.
David Cullinane (Sinn Fein)
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How will the proposed 50% saving on medication for rheumatology be made? We were told this morning it would be done by administering the drugs on a group basis.
Imelda Henry (Fine Gael)
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Senator Cullinane had his chance to ask questions. The Minister, without interruption.
David Cullinane (Sinn Fein)
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We received that information from the Health Service Executive, but the Minister is saying something different.
James Reilly (Dublin North, Fine Gael)
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I am not saying anything different. The Senator alleged that people would have to wait until Friday to get drugs when they need them on the previous Tuesday. He has no evidence to support that.
David Cullinane (Sinn Fein)
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How will the proposal that medications be administered on a group basis work out?
James Reilly (Dublin North, Fine Gael)
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It is a contention he has made in the House free from any legal challenge. I do not accept this will be the case and, as a doctor, I do not believe it would ever be allowed to be the case. We can achieve huge savings in drug costs through the use of generic drugs and by negotiating with the pharmaceutical industry to secure price reductions from the brand leaders. We are paying too much for these drugs. We have been using a basket of nine countries for reference and setting ourselves in the middle of the basket. However, some of these countries are on the more expensive side. The pharmaceutical industry is very important to this country in terms of research, innovation and the jobs it provides. At the same time, this is a small market. What has attracted those companies is the corporation tax rate, not the market in this State. We expect to do a deal with representatives of the industry.
I do not understand what the Senator means by money not going into hospitals. He is correct that some of them are carrying a deficit from last year which must be addressed this year. I made it clear last year that each manager in each hospital has a responsibility to stay within his or her budget or face the consequences. In the past the consequence was for the patient, but in future it will be for the manager. We will call in all of the managers who do not stay within budget, having a discussion with them and ensuring their contract for next year reflects the new reality. We are determined to achieve transparency and accountability. It is not patients but the people who are responsible for management of the hospital in the future who will suffer the consequences of their failures.
James Reilly (Dublin North, Fine Gael)
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It was stated that the impact of the cuts will be immense. I was asked what the difference was between the plan I sent back and the plan we ended up with. The difference was clear. The first plan was moving more in a linear fashion in terms of an 8% cut resulting in an 8% reduction in services, which was not acceptable. We now have a situation whereby cuts are minimised and there is no linear relationship between cuts and a reduction in services in that savings have to be made and efficiencies have to be achieved, and they will be. Members may have seen an article in yesterday's Irish Independent by Ms Eilish O'Regan to the effect that a procedure carried out by a GP was half the price charged in a private hospital. She also stated that the cost of having a procedure carried out in some public hospitals costs up to nine times more than that charged by a GP. That is a gross waste of scarce taxpayers' money. This is being addressed through treatment of patients at the lowest level of complexity that is safe, timely, efficient and as near to home as possible.
Senator Kelly referred to my texting while he was speaking. I was trying to get information on the issue he was raising. Discussion on the ambulance base is currently ongoing but I am unable to respond to the Senator's question in that regard. I will get the information and communicate it to the Senator. This issue was also raised with me by Deputy Feighan as late as this afternoon.
James Reilly (Dublin North, Fine Gael)
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I did not interrupt Senator Leyden. I will have plenty to say to the Senator when I get to respond to the issues he raised. On the urgent care centre, I have no knowledge of it being further downgraded and would not support that. The Senator's suggestion in regard to the community employment schemes is a great idea. However, the trade unions could have difficulty with it. They might feel that people coming off community employment schemes were taking real jobs of other people. That has always been an argument. The idea is worthy of further exploration. I will look into the matter of the fair deal scheme not responding in time. On bonuses for efficiency, we have moved away from the bonus culture.
I could not agree more with the Senator in regard to his comments on non-collection of VHI insurance fees. St. James's Hospital developed a system which enables it to collect 93% of outstanding insurance fees. Many of our hospitals are down to 15%, 20% and 25%, which is not acceptable. Work on this is ongoing. It is proposed that the system from St. James's Hospital will be transposed across all hospitals. Managers will be expected to deliver and collect. Some consultants are slow and some might like to use this as an industrial relations tool. However, I have a warning for them: I am prepared to bring in legislation to decouple this completely so that it will not be possible for it to be used in a negative fashion by some consultants. The vast bulk of consultants understand the importance of this to hospitals in terms of their overall funding and ability to deliver services to patients, which is their primary concern. They are co-operative but we need to make it easy for them. They should not have to be running around hospitals looking for files and charts before filling out forms. Again, this is a matter of management and efficiency and it will be done.
Senator Leyden commenced his contribution with the accusation that I had misled the people of Roscommon. To mislead someone means to knowingly say something one knows not to be true. I have no problem putting my hand on my heart and telling this House and the people of Roscommon that I fully believed, from what I knew prior to the election, that it would be possible to keep that emergency department open. On taking up office, I explored every possible way of doing so but was told by HIQA it was not safe. There has been much misinformation in the public arena. A meeting in the Department, which was attended by Ms Tracey Cooper from HIQA, the hospital action committee and Deputies Luke 'Ming' Flanagan, Denis Naughten and Frank Feighan-----
Imelda Henry (Fine Gael)
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I am sorry to interrupt the Minister but I must remind the House that as per today's Order of Business, this debate is to conclude at 5.15 p.m. I do not know how the Minister is fixed for time. Does the Acting Leader wish to extend the debate?
James Reilly (Dublin North, Fine Gael)
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I am happy to remain for another five minutes. I have to go then to attend a health committee meeting.
James Reilly (Dublin North, Fine Gael)
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I will be quick. The bottom line is that it was made clear it could not be made safe. I suggested we bring in extra consultants and registrars but was told that even if we had the money to do so, it would not make it safe because within 12 to 18 months they would become de-skilled, bringing us back to square one. I have previously expressed regret that this promise was made and I was unable to keep it. I have no problem with that. However, Senator Leyden was a member of a Government which brought this country to financial ruin, that encouraged people to buy houses, whose leader told people they should go away and commit suicide and that they were missing their opportunity to get on the property ladder. I did not hear any apologies from him or his party for that.
Terry Leyden (Fianna Fail)
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What does that have to do with Roscommon County Hospital?
James Reilly (Dublin North, Fine Gael)
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It has to do with the principle of knowingly misleading people and tying them to mortgages they could ill afford, leaving them in negative equity for the remainder of their lives. We will address that issue for people who find themselves in that situation.
Terry Leyden (Fianna Fail)
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At least we kept Roscommon hospital open.
Imelda Henry (Fine Gael)
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The Minister, without interruption, please.
James Reilly (Dublin North, Fine Gael)
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Comments about my misleading the people are a bit rich coming from Senator Leyden.
Terry Leyden (Fianna Fail)
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The Minister betrayed the people of Roscommon.
Martin Conway (Fine Gael)
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Senator Leyden's party betrayed the people of Ireland when in government.
James Reilly (Dublin North, Fine Gael)
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The air ambulance situation is an issue I was exploring long before any of the groups concerned, with the exception of Bond Helicopters, came forward with the suggestion. That matter is progressing. It is to be hoped there will be news in this regard during the next couple of weeks.
Terry Leyden (Fianna Fail)
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As regards the Senator's question on endoscopy, endoscopy will be delivered. There is no question about that. Senator Moloney-----
Terry Leyden (Fianna Fail)
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I asked about staff meetings, to which I would like a reply. There are six staff leaving the-----
Imelda Henry (Fine Gael)
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The Minister has the floor. The Senator had an opportunity to ask his questions.
Terry Leyden (Fianna Fail)
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The Minister is not replying to them.
James Reilly (Dublin North, Fine Gael)
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I am replying. I referred to staff in a broader sense. There are plans in place to deal with all of these issues. They are well advanced. Managers of the hospitals have a role to play in this regard and they have been told they will have to explain their plans to the people. It is their job.
James Reilly (Dublin North, Fine Gael)
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Senator Moloney referred to the long-term illness scheme extension also helping the wealthy. There is no perfect system. This is what was agreed in the programme for Government. However, in terms of benefit to the taxpayer and Exchequer, wealthy people can end up back in hospital. Having access to a GP card can keep them out of hospital and save us money. It may not be the most equitable way of doing this but it is a step on our journey - it will not be a long journey, only a couple of years - towards a situation whereby everyone will be covered by free GP care at the point of delivery.
I have already addressed the issue of medical cards.
Marie Moloney (Labour)
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Perhaps the Minister will respond on the issue of deciding and appeals officers.
James Reilly (Dublin North, Fine Gael)
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I am not aware that there is only one officer. As far as I am aware there are several. A group was established by me last year to address the issue of discretionary medical cards. The group is made up of doctors. Like the Senator I believe that people who are terminally ill should have a medical card and should not have to endure the stress of a lengthy application procedure. Also, there are many things available through the medical card that money cannot buy. These are simply not available to a private patient.
On organ transplant, Senator Ó Clochartaigh expressed concern about what would happen if the airport was gone. We have an agreement with the Air Corps which allows us to transport organs back and forth without reliance on an airport.
It was stated that 158 people are leaving Galway west HSE. There are contingency plans in place to ensure services there continue. The Senator stated there are not enough people to roll out the primary care teams. I do not believe that is the case. It may not be possible to achieve full primary care teams but I have never promised to be able to do that in the short term. I have in the past been a great critic of statements to the effect that there are 359 primary care teams. I want that qualified in terms of how many are fully functioning, how many are partly functioning and how many are there in name only. As far as I am aware, this breaks down roughly to a third each.
On St. Francis's community nursing unit-----
Imelda Henry (Fine Gael)
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There are only three minutes remaining.
James Reilly (Dublin North, Fine Gael)
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Information on that issue will become available during the next couple of days. Senator Moran raised the issue of inclusion on the LTI of patients suffering stress. We have no plans to do that. However, everyone will have a medical card in the not too distant future. I hear what the Senator is saying but it is not possible to cover everyone in one go. One must go about this in a structured fashion and within the reality of ever-diminishing budgets.
As for the closure of the laboratory in County Louth, that should not present a problem. It is 24 miles down the road and the journey takes 25 minutes on the motorway. Moreover, the use of information technology should allow for immediate reporting back to the hospital by electronic means. I am sure that is what is intended, but I will double-check for the Senator.
Senator Michael Mullins mentioned the reduction in the number of outpatient clinics because of workload and fears regarding the introduction of an 8 a.m. to 8 p.m. service. There is no plan for that to happen and staffing levels will be adjusted by the manager to ensure there is no reduction.
James Reilly (Dublin North, Fine Gael)
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I will, although I did not get to Senator John Crown's issue. I also apologise to Senator Jimmy Harte but thank him for his comments-----
Marie Moloney (Labour)
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Can the Minister stay on if the session is extended?
James Reilly (Dublin North, Fine Gael)
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I would like to finish, if Members are agreeable. I will only take two more minutes.
Marie Moloney (Labour)
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I propose that the time allowed be extended to enable the Minister to deal with all the issues raised by Members.
James Reilly (Dublin North, Fine Gael)
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I thank the Senators.
In response to Senator Jimmy Harte, the utterances of Dr. Humphreys were most unfortunate and ill-considered. He refers to a theory that went out 50-odd years ago. It was promulgated by a man by the name of Dr. Bettelheim and debunked initially by parents who had the good sense to speak out and point out that if they had four children, three of whom were perfectly normal, their parenting was not the problem. This is an organic condition with a multiplicity of genetic factors. As I told parents on TV3 last night, they know their children and their needs and should not let anyone set a limit on their horizons. In many cases, the outlook can be quite good. What all parents want is for their children to be able to reach their full potential. It is my responsibility and job to ensure the services are put in place to allow this to happen, even in times of financial stress. I announced the allocation of an additional €1 million per year for the next three years for services for children with autism to allow for earlier diagnosis and intervention. Moreover, I have made it clear to the service that I am not satisfied with the position where some receive a Rolls-Royce service, while others receive none, which is neither equitable nor fair. This issue is being addressed.
Lifford Community Hospital is a small hospital which will be difficult to maintain. The Minister of State, Deputy Dinny McGinley, has contacted me about it many times. Moreover, I have visited it myself, I am familiar with the general practitioners and acknowledge it provides a great service. However, in the overall scheme of things, one must try to consider some way to financially support it that makes sense. I will be happy to discuss any model that might emerge from local people if they have innovative ideas.
On the type 1 diabetes service in County Donegal, I am not aware that it is moving to County Sligo, but I can check the position for the Senator.
Last but not least, I come to Senator John Crown's contribution. I have visited the Irish co-operative for oncology research and the work it is doing provides a model for bringing together experts, not building a big premises but sharing information and being involved in world trials. An astonishing statistic that is worth repeating is that in clinical trials around the world the general participation rate is approximately 3% of patients, but in one of the group's studies it managed to achieve a participation rate of 30%, which speaks volumes. Moreover, it is important to emphasise the benefit to patients of being involved in such activities, which is they have access to cutting-edge medication, as well as phenomenal supervision because they are part of a trial.
As for the career path for junior hospital doctors, I have a report on my desk that I hope to have finalised shortly. The intention is to send a clear signal to those who have trained, have reached specialist registrar level and are now being interviewed for consultant posts but who do not get them because of the lack of such posts. Only one in four do so; the other three leave Ireland, despite our having spent up to €1 million on training them. As it is madness to let them leave the country, a clear career path should be provided for them. I have made it clear that this is not like the English system which is something of a graveyard for those who never get to become consultants. It will be a natural progression to consultancy as long as one meets peer group review requirements and the number of publications necessary.
I will conclude by noting the Senator's comments on the different contracts for research versus service make sense. This is certainly something I will explore.
I thank Members for their indulgence and for contributions. I look forward to returning to the House to update them on progress in the reform of the health service because the final message is that reform works. It is measurable and one can see it.
Colm Burke (Fine Gael)
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I thank the Minister for dealing with all of the queries raised. While he will revert to Members on a number of issues, I thank him for his contribution and wish him well in the implementation of the service plan for 2012.