Tuesday, 17 July 2012
Patient Transport Services
I welcome the Minister of State, Deputy Brian Hayes. This matter relates to the withdrawal of an essential service connecting Donegal and hospitals in Dublin. The service has been subsidised by the HSE, formerly the health boards, for some 38 years. The service entails the transportation to Dublin of patients with hospital appointments in the city when they are unable to receive their required medical care, attention or treatment in Letterkenny and Sligo general hospitals. Marley Coach Hire, which has operated the service for the past 38 years, received confirmation last week from the HSE that the subsidy of almost €100,000 would be withdrawn with effect from 27 July, ten days from today. The withdrawal will leave many families and ill patients, who may never even have used the service, without a service. The security of having the service will be withdrawn to make an apparent saving of €100,000. This is shameful and disgraceful, particularly given the waste within the HSE at present, despite the promises made by the Minister for Health to combat waste.
Let us consider some of the key statistics pertaining to the Department at present. Agency staff costs have doubled in four years and are in excess of €200 million this year, despite assurances by the Minister for Health in the Dáil last September, October and November that they would be reduced greatly. The cost of taxi services within the HSE has risen by 10%, from €26 million in 2010 to €28 million in 2011. Medico-legal payments and associated costs have risen from €39 million in 2008 to a projected €127 million this year. The overtime bill in the HSE and Department of Health was €170 million in 2011. In the first five months of this year, it has amounted to €69 million.
Despite what has been promised, the expenditure increases and waste have been escalating within the Department of Health. The service to which I refer costs only €100,000. If any of the aforementioned costs had been tackled, as promised by the Minister for Health, €100,000 would be but a drop in the ocean by comparison with the overall budget. We face over-expenditure in the Department of Health this year of at least €500 million. The returns that were to have been made to the Revenue Commissioners were late. The Department has been penalised and the interest and penalties that accrued amounted to €100,000, which is exactly what we need to keep the service open in County Donegal.
While I know the Minister of State, Deputy Brian Hayes, is not directly responsible for the Department of Health, he should note there is a serious issue within the HSE owing to taxpayers' money that is unaccounted for. There is significant over-expenditure. How can individuals in County Donegal, a geographically isolated area, be expected to travel to Dublin on public transport vehicles that are not wheelchair accessible, unlike those provided by Marley Coach Hire? If patients are ill, how can they be expected to attend for emergency treatment or urgent appointments? Many of the individuals concerned are elderly. How can they be expected to navigate through the streets of Dublin on foot, taxi or connecting bus? The nature of the service is hard to contemplate for somebody who lives in Dublin city. Those from a country area depend on the kind of service that would bring one from Letterkenny General Hospital to a hospital in Dublin in the morning for an appointment and bring one home in the evening without one having to get a taxi or navigate through the city of Dublin.
This morning, a Senator spoke on "Today with Pat Kenny" about the dangers in O'Connell Street in Dublin during the day and night. The people from Donegal to whom I refer will be dropped off in O'Connell Street if the service is withdrawn. I refer to sick, elderly and disabled people. This is simply unacceptable. How can it be justified given the massive over-expenditure and freefall in the HSE, bearing in mind that the service in question is critical if the elderly and most vulnerable are to be protected when travelling to emergency hospital appointments?
I thank the Senator for raising this issue, particularly in the wider context of non-emergency patient transport.
I wish to make it clear on behalf of the Minister for Health that the HSE has no statutory responsibility to provide transport or support for patients to attend its facilities or clinics. Patient transport funding is primarily intended to provide an emergency ambulance service. The cost of non-emergency transport rose significantly over the latter part of the previous decade, as stated by the Senator, and provision was not uniform across the State. Accordingly, this was an area identified for improved budgetary control and management.
Against this background, I wish to set out the principles that underpin the HSE's operational practice for non-emergency patient transport. As a rule, patients should make their own transport arrangements, especially where public transport is available, unless there are clear clinical factors involved. HSE ambulance resources and health care personnel should be used only where there is a clinical need for such service - for example, medical or nursing support during a journey or where a stretcher is required - and the HSE should arrange other transport only when the patient is not in a position to make or fund his or her transport arrangements.
The Donegal-Dublin bus service mentioned by the Senator has been extensively subsidised by the HSE over many years, and the HSE has now reviewed the service to assess its viability. In recent years, there has been an increase in public transport services on the Donegal-Dublin route, with shorter journey times. This has resulted in fewer patients using the HSE-funded service. The review has shown that, in recent months, on average five people per day have been using the service. Additionally, Letterkenny General Hospital has in recent years sought to reduce the number of people travelling outside the region by improving and increasing services.
Given the need for the HSE to operate within available resources, it is necessary to review all costs to ensure that spending is necessary and effective and that essential core services are maintained. The level of support available at any given time for non-emergency transport is dependent on financial resources, and such resources are very limited. The cost of the subsidised bus service is now approaching €100,000 per year. Based on the number of the people using the service, the alternatives available and the cost-effectiveness, the HSE has made the decision to discontinue funding the service from 27 July 2012.
I appreciate that the Minister of State was reading a response from the Department of Health. Expenditure on the patient taxi service within the HSE in 2010 amounted to €26,025,000. Last year, which, according to a recent response to a parliamentary question, is the last year for which we have up-to-date figures, expenditure in this area rose by €1.6 million. The HSE's contention that five people per day use the bus service from Donegal is disputed by the bus operator, whom I believe has more up-to-date figures. There are question marks over the HSE's figures. However, this is not really where the argument lies; the argument is that the service is essential. The taxi budget of the HSE, which has responsibility in this area, will escalate if the service is withdrawn. How can sick people who cannot physically enter a public transport vehicle with no means of access for the disabled travel to Dublin for an essential appointment without getting a taxi paid for by the HSE? The cost incurred by the HSE will escalate if the service is withdrawn. I have spoken to staff in the health sector who have confirmed this. It is wishful thinking to say that on one hand it would save €100,000 but the budget will escalate by €500 million this year anyway. It does not make sense.
Wearing my Department of Public Expenditure and Reform hat, I can confirm to the Deputy and the House that the overruns cannot happen in the HSE this year. This was referred to in the most recent visit of the troika. Everybody must live within the budgets and how the HSE manages its budgets is a matter for the executive in the first instance. It is not the job of the Minister for Health to second-guess those decisions if there is a belief, locally, that a decision like this must be taken. I appreciate the difficulty it causes for people who previously used the service. The overruns are a reality that must be checked between now and 31 December this year.