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 Header Item Ceisteanna - Questions
 Header Item Priority Questions
 Header Item Departmental Budgets
 Header Item Home Help Service Provision

Wednesday, 19 December 2012

Dáil Éireann Debate
Vol. 787 No. 4

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Ceisteanna - Questions

Priority Questions

Departmental Budgets

 1. Deputy Billy Kelleher Information on Billy Kelleher Zoom on Billy Kelleher asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the way he will achieve €780 million in savings in the health budget in 2013; and if he will make a statement on the matter. [57231/12]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly In the region of €500 million of these savings will be achieved through cost efficiencies and separately through reorganisation under the public service agreement. The majority of savings will have no recourse to front-line activity. However, 2013 will be a challenging year and will require taking a number of tough measures to ensure the most vulnerable are protected.

The following is a summary of measures to be taken by the health group of Votes in order to adhere to the 2013 expenditure ceiling. There will be a reduction in the cost of drugs and other prescribed items, saving €160 million; an increase of the drugs payment scheme threshold to €144 per month, saving €10 million; an increase in prescription charges for medical card holders, saving €51 million; reduced professional fees, saving €70 million; other changes to primary care schemes, saving €32 million; pay related savings of €308 million; increased generation of private income at €65 million; savings on the Department Vote of €60 million; procurement measures saving €20 million; and other measures of €5 million in savings. The total net saving is €781 million.

The Department of Health's own Vote is being reduced by €90 million, with €30 million transferring to the HSE and €60 million in savings. Even allowing for additional expenditure related to the EU Presidency, there will be a reduction in the Department's administrative budget. There will be savings with the National Treatment Purchase Fund, and €25 million of its budget will be transferred to the HSE. There will also be a range of further reductions, including reductions in funding for health agencies.

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher The Minister would forgive me for raising this question in view of the fact that we had to vote through a Supplementary Estimate last week. The Minister outlined that it was a very small percentage and that overruns are the norm for the health service because it is demand led. Nevertheless, we should set out in 2013 in a way unlike the way we set out in 2012, and there should be a path to the end of the year. We accept that the Minister is paring closer to the bone the whole time but there should at least be identifiable and realistic savings that can be achieved. If these are not achieved in the first half of the year, there is an immediate problem and rather than delaying or prevaricating, does the Minister agree that it would be timely to act? For example, there could be action on the public service agreement and cost efficiencies or pay. If there is discussion about a reduction in core areas, agreement will be required or else there will be confrontation. Has the Minister had discussions with the trade unions or others in that respect?

The Minister recently announced that graduate nurses would be taken on at 80% of the cost of the qualified nurses with whom they would work. Are we beginning to ask the generation behind us - which had no responsibility for anything - to carry the can for everybody? This is a distasteful approach that we are beginning to see evolve. Does the Minister accept that we should be clear that everybody must carry the burden? Asking graduate nurses to carry the burden is unacceptable, regardless of whether the issue is identified as a saving.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly The Deputy knows the service plan will be produced and it must come to me within 21 days of the Estimates. That means it will come to me on St. Stephen's Day, or de facto the end of this week. We have had a number of meetings about the issue, with the most recent last night. My colleagues, the Ministers of State, Deputies White and Kathleen Lynch, and I have been actively engaged in the process. As the Deputy notes, we want a very transparent methodology this year in order that we can measure what is happening.

  Last year I asked that there would be two-weekly and monthly reporting of financial parameters but that did not happen. It will happen this year. Through several reports, the latest being the Ogden report, we have also identified the deficiencies that lie within the HSE's financial reporting mechanisms. The PA Consulting report set out to confirm this and identify a remedy, which has come about. We have put in place six senior experienced individuals in the financing area, as it was shocking to tell the Dáil that only approximately 10% of people dealing with the finances of the HSE had specific financial training. Is it any wonder we find ourselves in the current position?

  I will specifically mention JobBridge for nurses, which is an excellent development that offers the opportunity for nurses who have trained here to stay here and continue training. It will also offer an opportunity to further the experience of these new nurses. I would like to see similar opportunities afforded to people who have studied physiotherapy. These people gained 550 points in the leaving certificate and have done four years in Trinity College, but many cannot find a job when they graduate and are unable to set up a practice on their own. If they could be given a couple of years experience, they would be fit to go into primary care where we need them badly.

Deputy Billy Kelleher: Information on Billy Kelleher Zoom on Billy Kelleher I hope the Minister will enjoy the reading the plan over turkey sandwiches on St. Stephen's Day. What happened last year was identifiable as early as March, April, May or June. There may have been overruns in the delivery of services but the clear failings were in the implementation of savings. That is our concern, and there are related issues of political accountability, administration and the publication of legislation by the Department of Health. We are concerned that if an issue is identified early, with a clear path laid out in the service plan, alarm bells can ring so that action can be taken. We do not want people outside Government Buildings like we had last September.

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly I agree with the Deputy. For far too long there were too many people who were quite happy to describe the problem but failed to do anything about it. Earlier this year people indicated there would be an inability to keep the budget, alluding to the two issues in particular of drugs and insurance. The insurance matter has been dealt with and the drugs issue has been dealt with comprehensively, albeit a little later than we would have liked. Even if those matters had been addressed, there would still have been a significant overrun in the general medical services and the primary care reimbursement service area. We are now moving toward further transparency and accountability, and not alone will we let people know where problems lie, but also we will indicate what will be done about them. It is not good enough for people simply to describe a problem and throw their hands in the air when they are meant to be managing it. That is what we had in the past but it will not happen in future.

With regard to labour arrangements, there have been major changes in how consultants operate. That is being bedded in at the moment. That will give a lead to the other care professionals and the changes in work practices expected to make our health service competitive, affordable and efficient, so that everybody using it can access it as required.

Home Help Service Provision

 2. Deputy Caoimhghín Ó Caoláin Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if the approximately 950,000 home help hours cut in 2012 will be fully restored; if all individual recipients of home help support who had hours cut in 2012 will have them restored immediately or early in 2013; and if he will make a statement on the matter. [57247/12]

Deputy James Reilly: Information on Dr. James Reilly Zoom on Dr. James Reilly The Minister of State, Deputy Kathleen Lynch, is currently in the Seanad dealing with equality legislation so I will take this question. The Government policy is to support older people to live in dignity and independence in their homes and communities for as long as possible. This is reflected in the HSE service plan for 2012, which includes various community-based services such as mainstream home help, enhanced home care packages, meals on wheels and day or respite care.


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