Written answers

Tuesday, 3 November 2009

Department of Health and Children

Programme for Government

8:00 pm

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Question 603: To ask the Minister for Health and Children the details of the revised programme for Government commitment to take further progressive, detailed steps towards building universal health services that provide high quality care, fair access and affordability for all; if she will explain what this commitment includes; and if she will make a statement on the matter. [39108/09]

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Question 607: To ask the Minister for Health and Children the details of the expert group on resource allocation in the health sector; when it is expected to report; and if she will make a statement on the matter. [39113/09]

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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I propose to take Questions Nos. 603 and 607 together.

The Deputy will be aware that the Revised Programme for Government states the following in relation to Financing "......also taking account of the report of the Expert Group on Resource Allocation in the Health Sector, we will examine the most appropriate future mix of sources of finance to support this vision of the health services, from among general taxation, social insurance/health levy, private health insurance and individual co-payments." I established the Expert Group on Resource Allocation and Financing in the Health Sector under the chairmanship of Professor Frances Ruane, Director, ESRI in April this year to examine how the existing system of resource allocation within the Irish public health service can be improved to support better the aims of the health reform programme. I have asked this Group to recommend the best ways to achieve this within the level of resources available to health and to report to me and the Minister for Finance in April 2010.

Specifically, I have asked the Group:

to analyse the strengths and weaknesses of the current resource allocation arrangements for health and personal social services;

to recommend appropriate changes in these arrangements, which would support and incentivise the achievement of the core objectives of the health reform programme;

in the light of its work, to take a view on the most appropriate financing mechanism for the Irish health service, and

to base its examination and recommendations on the existing quantum of public funding for health.

The membership of the group comprises representatives from the Department of Health and Children, Department of Finance, HSE, economists, voluntary hospitals, medical consultants, non-acute sector/primary care, non-statutory disability sector, public sector and private sector. The Expert Group has met five times while sub-groups established by the plenary group have been meeting on a regular basis since the first meeting of the Group on 28 April.

The Deputy will also be aware that there are a range of services that are provided on a universal or whole population basis such as public hospital in-patient and out-patient services including consultant services,while also available to the whole population are maternity and infant care and child health services. In regard to high quality care the Deputy will be aware that the Revised Programme for Government also refers to the commitment to organise hospital services on the basis of clear patient safety and quality care standards, drawn from best international practice, and progressively move towards mandatory licensing of services based on explicit standards. In that connection the continuing work of the Health Information and Quality Authority (HIQA) together with the work being done by the Implementation Steering Group for the Report of the Commission on Patient Safety and Quality Assurance in the area of licensing for example, is relevant.

The Deputy will also be aware that with regard to equity of access the Revised Programme for Government states "Equity of Access; implement key features of the new consultants' contract to ensure that public and private patients are treated equally for access to key outpatient and diagnostic services, for example in cancer care and colonoscopies."

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Question 604: To ask the Minister for Health and Children her plans, in relation to the revised programme for Government commitment, to create more primary care teams, through redeploying existing staff; the number of staff to be redeployed; when they will be redeployed; and if she will make a statement on the matter. [39110/09]

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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The Renewed Programme for Government contains a commitment by Government to lead a major re-orientation of health care delivery to primary and community-based care as the location where most healthcare is provided and to create more primary care teams by re-deploying existing staff so that they can deliver more planned and integrated care to patients, particularly those with chronic diseases. In line with the objectives of the Primary Care Strategy, the Health Service Executive has identified 530 Primary Care Teams and 134 Primary Care and Social Networks to be developed by 2011. Almost 130 Teams are already in place and the HSE aims to have 210 Teams in place by the end of 2009.

The HSE is reassigning staff working in primary, community and continuing care services to work in Primary Care Teams. The HSE also intends to redeploy into community services a significant number of staff from acute hospitals and corporate functions. As operational responsibility for the establishment of primary care teams and redeployment of staff rests with the Health Service Executive, the part of the question which relates to numbers being redeployed and timing of the redeployment has been referred to the Health Service Executive for direct reply to the Deputy.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Question 605: To ask the Minister for Health and Children the details of the revised programme for Government commitment to ensure that the primary care service is supported in modernised health eligibility legislation; and if she will make a statement on the matter. [39111/09]

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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As the Deputy will be aware, the current legislation for health and personal social services has been in place for many years and there is a need now to have a clear set of statutory provisions that ensure equity and transparency and to bring the system up to date with developments in service delivery and technology that have occurred since the Health Act 1970. Accordingly, work is underway in the Department on a new legislative framework to provide for clear statutory provisions on eligibility and entitlement for health and personal social services.

The legislation will define specific health and personal social services more clearly; set out who should be eligible for what services, as well as criteria for eligibility; establish when and in what circumstances charges may be made and provide for an appeals framework. As the Deputy will appreciate, this is a very complex undertaking as the current legislation has been in place since 1970, and there have been significant developments in services since then, with a growing emphasis on delivery of care in a community rather than institutional setting. As a consequence, eligibility for primary care services will be considered as part of the proposed new legislation framework underpinning eligibility for health and personal social services.

Photo of James ReillyJames Reilly (Dublin North, Fine Gael)
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Question 606: To ask the Minister for Health and Children the details of the revised programme for Government commitment to implement key features of the new consultants contract to ensure that public and private patients are treated equally for access to key outpatient and diagnostic services; the details of these features; the timeframe for implementation; and if she will make a statement on the matter. [39112/09]

Photo of Mary HarneyMary Harney (Minister, Department of Health and Children; Dublin Mid West, Independent)
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The Renewed Programme for Government affirms the implementation of key features of the new consultants' contract to ensure that public and private patients are treated equally for access to key outpatient and diagnostic services. Specifically, Consultant Contract 2008 provides that a common waiting list operated by the public hospital will apply to both public and private patients undergoing diagnostic investigations, tests and procedures (including radiology and laboratory procedures) on an out-patient basis in public hospitals (including referrals from General Practitioners). Status on the common waiting list is to be determined by clinical need only. The list is subject to clinical validation by the relevant Clinical Director.

One of the key features of Consultant Contract 2008 is the introduction of new private practice provisions ranging from a total prohibition (Type A contract) to an upper limit of 20% of overall clinical throughput for new consultants. To date the HSE has appointed 49 Clinical Directors who will monitor compliance by individual consultants with the agreed ratio of public to private practice, taking corrective action where the private practice limit is being exceeded. I regard equity of access for public and private patients to public hospital services as being of fundamental importance in the delivery of our health services. In this regard Consultant Contract 2008 specifies that the implementation of the 80:20 ratio of public to private practice shall be the subject of audit including audit by my Department.

The Health Service Executive is responsible for the detailed implementation of Consultant Contract 2008. I have therefore forwarded the Deputy's question to the Executive and asked it to reply to him directly on the operational details sought.

Question No. 607 answered with Question No. 603.

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