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Estimates for Public Services 2016 (Resumed) (Continued)

Thursday, 16 June 2016

Dáil Éireann Debate
Vol. 913 No. 3

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  3 o’clock

(Speaker Continuing)

[Deputy Eamon Ryan: Information on Eamon Ryan Zoom on Eamon Ryan] The Minister should push preventive medicine, the use of information and communications technology, residential care and community design systems. I do not see this being done and it is the Minister's job to change it.

Minister of State at the Department of Health (Deputy Finian McGrath): Information on Finian McGrath Zoom on Finian McGrath I welcome the opportunity to speak on the Revised Estimate with reference to disability services in this important debate. I listened with great interest to the views and concerns expressed by Deputy Stephen S. Donnelly. Ministers had an important meeting on the health service this morning, at which we addressed the issues of accountability and proper management in the health service. We are listening to Deputies' views and pushing the accountability agenda. I am specifically demanding investment in disability services, reform and accountability. My aim is to empower people with disabilities to live independent lives, provide them with greater independence in accessing the services they choose and enhance their ability to tailor the supports they require to meet their needs and plan their lives. In this context, I am particularly pleased that the €30 million in additional funding secured last week will support the programme for Government commitment to ensure all 18 year old school leavers with disabilities will have access to supports and services which meet their needs at this crucial point in their lives. Service providers must also be able to respond effectively and sensitively when people experience crises in their lives and require immediate support. The additional funding secured will also cover costs incurred in meeting compliance with national residential standards, services provided to meet the changing needs of people with disabilities and emergency residential places already provided. It is important to get that message across.

Deputies should note that funding of €1.56 billion was allocated by the Health Service Executive for disability services in the national service plan 2016. Together with the additional €31 million I managed to secure last week, the total allocation for disability services now stands at €1.59 billion. We must ensure these services are managed efficiently and properly. Investment will be made; reform will be introduced and accountability achieved.

Minister of State at the Department of Health (Deputy Helen McEntee): Information on Helen McEntee Zoom on Helen McEntee I thank my colleague, the Minister for Health, Deputy Simon Harris, for his commitment to the health budget, as is clear from this discussion. In particular, I welcome the additional funding provided for home care services. In recent weeks I have engaged with numerous advocacy groups, officials from the Department of Health and the Health Service Executive and, most importantly, individuals who use home care services. Older people have consistently stated they want to stay in their homes and communities for as long as possible. Home care services are key to achieving this objective. In 2016 the HSE has a core provision of €324 million for home care services. Notwithstanding the significant improvements in the overall economic position, pressures continue to apply and demand for home care services is rising with an ageing and growing population. People want to be supported at home rather than in hospitals or nursing homes.

Without a shadow of doubt, home care services need more resources than are available. For this reason, the programme for Government commits to increasing funding for home care packages and home helps year on year in the coming period. Of the additional funding of €40 million provided for this area, €20 million will be allocated to ensure the services provided in 2015 are maintained; €10 million will be used to ensure the rate of service allocation can be maintained during the summer months, while €10 million has been ring-fenced for home care services as part of the new winter initiative. While there is always scope to do more, Deputies will agree that this is a step in the right direction.

Long-term care is one of the most challenging issues facing older people. Many reports, reviews and other documents have been written in the past 20 years, all of which ask the same question, namely, "How can we make Ireland a great place for older people to live in?" For the most part, the answer is the same - older people will live longer, healthier and happier lives if they live in a family or home setting.

As Deputy Michael Harty correctly stated, we need to change the current approach and move away from secondary to primary care services. It is my intention to set out a clear plan for how we can progress that vision.

As the Minister of State with responsibility for mental health services, I welcome the reinstatement of €12 million to the development budget. Just this week, I conveyed sanction to the HSE for the spending of €18 million in 2016. In addition, sanction has been given to spend €4 million, on a once-off basis, on minor capital works. A further €6.55 million will be spent in significant service areas, including in providing additional bed capacity, peer support services, to meet the additional cost of private placement of complex cases and additional posts to provide for improved patient safety in certain areas. Some €11.37 million will be spent on new developments outlined in the HSE national service plan. These include the development of early intervention and counselling services in primary care, further expansion of Jigsaw services in three cities, opening new acute care units and high-observation units and the provision of funding for the child and adolescent eating disorder service, the homeless and the mentally ill. A sum of €80,000 will be spent in meeting other commitments commenced in previous years. I am engaged in discussions with the Health Service Executive and other Departments on the figure of €12 million and will revert to Deputies on the matter as soon as possible.

Deputy Jackie Cahill: Information on Jackie Cahill Zoom on Jackie Cahill I wish the new Minister and Ministers of State the best of luck in their portfolios. I welcome the allocation of an extra €500 million for health services.

  As a representative of County Tipperary which no longer has a Government Deputy or Senator, I will focus on the lack of mental health facilities in the county. With a population of 160,000, County Tipperary does not have psychiatric beds, while the clinic in Thurles is under-resourced. For example, it does not have an occupational therapist; a psychiatric counselling service is not available and it is only open from 9 a.m. to 5 p.m. five days each week. This means that people from the north of the county must travel to Ennis to avail of care, while people living in the south must travel to Kilkenny. This issue must be addressed and I look forward to the Government making proposals in that regard.

  The Minister did not provide detail on how much funding is being provided for home care services and home care packages. Two completely different policies on managing home help hours are applied in north and south Tipperary, respectively. The service in south Tipperary uses its entire allocation of hours with HSE staff and thereafter employs agencies, whereas the service in north Tipperary uses a combination of HSE staff and agencies throughout the year. A consistent approach is required because the use of different approaches in the same county is preventing the system from operating efficiently. In any case, the service requires more funding if an adequate service is to be provided for those who need it most.

  The HSE practice of offering home help hours in half-hour segments must be addressed as it is not an efficient use of resources. It is certainly not satisfactory for the service user and employees of the service.

  I would like to know if any of the additional funding will be used to tackle the ever-increasing numbers on waiting lists. The numbers on the inpatient and day case lists have increased by almost 50% in the past two years. Figures for May this year show that 509,994 patients are either waiting for an operation or an outpatient appointment. The number waiting for an outpatient appointment has increased from 407,257 to 415,584 in the space of one month, while more than 62,000 of these individuals have been waiting for more than one year. In addition, the backlog of patients who need surgery increased from 74,274 to 74,986, having stood at 50,000 in 2014. This is an increase of approximately 50%. Last year’s targets are being missed, with more than 5,000 waiting for surgery for more than 15 months in May. This is a significant jump when one compares it with the figure of 4,603 who were enduring the same delay in April.

  The figures also show that the number waiting in excess of 18 months for an outpatient appointment to see a specialist increased from 8,570 in April to 13,095 in May. Of those waiting for surgery, 4,704 are children, 58 of whom have been waiting for more than a year and a half. More than 60,000 people, including more than 4,500 children, have been waiting for more than one year for an outpatient appointment.

  As a first-time Deputy, I find that the annual merry-go-round of health budget overruns followed by the introduction of a Revised Estimate smacks of poor planning. It appears that the HSE runs the service until its budget runs out before being bailed out by the Government. Surely a budget should be presented for a 12-month period. In every year since 2011 the HSE has required a substantial supplementary budget. Given the ad hoc approach to health planning and changing demographics, does the Minister agree that we are storing up major problems for the future? The population grew by 23% in the past 15 years and is set to grow by a further 30% in the next 25.


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