Written answers
Thursday, 14 October 2010
Department of Health and Children
Departmental Expenditure
5:00 pm
Lucinda Creighton (Dublin South East, Fine Gael)
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Question 107: To ask the Minister for Health and Children the recommendations contained in the report of the special group on public service numbers and expenditure programmes that pertain to his Department; the detail of each and proposed savings relating to his Department; which of these have been implemented to date and the expected savings to be achieved on each of these in one calendar year; and if she will make a statement on the matter. [36990/10]
Mary Harney (Dublin Mid West, Independent)
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Health expenditure in line with public expenditure generally is being addressed in the context of the Government's strategy for economic recovery and its target to reduce the general Government deficit to 3% of GDP by 2014. Already this year the Government has made a series of decisions which significantly reduced the Health Estimates by €630m on pay and €394 on non-pay, over €1bn overall. The Government will continue to take measures to control health expenditure within the context of overall Government policy on public expenditure whilst ensuring that patient safety and quality are at the centre of the delivery of healthcare. In general the approach taken by the Government has been informed by the recommendations in the Special Group's Report. However, in addressing particular areas, in some instances different measures have been implemented where these have proved more effective.
The recommendations pertaining to the Department and agencies under its aegis, and the Health Service Executive, are set out in the following table. Full year savings in excess of €625m are detailed.
| Recommendations | Status |
| Vote 39 | |
| Reduce the size of the Department of Health & Children | Special Group target savings - €11mThe Report indicated a total of 526 staff. Government policy on public service numbers requires my Department to meet a reduced civil service staffing level of 450 WTE by the end of 2012. These targets are set out and agreed by way of an Employment Control Framework (ECF).This target takes account of adjustments to reflect the taking on of additional functions such as responsibility for Youth Affairs transferring into my Department and three agencies being subsumed under the Government's rationalisation of agencies programme.There were 477.35 whole-time equivalents (WTE) employed at my Department at the end of September 2010 and all appropriate mechanisms such as re-organisation and re-allocation of work, including redeployment where necessary, will be utilised to meet the ECF target by end 2012. |
| Merge the Ombudsman for Children with the Office of the Ombudsman | Special Group target savings - €0.3mGovernment decided not to implement this |
| Merge Health Research Board with single stream science funding | Special Group target savings - €10.6mIn the 2010 Estimates for the Public Service the Government established a single stream of Science, Technology and Innovation (STI) funding. The allocation to the HRB funds part of the single stream of STI funding. Savings of approximately €1m have been achieved on HRB expenditure in 2010. In addition, under the Government's STI strategy additional research responsibilities were allocated to the Department of Enterprise, Trade and Innovation earlier this year. The Government is continuing to keep progress in this area under review. |
| Integrate the Health Insurance Authority into the Financial Regulator | Special Group target savings – n/aNot implemented but no Exchequer savings would acrue here as the Health Insurance Authority is funded by the industry |
| Restrict the National Treatment Purchase Fund | Special Group target savings - €7.5mImplementation of this recommendation was not considered feasible or appropriate. The NTPF needs to have access on a limited basis to treatment capacity in public hospitals in Ireland for cases where for clinical reasons it is not possible or appropriate to use a private hospital - for example, where certain paediatric surgery is concerned. The amount of treatment the NTPF is allowed to source in this way is limited to 10% of its patient throughput. For reasons of convenience to patients as well as the additional non-patient-care costs that would arise, the NTPF does not generally purchase services abroad. It does however buy some services from Northern Ireland for patients living in border areas. |
| Remove the Exchequer element of agencies part funded by the National Lottery | Special Group target savings - €1.8mFunding has been reduced by €199,000 in 2010. |
| Vote 40 | |
| Health sector efficiencies | Special Group target savings - €90mHSE is to achieve €106m in efficiencies in 2010 |
| Health sector staffing | Special Group target savings - €300mHSE pay is being reduced by €100m in 2010 for reduced staffing of 1,520 WTEs. The Employment Control framework requires further reductions of 1,520 in each of the years 2011 and 2012. |
| Eliminate all bonus payments to HSE staff | Special Group target savings - €1.3mBonus payments eliminated in 2009 and 2010 |
| Revise income guidelines for medical cards | Special Group target savings - €100mThe Department is currently reviewing all legislation relating to eligibility for health and personal social services with a view to making the system as fair and transparent as possible. As part of this exercise, a review of eligibility for medical cards in the context of financial, medical and social need is being undertaken. |
| Increase threshold for Drugs Payments Scheme | Special Group target savings - €37mThreshold increased to €120 per month with effect from 1 January, 2010. Expected to produce savings of €27m in a full year |
| Introduce co-payment (€5) for GMS and LTI prescriptions | Special Group target savings - €70mA charge of 50 cent per prescription item, subject to a monthly ceiling of €10 per family, was introduced on 1 October, 2010. Expected to raise €24m in a full year. |
| Tendering for GMS services | Special Group target savings - €370mReductions in drug costs agreed with the IPHA, together with other measures, expected to produce savings of €94m in a full year. Reductions in drug costs agreed with the APMI expected to produce savings of €24m in a full year. Reductions in pharmacy, GP and other health professionals fees were also implemented under the Financial Emergency Measures in the Public Interest (FEMPI) Act, estimated to produce savings of €159m in a full year. Following a recent review and consultation process further savings may be achieved. |
| Increase hospital charges | Special Group target savings - €6mCharges are not being increased this year but the HSE is required as part of its National Service Plan to improve the collection rate of charges |
| Increase charges for private beds in public hospitals | Special Group target savings - €50mCharges are not being increased this year but the HSE is required as part of its National Service Plan to improve the collection rate of charges. A target of €75m has been set for 2010. |
| Introduce mandatory protocols to use generic medicines | Special Group target savings - €30mThe Government has decided to introduce a system of reference pricing combined with generic substitution of medicines. A report which sets out a proposed model for the operation of generic substitution and reference pricing was launched in June. Progress on the implementation of this initiative, including the legislative and administrative changes required to give it effect in 2011 will continue. |
| Efficiencies in non-emergency patient transport | Special Group target savings - €10mHSE is to make savings of €4.3m in 2010 |
| Efficiencies in Disability and Mental Health administration | Special Group target savings - €50mOverall €106m savings to be achieved on non-pay by HSE, including Disability and Mental Health service providers, in 2010 |
| Increase percentage recoupment under Fair Deal | Special Group target savings - €50mNot implemented |
| Introduce Means Test for Homecare Packages | Special Group target savings - €24mHome Care Packages (HCPs) were introduced in 2006. The current annual funding of €130m supports approximately 9,600 recipients at any one time (or 13,000 per annum). It is noted that approx. 90% of those in receipt of home care packages have a medical card.There would be considerable practical and resource implications for the HSE to introduce means testing. Primary legislation would be required and the McCarthy proposal, as framed, has implications for overall eligibility legislation, and would therefore be more appropriate to the wider review of eligibility for health services which is underway. |
| Vote 41 | |
| Abolish the transitional provisions for the National Childcare Investment Programme | Special Group target savings - €2mThe NCIP included a capital grant scheme and a revenue support scheme for community childcare services. The capital grant scheme closed to new applicants in April 2009. The recommendation of the McCarthy Report concerns the Community Childcare Subvention Scheme (CCSS) which was implemented under the NCIP. The Childcare Directorate of the OMCYA responded to this recommendation by closing the CCSS at the end of August 2010 and replacing it with a new Community Childcare Subvention (CCS) scheme with effect from 1 September 2010.Full year savings of €5m |
| Alter the means test by eliminating Band C | Special Group target savings – €5mA different approach to restructuring the CCSS than that proposed in the McCarthy report has been taken. The outcome achieves the savings sought by the Report but maintains and improves the provision for disadvantaged and low income parents under the new CCS scheme. In particular, the new CCS scheme improves the subvention levels for low income working parents. The new CCS also continues the policy of tapered withdrawal of the subvention to assist parents moving from unemployment back into the workforce.The CCSS provided for three subvention Bands, with the highest level of subvention paid for Band A parents, the next highest paid for Band B parents and a lesser level paid for Band C parents. The CCS provides for two subvention Bands. Band B has been raised to the Band A level and Band C (now Band B) has been increased by 11%. These changes were made possible by restricting parents in receipt of Job Seeker's Benefit/Allowance to part-time childcare provision (up to 5 hours per day). Restructuring the subvention Bands in this way has improved the level of provision under the scheme for low income working parents (e.g. parents in receipt of Family Income Supplement (FIS) are now categorised as Band A, and Medical Card and GP card holders benefited from the 11% increase to the new Band B).Full year savings of €5m |
| Rationalise the administrative structures of the National Childcare Investment Programme | Special Group target savings - €3mThis recommendation has been overtaken by the introduction of the free Pre-School Year in Early Childhood Care & Education (ECCE) scheme in January 2010, and more recently the Childcare Education and Training Support (CETS) scheme, both of which are administered by the OMCYA in addition to the CCS scheme. Approximately 4,300 pre-school services are participating in the ECCE scheme and 63,000 children are availing of the free pre-school year. In addition, 600 services are in the new CETS scheme and 950 services are participating in the CCS scheme. The existing administrative structures, which supported the original NCIP programme and its broader policy objectives, are now supporting a greatly expanded area of work at no additional cost to the State. These structures are also supporting the implementation of Síolta (the national early learning framework) to underpin the quality provision of the pre-school year. In effect, the work of the existing support structures for the NCIP has more than doubled and is being successfully delivered with no additional resources or costs arising. |
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