Colm Burke (Fine Gael)
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I am raising a matter relating to dieticians employed by the Health Service Executive. I understand that in many parts of the country elderly patients who seek access to a dietician must attend a clinic in a hospital. This costs the health service because an ambulance or taxi must be provided to take the patient to the hospital. As a result, many nursing homes now rely on privately-employed dieticians, many of whom are employed by pharmaceutical companies. I do not doubt that these dieticians are above board and I do not question their decisions but they tend to prescribe drink supplements, some of which are extremely expensive, that are added to the health budget. I was surprised to learn there is no procedure whereby dieticians are employed to visit nursing homes on a monthly or bi-monthly basis to assess patients and advise as to their management. I am seeking to reduce costs to the health service regarding care of the elderly.

I accept that existing dietician contracts cannot be changed and that what I have proposed is not currently part of a dietician's work programme. I know that there is a recruitment embargo but in future when contracts are offered by the HSE to dieticians they should state that they may be required to visit nursing homes to give assistance. More than 22,000 people are in nursing homes under the fair deal scheme - that is in addition to those in public nursing homes - and that is why I have raised this Adjournment matter.

Leo Varadkar (Dublin West, Fine Gael)
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I thank Senator Burke for raising this important issue and for allowing me to address the matter. I am answering on behalf of the Minister of State, Deputy Kathleen Lynch, who is responsible for social care.

The HSE is responsible for the delivery of health and personal care services. The current health reform programme involves a major change process which will see a

greater integration and a streamlining of service access and provision for the public. The staff appointed to dietician posts will be required to work as part of multi-disciplinary teams delivering a co-ordinated approach to client care. Currently dieticians practice across health promotion, acute hospital services and primary care and interact on a daily basis with service users. There are 129 community facilities through which the HSE provides residential care for older persons and all of these facilities have access to dietetic services. This service recognises the fact that making healthy and nourishing food choices easily accessible to older people in residential care can help reduce the incidence of poor nutrition - both under-nutrition and over-nutrition.

The nursing homes support scheme, the fair deal, provides financial support towards the cost of long-term residential care in nursing homes. The scheme covers the cost of standard components of residential care. While access to dieticians is not covered by this scheme, older people in residential settings are entitled to be referred and assessed for HSE ancillary services and therapies. These include physiotherapy, occupational therapy, OT, and access to dieticians - access is provided in the same way as to those who are resident in the community.

In conjunction with the development of primary care teams, specific development funding has been provided to develop services for older people in the community. Referral protocols, direct access to diagnostics, individual care plans, discharge planning, integrated care pathways and shared care arrangements will allow for a more fully integrated primary care service.

As the HSE implements the reform programme, it continues to review the job descriptions for all posts with a focus on maximising the contribution of all professionals to the overall well-being of the public and all service users.

Colm Burke (Fine Gael)
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I thank the Minister for his comprehensive reply, which dealt with the issue I raised by acknowledging that patients are entitled to access to dieticians under the fair deal scheme, but not in a nursing home setting. Short cuts are being taken and dieticians who are not employed by the HSE are being used by nursing homes.

As a result, an additional cost is imposed on the HSE in real terms. I urge the Minister to examine the matter. While dieticians do have access to community facilities and provide support in community facilities, we should now examine the issue in the context of the fair deal scheme in order to ensure we get value for money for the service they provide. The matter should be addressed in future contracts.

Leo Varadkar (Dublin West, Fine Gael)
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The Senator makes a very good point. I must admit I have never read the contract of a dietician so I am not sure what is in it. Many of them would be private to the individuals concerned. However, what would seem to me to be eminently logical is where a dietician is part of a primary care team or is employed within the community, that he or she would be available to go to nursing homes and speak to relatives in the way a GP does, as suggested by Senator Burke. The situation is different where a dietician is based in a hospital and his or her job is to work full time in the hospital. I will certainly bring the matter to the attention of the HSE.