Vol. 965 No. 3
6. Deputy Mick Barry asked the Minister for Health if funds will be made available by his Department to help resolve the dispute involving section 39 workers in the health care sector whose historic link to their public service comparator in terms of pay and conditions other than pension conditions has been broken due to them not obtaining equivalent pay restorations; and if he will make a statement on the matter. [6088/18]
9. Deputy Thomas P. Broughan asked the Minister for Health when additional funding will be provided to the HSE and section 39 organisations to enable them meet pay restoration commitments as per the Labour Court recommendation of 20 November 2017; the amount of funding to be provided; the timeframe for the provision of these additional funds; and if he will make a statement on the matter. [2124/18]
Question No. 6 in the name of Deputy Mick Barry is grouped with Question No. 9 in the name of Deputy Broughan. The procedure is that double time is allocated when two questions are taken together. Deputy Barry will introduce the question, the Minister will reply and then the two Deputies can make their contributions, and if time permits Deputy O'Reilly would also like to make a short contribution.
We are less than a week away from strike action by 7,500 members of SIPTU working effectively in the health service.
I ask the Minister whether funds will be made available by his Department to help resolve the dispute involving these section 39 workers, whose historic link to their public service comparators in terms of pay and conditions other than pension conditions has been broken due to them not obtaining equivalent pay restoration. Will the Minister make a statement on the matter?
I propose to take Questions Nos. 6 and 9 together.
I thank Deputies Barry and Broughan for raising this important matter. Under section 39 of the Health Act 2004, the HSE provides financial assistance to organisations by means of a grant. Many of those organisations provide very useful and valuable services that our citizens appreciate. Section 39 legally underpins the provision of services similar or supplementary to a service that the HSE may provide. In 2017, the HSE provided funding of approximately €800 million to over 2,200 of these agencies. The funding provided can range from high value, in the millions, to relatively modest amounts of just a few hundred euro. The point I am making is that many section 39 organisations have different scales and sizes
Staff in these organisations were not subject to the provisions of the FEMPI legislation. They were not a party to the public service agreements and are not covered by the pay restoration provided for in these agreements. These are not value judgements or views; they are just facts. While it is understood that pay savings were made by the organisations, the precise mix of pay cuts or other savings measures will have varied. I have seen that some did apply pay cuts and others may not have while some have restored them and some may not have. Also, where there were pay cuts, it is not at all clear that they were applied in a universally consistent manner, as was the case in the public sector and consequently, there is a complexity to this issue.
Therefore, the Government believes that we need a much deeper understanding of the funding position in these grant-aided organisations and the true extent of the pay reductions applied. In establishing the position, I am obliged to have regard to the legitimate taxpayer and value-for-money issues that arise. That is why I have requested that the HSE engages with the section 39 organisations to establish the facts around what cuts were applied and how and when they were implemented. I have asked that the executive complete this exercise as soon as practicable having regard to the large number of organisations concerned. Officials from my Department and the executive are continuing to engage with the relevant trade unions to ensure that this work is carried out on a consensus basis. We want to reach agreement in terms of how we do this. I note that one union has already agreed to how this should proceed while another has not.
I am mindful of the threatened industrial action in a number of these organisations, which is scheduled to commence with a one-day work stoppage next week. I believe that the process which I have outlined should address the concerns raised by the trade unions in a fair and transparent way. I am very conscious that the trade union movement has called for a process. I believe we need a process and I genuinely hope that agreement can be reached. I understand that the Irish Congress of Trade Unions is engaged in conversations with management in this regard. It is at a very sensitive stage so while wishing to be as forthcoming as I always like to be with the Dáil, I must be careful not to say anything that would in any way jeopardise something that is at a very sensitive stage. I hope a resolution can be reached because there should be no disruption to the delivery of these services. I know the unions do not want that, I do not want that and certainly the people depending on the services do not need that either.
We are six days away from a national strike and I do not sense any degree of real urgency in the Minister's reply. The case of these workers is basically unanswerable. How can the Minister stand over a situation where a nurse in the HSE is getting paid one rate with her pay restored while a nurse in Rehab doing very similar - essentially the same - work has not had her pay restored? I noticed that the Minister is wearing a little badge. My eyesight is not good enough to see exactly what it is. I suspect it marks the 100 years since votes for women were granted. The Minister will wear a badge about 100 years of votes for women. What about these workers, many of whom are women workers and low-paid women workers, who are being forced to wait for pay justice and to have their pay restored? Can we have some urgency and justice for these workers?
The Labour Court recommendation of 20 November is very clear. It states "The Court has given careful consideration to the submissions of both parties and is clear that the worker’s pay is clearly aligned with the HSE pay scales." The Irish Wheelchair Association was the key mover in the case. It could not be clearer but yet, as Deputy Barry noted, we are just a few days away from a work stoppage involving 7,500 workers in nine section 39 organisations. As the Minister knows, they provide services to some of the most vulnerable citizens in our community. It is outrageous that we have reached this stage. The Not for Profit Association has been negotiating with the Minister for almost a year. When I visited the Irish Wheelchair Association last year, I raised the matter with the current Taoiseach, who admonished me that in no way were services to be cut. It was up to him, however, to bring the funding up to the required level for those organisations. The Government had an opportunity in budget 2018. We had a discussion yesterday and other debates about the deficit in the health budget for 2018. I welcome that the Minister has said he is prepared to reach but he needs to move very fast, as my colleague has said.
The Minister stated that talks are at a sensitive stage. I do not believe they are and I have had that confirmed to me in the past couple of seconds. In fact, very little talking is taking place. The Minister also talks about a process. It is important that the record of this House reflects that there was no process when these workers were having their pay cut, there was no recourse and no analysis was done. No money was identified. A cut was simply imposed on them. I know this because many of the Labour Court recommendations that found against the cases initially had my name on them. There was no process. It is really unfair to these workers to say that we cut their pay when we felt we needed to do so - they did not feel there was a need to do so and neither did I - and now the Minister is going to hide behind process. That is deeply unfair to those workers. We are six days away from a dispute. We need a sense of urgency about this.
I am not sure what Deputy Barry's comment about the badge relates to. I am very proud that women have had the vote for 100 years and I hope we will do an awful lot more to advance women's rights in this country in the coming months. There is an urgency in terms of resolving this but, and I mean this respectfully, with the position I hold I do not have the luxury of being able to say some of the things Deputies can say on the other side of the House. In response to Deputy O'Reilly, I am informed that talks are at a sensitive stage. I checked that before I came into this House. I am informed that unions and the Irish Congress of Trade Unions are involved. I am also aware, as is the Deputy, that one union has already accepted the proposal and has issued a statement welcoming it. Where people get it somewhat wrong is the idea that this was applied universally in each and every section 39 organisation. That is not the case. There are 2,200 organisations with their own boards, governance structures and CEOs and they applied them in different ways.
Let me be clear in case there is any misunderstanding: I accept there are a number of legitimate issues. I accept that a number of people experienced pay cuts, that we need to establish the facts and that this will come with a bill that ultimately will need to be met. I accept that but the unions are calling for a process and I want a process. I accept that Deputy Broughan raised this issue a number of times. I believe there is a legitimate issue here but I am making the point that there is a complexity to this issue that is not there with public servants. This Oireachtas did not pass a law to cut the salaries of people in section 39 organisations. This Oireachtas did cut public servants' pay. This Oireachtas passed a law to restore public servants' pay. It did not pass a law regarding section 39 organisations. It is a process and we must work our way through it. I am determined to work our way through it. There is no need for industrial action because we will put a process in place and I hope we can reach agreement on that very quickly.
The significance of the badge is that the Minister is prepared to advertise his support for women who fought for their rights 100 years ago. He has a practical opportunity here to demonstrate his support for workers, largely women workers, who are fighting for their rights today yet these workers are left to face the prospect of picket lines next week because of inaction on his part. Their case is unanswerable. So unanswerable is it that their own employers in the sector have accepted that pay parity is warranted. Solidarity stands foursquare behind the thousands of section 39 workers who are fighting for pay justice and preparing for industrial action next Wednesday. The Government, the HSE and the Minister must see sense before the deadline for action. If they do not, the responsibility for any ensuing disruption and stress will be entirely on their shoulders, including the Minister's shoulders.
As the Minister is well aware, a number of organisations, including the Irish Wheelchair Association and Rehab, have been under intense pressure in terms of recruiting, retaining and looking after staff because of the ongoing issue arising from pay restoration in the public service. It is clear, from the Labour Court, the conciliation conference and every aspect of the human resources process, that the Minister forced the Irish Wheelchair Association to engage in that the workers in question are entitled to pay restoration. It is outrageous that we have reached a point where services are set to cease next Wednesday.
The Minister referred to a mapping process in a number of responses. When will we receive the report on this process and when will the HSE receive it? It is intolerable that workers in section 39 organisations who do exactly the same jobs as workers in section 38 organisations and the HSE have not been paid the same rate since we embarked on pay restoration. As my colleague stated, we need to do justice to these workers urgently.
There is an alternative to industrial action, namely, talking and engaging, which is generally the way we settle industrial disputes. We have dealt with a number of such disputes in the health sector since my appointment as Minister. I do not need to wear a badge to prove my record of willingness to engage and work through issues.
Deputy Broughan is entirely correct that a number of organisations are experiencing a recruitment and retention challenge. I accept that a person working in a section 39 organisation could receive a higher salary in a section 38 organisation and I see how this will play out and cause difficulty for organisations. I also hope the Deputy will also accept the legitimacy of the point that there are 2,300 section 39 organisations, ranging from groups that receive grants of a few hundred euro to organisations that receive grants of many millions and provide vital services nationwide.
In terms of the timeline for concluding the mapping process, this is one of the issues on which I want to reach agreement with the trade unions and other stakeholders. I could announce the process but I want to try to agree it with the stakeholders. There is time to achieve this and the process should be agreed as quickly as possible in order that we can provide reassurance to service users regarding their services next week. It is only by getting into a process that we will be able to successfully resolve this issue.
The Office of the Ceann Comhairle has received written correspondence from Deputy Niall Collins, who tabled Question No. 7, requesting that the House agree to allow Deputy Billy Kelleher to take his question. Is that agreed? Agreed.
7. Deputy Niall Collins asked the Minister for Health the extra support that will be provided to University Hospital Limerick in 2018 to reduce waiting times for a first-time appointment to see a neurologist in view of the fact that 418 persons had been waiting more than 18 months for appointments at the end of 2017; and if he will make a statement on the matter. [6421/18]
I ask the Minister for Health what extra support will be provided to University Hospital Limerick in 2018 to reduce waiting times for a first-time appointment to see a neurologist in view of the fact that 418 persons had been waiting more than 18 months for appointments at the end of 2017.
I thank Deputies Billy Kelleher and Niall Collins for raising the important issue of the need to reduce waiting times for appointments to see neurologists at University Hospital Limerick. Reducing waiting times is one of the Government's key priorities.
I am advised by the HSE that outpatient waiting lists, including neurology lists, are managed centrally at University Limerick hospitals group. All patients who are waiting are prioritised according to clinical need. University Limerick hospitals group will continue, as is right and proper, to focus on seeing and treating those who have been waiting longest.
The number of outpatients waiting for a neurology appointment at University Limerick hospitals group increased in 2017. At the end of January 2018, 408 patients were waiting. Among the reasons for the increase are growth in demand, an increase in the number of urgent referrals and a shortage of consultants.
This year, particular focus will be placed on the validation of outpatient waiting lists by University Limerick hospitals group to ensure all those who are waiting require appointments and resources can be targeted at those who need them. The scheduling of patients waiting longest will also be a focus. This will be subject to weekly review at hospital level and as part of this process, neurologists at University Hospital Limerick have commenced reviewing referrals of patients waiting longer than 36 months. Following consultation with patients' general practitioners, University Limerick hospitals group will schedule appointments as required. Hence, there is a weekly procedure in place at the hospital to try to get on top of this issue.
Recent experience with waiting list initiatives, including outsourcing, suggests there are opportunities for further improvements and a number of steps are being taken to ensure that lists are accurate. These efforts will intensify in the coming months. My Department has also requested the HSE to develop an outpatient waiting list action plan for 2018. I will ask that neurology waiting lists in University Hospital Limerick forms part of this action plan.
This issue is indicative of the serious problems in neurological services nationwide. They are overwhelmed as a result of changing demographics, the ageing profile, the increased incidence of dementia, stroke and other neurological illnesses such as Parkinson's disease and multiple sclerosis. People cannot access the treatments they are entitled to and need. Early diagnosis is another issue that must be addressed. There are not enough beds, neurological consultants or capacity in the system to deal with the problem. Large numbers of vulnerable people are waiting for diagnosis, not to speak of treatment, and cannot access neurological services.
According to the Association of British Neurologists, there should be one consultant neurologist per 70,000 of population. In some areas of this country, the ratio is one consultant neurologist per 200,000 of population. We are, therefore, well off the mark even in terms of the basics, and this must be addressed urgently in view of the demographic changes that lie ahead.
I largely agree with the Deputy on this matter. The HSE launched a model of care for neurology in 2016 and is moving towards the implementation of this model. The national clinical programme for neurology model of care document recommends an increase in the number of consultant neurologists and nurse specialists, including clinical nurse specialists, and other health care professionals. This would have a positive impact on addressing waiting time issues. The programme also proposed implementation of its recommendations over a five-year period. This would significantly improve access for all neurology patients. I welcome that the clinical community has come together to draw up this roadmap.
The national clinical programme for neurology reviewed demand and capacity for access to neurology consultants for adult services. Arising from this work, the number of consultant neurologists nationally is planned to increase by ten, which would be an increase in numbers of almost 50% and the single largest increase in the history of neurology services in Ireland. Seven of the ten additional consultants are already in place.
The point identified by Deputies Kelleher and Niall Collins is correct. The HSE will increase the number of neurologists and, in the meantime, weekly efforts will be made in University Hospital Limerick to drive the process forward.
Multi-annual budgets are required for key areas such as neurology services to ensure the plan that has been drafted can also be implemented with sustained funding to allow the service to catch up with demand. Government, Parliament and citizens must debate the issue of demographics which will clearly present serious challenges in many areas, including dementia and other neurological diseases and conditions in the years ahead. We will not have the capacity or ability to address these challenges unless we commit ourselves to funding the necessary services. This will require the provision of additional resources from tax revenues. We must have this conversation because people will otherwise get lost in the system and we will have delayed diagnoses and poor outcomes and treatments.
The Deputy raises a valid point. Capital projects will increase capacity in terms of the number of beds and dementia facilities. An issue also arises regarding the number of people on the outpatients list, particularly those with dementia, who could be treated in the community. This issue applies to the outpatients list in general. When so many people on such a large list miss appointments, it suggests there may be a mismatch between the number of people on the list and their requirement for a service. Many of those on the list may wish to have a service in the community and may want to be referred back to primary care.
Deputy Kelleher noted that 418 persons had been waiting more than 18 months for an appointment at the end of 2017. This figure has since fallen to 408 and I would like it to continue to reduce. The University Limerick hospitals group is prioritising this matter.
8. Deputy Mick Wallace asked the Minister for Health his plans to increase resources for suicide prevention services in County Wexford in view of the number of recent suicides in the county and the county's high suicide rate compared with national averages; and if he will make a statement on the matter. [6379/18]
According to the Central Statistics Office and National Office for Suicide Prevention, Wexford consistently has one of the highest suicide rates per capita in the country. At times in the past ten years, the suicide rate in the county has been almost double the national average. Will the Minister provide an update on his plans to increase resources for suicide prevention services in Wexford given the number of recent suicides in the county, its high suicide rate when compared with the national average and the abysmal services currently in place in Wexford?
I thank Deputy Kelleher for the opportunity to address this serious issue. Suicide prevention is a priority for the Government. Since 2012, we have increased the funding for the National Office for Suicide Prevention from less than €4 million to more than €12 million.
While there has been a very welcome reduction in national suicide rates, I acknowledge that the rate in County Wexford is higher than we would hope.
In order to reduce the rate, we have put in place a number of support services in the county. Support is available in the Wexford region for people who are feeling suicidal and for families or friends who are concerned. There is a range of services available in the area of suicide prevention, as well as support in the aftermath of a suicide.
Each community health organisation, CHO, has at least one resource officer for suicide prevention based within its area. This includes CHO area 5, of which Wexford is a part. The HSE's suicide crisis assessment nurse service, SCAN, is also available in Wexford. This is an expert mental health nursing service which is available within primary care and which offers an accessible and speedy response to GP requests for assessment of those who are self-harming or in suicide distress. Wexford also has the HSE's self-harm intervention programme, SHIP. This is a free service offering short-term counselling to individuals aged 16 and over who are experiencing suicidal ideation or the impulse to self-harm. Referral is through a person’s GP or other medical professional.
The HSE continues to work not only through its professional staff in mental health services but also through GPs, within counselling services and in the community and voluntary sector, in developing various responses to the incidence of suicide in Wexford. Training programmes are offered to HSE and other relevant front-line staff in Wexford in partnership with voluntary organisations and the National Office for Suicide Prevention. These training programmes include e-suicide TALK, safeTALK, applied suicide intervention skills training, or ASIST, and understanding self-harm.
Connecting for Life is Ireland’s national suicide prevention strategy for the period 2015 to 2020 and the National Office for Suicide Prevention is tasked with its implementation. This strategy sets out a vision of an Ireland where fewer lives are lost through suicide and where communities and individuals are empowered to improve their mental health and well-being. Connecting for Life local plans are developed by communities for communities. The local plans align with the national strategy in terms of vision, with a core component being local implementation and empowerment of communities. The Wexford Connecting for Life local plan was updated and relaunched in 2017.
I do not know how much the Minister of State knows about what it is like on the ground but it is abysmal. The HSE web page for Wexford mental health services lists two mental health hospitals and five day services. There are no links to provide more information but there are phone numbers. If one Googles the names of the five day services, only one has a website, and it - like two of the other five day services - is clearly not a mental health service. At the bottom of the page there is a note on a regional suicide resource office, with a phone number for St. Patrick's Hospital in Waterford, which was highly criticised in a report by the Mental Health Commission in 2016. If I were in crisis and I needed some help after 6 p.m., there are three numbers I could call and one is in another county. I would have no idea what would happen, the kind of care I would get, if somebody would talk to me, who I would speak with and if the relevant person could prescribe medication or if I would be kept overnight. It would be money well spent to simply provide some information on web pages relating to these services on the HSE website. I am sorry but the people in Wexford would say this to the Minister of State. Several people have been affected by this lately and it can be devastating. They will say the services are not there.
I appreciate that this is a sensitive matter and one about which the Deputy is very passionate. One of the challenges I have seen since coming to the Ministry is the myriad services which exist but which are not joined up. There is no up-to-date or real directory of services available. If I wake up with a mental health issue in west Cork or the Deputy wakes up with one in Wexford, the question is who to call. Does a person call Aware, ALONE, the Samaritans, Childline, Pieta House or Jigsaw? There is a variety of different services. Nobody in a perfect state of health, let alone with a mental health challenge, could figure out the myriad of services and what is most appropriate.
One of the first actions I asked of the HSE since starting in this job is to have one national helpline that would be as identifiable as the 999 number that we know. This should refer everybody who calls it to the most appropriate local service in the area suitable to their needs. Work is ongoing and I hope we can make significant progress on it before the year is out. It will be a very positive step towards remedying what the Deputy is highlighting.
In 2010, when the acute beds were closed at St. Senan's hospital in Wexford and the service moved to Waterford, we had the same suicide rate as Waterford. Now, however, the rate in Wexford is double the rate in Waterford. This is an issue and St. Patrick's Hospital in Waterford is not even fit for purpose. I understand that not everybody presents with suicidal ideation. It is not always easy for the State to know somebody will kill himself or herself; that cannot be known unless a person presents. In Wexford there is a lack of emergency response to those who present. I spoke in this Chamber last year about a 14 year old girl, a ten year old boy and a seven year old boy who presented with suicidal ideation but all of them had to wait almost two years to see a child psychiatrist. Surely there should be some kind of "break-glass-in-case-of-emergency" service for such children. The problem is compounded by a lack of a joined-up mental health and disability service. The mother of one of these kids has said her son repeatedly tells her he wants to be dead but she is still awaiting an autism assessment for him, with no clear date as to when that will take place. She has been told her son is sixth on the list but the psychologist left before Christmas and no replacement has been found. I am not saying this is the Minister of State's fault but there is a serious crisis in Wexford. Not enough is being done.
I am sorry to curtail the Deputy on such a sensitive matter and I appreciate how he is speaking on it but I must move on.
We are aware of those challenges. We are trying to give GPs access to consultants so they can immediately advise them. GPs will be the front line in many of these cases. To be fair, they cannot know everything that is right to do so if we can get them immediate access to a consultant in the mental health area, it would be a positive step. The Connecting for Life strategies are very important as they devolve responsibility and authority locally to joined-up thinking. The Deputy argues there is a lacking in that regard. In fairness, Wexford's plan has been revised and relaunched. Some counties are better than others at keeping everybody in the loop, including gardaí, local authorities, health services, schools and the agencies working together. There is a challenge in tidying up the directory of services and making a more accessible single list. Access is one of the biggest challenges and people must be signposted to the most appropriate service. There are many services not being utilised that people are not aware of.
If Members stick to the allocated times, we might get to deal with four more questions.
10. Deputy Alan Kelly asked the Minister for Health the status of the work being carried out at Beaumont Hospital in respect of publishing a freedom of information disclosure log, as per the Freedom of Information Act 2014, on the hospital's website; if this process will be expedited; the timeframe for completion; if he will direct the hospital to publish as much information as possible in an open and accessible manner on a routine basis outside of freedom of information; and if he will make a statement on the matter. [6097/18]
This is a very specific question. It asks the Minister the status of the work being carried out at Beaumont Hospital in respect of publishing a freedom of information disclosure log, as per the Freedom of Information Act 2014, on the hospital's website; if this process will be expedited; the timeframe for completion; if he will direct the hospital to publish as much information as possible in an open and accessible manner on a routine basis outside of freedom of information; and if he will make a statement on the matter and why this has not happened to date.
I thank the Deputy for this question, which has caught my attention because we are very clear on what people should do in this regard. Beaumont Hospital is a prescribed body, as the Deputy knows, in its own right for the purposes of freedom of information. Statutory responsibility for the hospital's compliance with the provisions and requirements of the Freedom of Information Act 2014 rests with the hospital authorities. Inquiries have been made with the hospital on the publication, under section 8 of the legislation, of its publication scheme. The hospital has advised that work is under way collating and compiling information for publication on the Beaumont Hospital website. This will include up-to-date details of the services provided by the hospital, high-level policies and procedures, financial information, procurement data and other relevant information.
I am advised that, in parallel with this, the hospital has recently commenced a major overhaul of its website, which it anticipates will be completed by quarter 2 of this year, including the publication of the publication scheme and the disclosure log. On foot of the question received from the Deputy, I will write to the chair and chief executive of Beaumont Hospital requesting that the work under way is expedited and that as much public information as possible is provided outside of the freedom of information process. I welcome any further thoughts or insights that the Deputy might have on the matter.
I clearly asked the question for a reason. The hospital is running afoul of the Act. It is not meeting the requirements of the 2014 Act, which allowed six months for implementation, and it is now 2018. What is it hiding? There is no disclosures log on the website and there is a link to nothing. I know a number of freedom of information requests and other requests for information have been made of the hospital but these are not public. The information given out is contradictory. Why is it not publishing the information in order that we all might see it?
The hospital is not like other hospitals that are maintaining the log and adhering to Freedom of Information Act requirements. I want to know why it is behaving in this manner. I appreciate what the Minister is saying and that he will expedite it. I am asking this as an oral question because I already asked it as a written question in November 2017. The answer was the exact same as the one the Minister has read out here. There is something going on. I ask that the Department looks at Beaumont Hospital and what is happening in all the other hospitals. Why are all the other hospitals adhering to this and providing the information as required but Beaumont Hospital is not?
I thank Deputy Kelly. There is nothing the Deputy has said that I disagree with in terms of the law of the land, which is very clear and there for everyone to see. I am informed that the deadline for the publication of this scheme was 14 April 2016 so clearly anybody who does not publish is not in compliance with the Act. The Office of the Information Commissioner is the body this can be examined by but I do not think that is the point. The point is why it is not being done. In light of the Deputy bringing it directly to my attention by way of oral parliamentary question, I have now written to the chief executive officer and the chair of the board. I will also ask my Department to probe it further. The law is very clear and everybody should publish their logs. I expect Beaumont Hospital to do the same.
That is why I asked it as an oral question. Beaumont Hospital stands out. I know people who have asked numerous questions. I have put in freedom of information requests and the information has not been published or sent out and there are contradictions. The hospital, as other hospitals, is supposed to routinely publish its key performance indicators, KPIs. It does not do so. Its annual report from 2017, which refers to the year 2016, refers to its KPIs without providing detail. It seems the information provided when requested by numerous people about bed capacity at the hospital changes quite a bit. This hospital is way behind for some reason that needs to become public in providing freedom of information requests and other information through the website, which is their statutory role. It should be available for everyone. Why is this the case? What is being hidden? If something is being hidden, we need to find out why the hospital is an outlier compared with all other hospitals. The idea that the hospital would write to me late last year or tell the Minister today that it is putting in place a plan to do it is not acceptable. I want all this information available by this day next week because it has had four years to do it.
The Deputy is preventing his colleagues from having a chance to ask a question.
I have outlined the action I will take. In terms of compliance with the law, Beaumont Hospital is a prescribed body in its own right. The Office of the Information Commissioner oversees the implementation of the Act. It is disappointing to hear this because Beaumont is a hospital I very often reference in terms of its very positive progress on the number of patients on trolleys and waiting lists-----
So do I.
-----as does Deputy Kelly. I do not know the reason for this but now the Deputy has brought it to my attention, I will correspond with the hospital and try to establish the facts and revert to the Deputy.
11. Deputy Louise O'Reilly asked the Minister for Health his views on the difficulties in accessing home care packages in Dublin city and county in which the HSE is only providing palliative care in view of the fact it does not have the funding for extra staff to provide a full range of home care services; and if he will make a statement on the matter. [6369/18]
The question is fairly specific. It is to ask for the views on the difficulties accessing home care packages. I will be very clear with the Minister of State. It is not an opportunity to tell us a lovely story about how there are no difficulties. There are difficulties. I am aware of them and so are my constituency colleagues. The Minister of State must be aware of them as well. Will he spare us a description of what a waiting list is and comment on the fact that there are difficulties?
I assure the Deputy story-telling was never my forte and I do not intend to start now.
Since being appointed as Minister of State with responsibility for older people, I have made improved access to home support services a key priority. Progress in this area is reflected in the additional funding made available for winter 2017, the increased funding and level of activity planned for 2018 and in the work being progressed on the development of a statutory home care scheme.
Home support services are a particular area of focus in budget 2018, with an additional €18.25 million allocated. The additional resources bring the budget for the direct provision of home support services to €408 million delivering over 17 million home support hours to about 50,500 people. This compares with the estimated 16.34 million hours delivered to 50,000 people last year. In addition, 235 intensive home care packages will provide 360,000 home support hours for people with complex needs.
There is a high level of demand for home support services in community healthcare organisation 9, which includes Dublin north city and county area and over €55 million was spent on home support in the community healthcare organisation, CHO, last year. Waiting lists for services are managed based on the assessed need and within available resources. Applications are assessed by the HSE and clients are provided with a service having regard to their assessed needs. Cases of individuals with palliative care needs and people discharged from acute hospital settings, who are in a position to return home with home support, are prioritised. The provision of services for the area is delivered primarily by private providers who were selected through the HSE tender process and who demonstrate the capacity to meet HSE requirements. I understand that from time to time, providers are unable to meet the service levels required by the HSE due to staff recruitment difficulties. Therefore, while there is a waiting list for home supports in the area, additional resources have been made available this year.
I was looking for a comment on the difficulties. The Minister of State has accurately described the recruitment difficulties and I am sure they exist. I am not convinced, and the Minister of State has probably heard me say this on more than one occasion, that outsourcing this function to the private sector is the best way to do it. In many cases, notwithstanding the good work done by the individuals providing the care, it does not represent good value for money. The prioritisation of people who are being discharged from hospital and people who need palliative care does absolutely nothing to help keep people out of hospital. The Minister of State will be aware of that.
I want to bring two cases to the Minister of State's attention. A father and son met me last Monday. Their wife and mother has a very severe form of dementia. She is in Beaumont Hospital now and cannot get out to the community. They want to look after her at home. They were offered six hours. After they kicked up, they got another seven hours. They have 13 hours but they need a minimum of 30 hours a week. They cannot access them. Another case is that of an 82-year-old woman with diabetes who is effectively confined to her home. Her daughter is working 16 hours a day to look after her. There are very real cases and they cannot access home care. If the Minister of State is serious about home care the resources have to be put into it and we need to target recruitment. The best way to do that is not by outsourcing.
I do not need to go to Dublin to understand the challenges in the provision of home care. I am a practising politician. It is one of the beauties of our democracy that Ministers and Ministers of State also have constituencies to run. I meet people every week in my village who cannot access home care and who need it. I am well aware of the challenges. That is why we have decided the current scheme is not fit for purpose because it will never meet the expectation. If we are spending €408 million on home help hours, we all agree in the House that it does not go far enough and does not meet the demand. We need to radically change how we do what we do. That is why we launched the consultation in July. It was completed in October. The 2,600 responses are now being reviewed and a breakdown of them will be on my desk in the next two to three weeks. We need to build a scheme that mirrors the fair deal scheme where everybody is entitled to home help in their own home by law. We need to do that to ensure there is proper funding for the staff and resourcing of it. We intend to do it but it will take time.
Does the Deputy want to make a final comment?
Does Deputy Breathnach wish to make a quick comment on this?
It will save me asking a question on promised legislation. It has come to my attention-----
I think the Deputy is in the wrong arena.
My question is about health services.
Does the Deputy wish to comment on Deputy O'Reilly's question?
Yes, my question is on home care packages. It has come to my attention in respect of home care packages that different sectors are refusing home care packages that were in existence for people with a disability. They are taking those home care packages from them, telling them the services must be provided by the disability service, and withdrawing the package before the disability service is put in place. That is wrong and I am asking the Minister of State to take it in hand immediately. People are moving budgets from one place to another section in the service and leaving people with a disability with no home care package.
I will look into it for the Deputy. I am not aware of it but I will look into it.
12. Deputy John Brady asked the Minister for Health if funding will be allocated for the delivery of a general practitioner out-of-hours service for north County Wicklow in the HSE service plan; and if he will make a statement on the matter. [6109/18]
In October 2016, the Minister announced he had secured the funding to roll out a GP out-of-hours service in his constituency of Wicklow and specifically in the north Wicklow area, which is one of the last major urban areas in the State to have a dedicated HSE-funded out-of-hours service. It was due to come into operation in early 2017 and mysteriously the funding was pulled.
Will the Minister update the House about that service which was due to be rolled out in 2017 and if the funding is now secure?
I am delighted to be delivering this service which is badly needed for people in north Wicklow. He is right that I would have liked to have seen it delivered earlier, as I know he would have also. We are one of the last parts of the country without an out of hours general practitioner, GP, service, which is very important for looking after citizens in north Wicklow and to ease pressure on the acute hospital setting. I am committed to the development of an out-of-hours GP service for north Wicklow which can provide the appropriate level of cover for the population in our area. The development of such a service will allow GPs to participate fully in the provision of an integrated health care system, providing medical services that are appropriate, timely and effective, easily accessible and responsive to the needs of patients.
There is funding provision for the introduction of a structured out of hours GP service for the south Dublin and north Wicklow area in the HSE 2018 national service plan. I previously directed the Deputy to page 28 of the plan. This service is intended to cover the night time hours from Monday to Friday and to provide cover at weekends and public holidays, providing urgent general practitioner services to patients outside normal surgery hours. The service will include initial triage and GP consultation at treatment centres or home visits as appropriate, in accordance with HIQA standards for safer better health care. The procurement process to identify a service provider is expected to commence shortly and, subject to successful selection of a suitable service provider, the service is scheduled to be operational in the second half of this year. As I have said, that means this summer. Most importantly, the HSE will be arranging to meet with local GPs to consult them on the development of this service and to brief them on these developments. I expect that to happen in the next few days.
We have had promises from the Minister before that the funding was secured for this in 2016. He took to social media and the airwaves to announce that it would be rolled out in the early part of 2017. No explanation was ever given to his constituents, the people who desperately need this and lie waiting for 72 hours for a GP who never shows up. An explanation is due to those people and to the GPs who had signed up to the new north-east Wicklow doctor on call service which was due to be rolled out in February 2017. No explanation or apology was ever given to those people. While the Minister's words here today are welcome, they are taken with a pinch of salt because we have not seen the tender documents or no negotiations have taken place with the GPs who had formed the co-operative last year to roll it out. Will the Minister give categorical assurances that discussions have taken place with those GPs that have formed the co-operative? Will he give an explanation of why funding was pulled from that service in Wicklow?
The Deputy will prevent his colleague from asking her question if he continues.
His constituents and my constituents, the people who depend on that, deserve an explanation.
I know very well how to communicate with the people of my constituency.
Maybe not on this issue.
This issue is one that I will deliver on. The Government will deliver on it and make a better health service in north Wicklow. Those are facts. If the Deputy wants to know where the money is, some €25 million is ring-fenced in a development fund for primary care in 2018. The funding for the delivery of a north Wicklow and south Dublin out of hours GP service will come from that primary care fund. This is already spelled out in the HSE service plan; I think it is on page 28. As I have said, it is in black and white in the HSE service plan. The funds are being held in my Department to ensure the delivery of the service. I would have liked to see the service delivered last year, and so would the GPs. The HSE hoped to put it in place but was not possible. It will be delivered this year. There will be consultation with the GPs which will happen in the coming days but then there will have to be a procurement process which I expect to happen this month.
The Minister says that the procurement process will be initiated this month for a service to commence in June. No discussions have taken place with any GPs so he does not know if the GPs, who were essentially burned this year although they had signed up and formed a co-operative, are available and willing to offer this service to people. There is bad taste there from the Minister's office with GPs who are ready, willing and able to roll this service out. No discussions have taken place. Is the Minister giving categorical assurances that this service will be rolled out in June one way or another?
No discussions have taken place because the HSE does not go into a room with a bunch of people and decide to award a public contract. Public procurement will have to be advertised on the eTenders website for anybody who wishes to provide the service to be able to apply. I think the Deputy and I would agree that it is appropriate to ask the HSE to brief the local GPs about that service. That will happen in the next number of days. I expect the procurement process to commence this month. Obviously, in a procurement process, one needs people to apply but subject to people successfully navigating that procurement process, I expect the service to be provided in June. This is a fully funded service. There is a dedicated resource for this. We just have to go through the formal process of procurement.
13. Deputy Louise O'Reilly asked the Minister for Health the reason the HSE has discontinued waiting list targets set in 2017; the number of persons who will be affected; the number of complex cases still waiting for surgery; if new more ambitious targets will be now set; and if he will make a statement on the matter. [6365/18]
This question specifically relates to scoliosis but arises from contact that we have had from campaign groups to advise us that they are being told that the waiting lists have been discontinued. The targets which were set were not met so we do need to talk about that and it appears that the waiting lists have now been suspended, which is very worrying for people who had loved ones on those lists.
I thank the Deputy for the clarity about scoliosis. I presumed that was what the question was about and I thank her for raising this issue. The inpatient and day case waiting list action plan 2017, developed by the HSE in conjunction with the National Treatment Purchase Fund, NTPF, focused on reducing the number of patients who will be waiting the longest by the end of October 2017. As a result of this plan, 27,981 patients came off the waiting list. We are now developing a plan for 2018. Considering I know we are tight on time and that the question specifically refers to scoliosis, I will say that in May 2017 the HSE published the scoliosis waiting list update and service development plan which aimed to deliver on its commitment that no patient who required surgery for scoliosis would be waiting more than four months by the end of the year. As a result of the action plan, 321 surgeries took place in 2017, compared to 220 in 2016, which represents a 46% increase in activity, a very large increase. The HSE has confirmed that it will maintain the four month target in 2018 and beyond, which is international best practice, for all patients who are clinically deemed to require surgery now. I make the point, as I think the Deputy is familiar with, that there is a co-design group of clinicians who carry out the surgeries and advocacy groups that have been doing much good work with an independent chair. They are due to publish their proposals about how the scoliosis model of care should work in the next couple of weeks. Once a person is clinically deemed appropriate for surgery, four months is still the target.
The Minister knows that the operating theatre only opens three days a week. Five days a week would be preferable or seven days a week if there was any sense of urgency about this issue. I have specifically raised the 68 medically complex cases with the Minister on a number of occasions, not for sport but because it is being raised with me. It would appear that the reality of people on waiting lists is not matched by reports that we get in this House. The 68 children who have complex medical needs should be treated here. They may not necessarily be suitable for travel abroad but, to do that, that theatre would have to be open five days a week, if not seven days a week. The three days a week opening is not good enough.
The Children's Hospital Group will shortly publish, with the scoliosis co-design team, how the extra resources provided to it for 2018 will be expended. It will be used with a view to opening the theatre five days a week. They need to recruit for that. I do not want to mislead the Dáil and need to check whether that recruitment has started but I know the intention is to open that theatre five days a week. I will provide the Deputy with a detailed note on the plan for 2018.
14. Deputy Brendan Smith asked the Minister for Health his plans to change the criteria for the home support scheme in view of the fact that those persons that have been approved for home help often remain on a waiting list for some time until hours become available (details supplied); and if he will make a statement on the matter. [6362/18]
42. Deputy Brendan Smith asked the Minister for Health the measures he plans to implement to ensure that persons who have been approved for home support do not have to wait a considerable length of time for the commencement of such a service; and if he will make a statement on the matter. [6375/18]
If Deputy Smith will forgo his 30 seconds, I will let the Minister reply and give the Deputy one minute for a supplementary. Is that all right?
Yes.
I thank Deputy Smith for raising this matter. The Government is committed to promoting care in the community so that people can continue to live with confidence, security and dignity in their own homes for as long as possible. To support this, we plan to establish a new statutory scheme for the financing and regulation of home care services. I know the Deputy supports that move and the Department is currently engaged in a detailed process to progress this issue. My colleague, the Minister of State, Deputy Daly, recently outlined how we have received over 2,600 submissions as part of that consultation. They are currently being collated and a report will go to the Minister of State, Deputy Daly, in the coming weeks.
In the meantime, the Department and HSE are continuing efforts to incrementally improve our existing services. As detailed in its national service plan, the HSE is streamlining home care services by moving towards a single funded service. This combines the funding for home help and standard home care packages which will operate as a single home support service from this year onwards.
Home support services are a particular area of focus in budget 2018, with an additional €18.25 million allocated.
The additional resources bring the budget for the direct provision of home support services to €408 million, delivering over 17 million home support hours to 50,500 people. This compares with an estimated 16.34 million hours delivered to 50,000 people last year. In addition, 235 intensive home care packages will provide 360,000 home support hours for people with complex needs. Despite this significant level of service provision, the demand for home care continues to grow. It is important to note that the allocation of funding for home care across the system is finite and services and the HSE must distribute it across the CHOs.
I thank the Minister for his reply and welcome his commitment to the introduction of a statutory scheme. I hope the Minister can indicate that it will be implemented within a short time. The Minister pointed out, quite rightly, the importance of home support. In too many instances when we make representations on behalf of people who need home support, we are told that while the patient has been approved for support, the service will not be provided until hours become available. We are all well aware that patients are being kept unnecessarily in hospital beds because the supports have not been put in place to allow them to be discharged. Likewise, there are people in nursing homes who would much prefer to be in their home environment with adequate home care support. This is an extremely important scheme and the people delivering it do an exceptionally good job. All of us know there is a desire on the part of people to remain in their homes as long as possible. Additional funding will save the Exchequer and the HSE money in other parts of the health service. As such, I appeal to the Minister to try to provide additional resources so that the time lag between a patient being approved and the service being put in place can be reduced dramatically.
