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Dáil Debates & Questions
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23 November 2010 Dáil Debates Parliamentary Questions
DÁIL DEBATES Deputy Deirdre Clune (FG): The Acting Chairman, Deputy Kathleen Lynch, will be aware of the matter I raise as I have raised it on the Adjournment on two previous occasions in this Dáil. I also believe the Minister of State, Deputy Seán Haughey, responded on at least one of those occasions. Adults with special needs who require dental services, including routine or minor treatments such as fillings and cleaning, must have the work done under general anaesthetic. This usually requires a day procedure in hospital for which theatre space is required. In the Cork area such procedures are performed in Cork University Hospital. Following the development of a significant waiting list for dental services for adults with special needs, a new service was established in Cork in October 2009. As it amounted to only one session per month and usually involved the treatment of only one or two persons, depending on the nature of the work, the service has failed to make an impression on the waiting list in the 12 or 13 months it has been in operation. I have spoken to people who have been waiting for more than three years for services and there is still no sign they will be treated. Recently, for example, the mother of a man of 29 years contacted me because her son was waiting for treatment at Cork University Hospital. He required a filling and had a developed an abscess which could not be treated owing to another medical complication. As a result, antibiotics could not be administered and he howled in pain for more than week until some form of pain management was eventually provided. It is pathetic that individuals in this position who deserve to have a dental service provided to them are neglected in this manner. Everyone, whether a medical card holder or private patient, should be able to access routine and commonplace procedures such as fillings. The individuals in question, their families and carers are experiencing major trauma. Additional theatre space is required to reduce the waiting list for treatment. A serious attempt must be made to eliminate the backlog of more than 200 patients. Once this has been achieved, it will be possible for the service at Cork University Hospital to function as envisaged. The limited service provided at present will not make an impression on the waiting list. When I wrote to the HSE I was informed the matter could be addressed in the reconfiguration of hospital services in the HSE south area. We do not have time for long-term planning of this nature. The matter must be addressed immediately. I wrote to the director of Cork University Hospital, the centre that is failing to provide the necessary service, who indicated that the matter is one for the HSE. The individuals in question are being passed from Billy to Jack because a proper service is not being provided. The neglect of their dental heath may lead to further complications, which is a source of major frustration for parents, carers and the adults who depend on the service. I hope the Minister of State will not indicate that the issue is one to be addressed as part of a reconfiguration process and will instead outline a plan to provide some form of emergency service to accommodate the 200 or more individuals on the waiting list and relieve the awful distress they are experiencing. Deputy Seán Haughey: I thank Deputy Clune for raising this matter, to which I will respond on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. It was estimated in 2007 that 43% of special care adults required either intravenous sedation or general anaesthetics for completion of their care. Where general anaesthesia is provided, access to resources such as anaesthetists and theatre space is necessary. Some patients, especially adult patients, who are seriously medically compromised require supporting hospital services. In the HSE south area, Cork University Hospital, CUH, has been the principal provider of such services. In Waterford and Wexford, local hospitals provide these services, with only the most complex cases referred to Cork University Hospital. The service in Cork University Hospital was suspended in 2007 for safety reasons and reactivated in September 2009. There is currently a waiting list for this service of 113 patients. The current facility only has the capacity to meet the needs of the most urgent cases. Since August, the HSE has been working on a plan to prioritise and target vulnerable groups and those with intellectual disabilities. A pilot initiative has been established in the HSE south area for children and adults with intellectual disabilities who require dental services. It is expected that the outcome of this initiative will lead to a reduction of up to 50% in the current waiting lists for general anaesthetic. The initiative takes a multifaceted approach. I will outline the initial steps, the first of which is the reprioritisation of waiting lists. An audit is near completion which will provide information regarding the complexity of care that patients require. Following this, a clinical assessment will be carried out on patients. Early results indicate that the majority of patients have moderate to mild medical complexity. This means their dental care may be carried out in a district hospital setting. The second step is to take a two phased approach to treatment. This will involve providing more urgent as well as less complex care. This will mean stabilising the patients to ensure they can enter a preventative programme while awaiting treatment for any remaining oral health needs. This is to begin in January 2011. The third step is the training and up-skilling of dental staff. Training dental staff in relative analgesia and intravenous sedation will enable those patients who can be treated by other means to be removed from the general anaesthetic waiting list. The training of staff will begin in spring 2011. The HSE is also exploring the opportunities for the realignment of services in the south in order that access to other general anaesthetic facilities outside of Cork University Hospital will be available to less medically compromised patients. The impact will be immediate since patients with less complex medical histories will be removed from the Cork University Hospital waiting list. The capacity of other hospitals is currently being determined with a view to treating patients with the least complex medical needs. This will support the two phased approach. As a result, in six to nine months this approach will be used to treat approximately 40% of patients on the current general anaesthetic waiting list. I thank the Deputy again for raising this matter on the Adjournment. PARLIAMENTARY QUESTIONS Deputy Seán Barrett (FG): asked the Minister for Social Protection if he has conducted a cost benefit analysis prior to cutting the dental treatment benefit scheme; Minister for Social Protection (Deputy Éamon Ó Cuív): The current budgetary position necessitated the changes made to social welfare benefits, including the dental treatment benefit scheme, in Budget 2010. From January 2010 the treatments available have been limited to a free dental examination. Current trends in 2010 indicate that around 280,000 people will receive the free dental examination. These have been retained in order to encourage people to continue attending for checkups and help address the concerns expressed about the general dental health of the public. In addition to this, some 210,000 customers who had applied for approval to commence treatment prior to the end of 2009, either directly to the Department or through their practitioners, will receive the full range of treatments as available under the schemes prior to 1st January 2010. There is also strong evidence that increased competition in the market is having an effect on price. Shortly after the announcement of the changes to the scheme, for example, one major dental chain announced a price cut of 30%, and the Irish Dental Association (IDA) subsequently announced that its members would either freeze or reduce their prices. Indeed I understand that recently the IDA estimated that around 50% of dentists have reduced their prices during 2010. Developments such as these are to be welcomed as they will make treatment more affordable for consumers. Tax refunds are available from the Revenue Commissioners for certain kinds of more expensive dental treatments. While a full-scale cost-benefit analysis was not possible, decisions were taken with the public health in mind. Tax refunds, enhanced competition, and the retention of free examinations all mean that routine dental care should remain affordable and widely available in Ireland.
Deputy Ciarán Lynch (L): asked the Minister for Social Protection the action he is taking to address the delays on disability allowance claims; Minister for Social Protection (Deputy Éamon Ó Cuív): To be eligible for disability allowance, a claimant must (inter alia) satisfy a medical examination, a means test and be habitually resident in the state. The processing time for individual disability allowance claims may vary in accordance with their relative complexity in terms of the three main criteria listed above. Certain claims have to be referred to social welfare inspectors for means investigation and this can add to the overall processing times. In addition, factors outside the department’s control can have an impact, for example, the supply of relevant information by the customer, employers or other third parties. The volume of disability allowance claims has increased in recent years as the scheme rules changed to, for example, extend eligibility to persons in residential care and to persons aged 16-18 whose family were previously in receipt of domiciliary care allowance. The general growth in the population and the relatively beneficial terms available to disability allowance applicants, compared to other EU countries, have also had an impact on this growth. Going forward, my Department is addressing the challenge posed by this increased level of activity by deploying new computerised processing systems. In the meantime, measures taken to reduce delays in claim processing include an increase in the number of claims being desk assessed thus reducing the number of cases being referred for investigation by social welfare inspectors. Since August 2009 all claims are now being desk assessed by medical assessors to determine medical suitability, ongoing review of existing processes and procedures and the approval of overtime working. In the meantime, people who have urgent income support needs can apply for the means tested supplementary welfare allowance (SWA) from their local community welfare officer. The department is committed to delivering the best possible service to its customers. Operational processes and procedures and the organisation of work are continually reviewed in all areas of the department, including disability allowance section, to ensure that claims are processed and decided in the most efficient and expeditious way possible, having regard to the eligibility conditions that apply to each scheme. Deputy Bernard J. Durkan (FG): asked the Minister for Social Protection his plans to maintain and extend the carer’s allowance in lieu of institutional care thereby saving the State considerably. Minister for Social Protection (Deputy Éamon Ó Cuív): In considering any changes to social welfare schemes, full consideration is given to the impact of any proposals on the recipients involved. Government policy is to support older people to live in dignity and independence in their own homes and communities for as long as possible. In the case of persons being cared for at home, the care they receive is usually a balance of support from family and professional help. The Department of Social Protection provides income supports for family carers while the Department of Health and Children provides professional support. The Government is acutely aware and appreciative of the contribution made by carers. It was for that reason, that when resources were available, we invested heavily in improving social welfare rates and services for carers. Following this year’s Budget, the carer’s allowance rate for carers over 66 years of age has not changed and remains at €239. The rate of carer’s allowance for someone under 66 is €212. Since the introduction of the carer’s allowance in 1990 payments to carers have been increased and expanded. Carer’s allowance was increased in 2007, 2008 and 2009 by 12.1%, 6.5% and 3.3%, respectively. As a result, even with the reduction announced in the last Budget for carers under 66, the weekly rate of payment for the carers allowance is still almost 20% higher this year than in 2006 and more than 147% higher than in 1997. The means test for carer’s allowance has been significantly eased over the years, and is now one of the most generous means tests in the social welfare system, most notably with regard to spouse’s earnings. Since April 2008, the income disregard has been €332.50 per week for a single person and €665 per week for a couple. This means that a couple with two children can earn in the region of €37,200 and qualify for the maximum rate of carer’s allowance as well as the associated free travel and household benefits. A couple with an income in the region of €60,400 can still qualify for a minimum payment, as well as the associated free travel and household benefits package. These levels surpass the ‘Towards 2016’ commitment to ensure those on average industrial earnings continue to qualify for a full carer’s allowance. From June 2005, the annual respite care grant was extended to all carers who are providing full time care to a person who needs such care, regardless of their income. The rate of the respite care grant has also been increased to €1,700 per year in respect of each care recipient since June 2008. The professional support provided for people at home is delivered through a range of community services such as home-help, home care packages, meals-on-wheels, and day/respite care. Such supports have the added objectives of reducing inappropriate admissions by older people to acute hospital or long-term residential care. The importance attached to these services is highlighted by the fact that over €200m additional funding has been provided in recent years for these services. The HSE has responsibility for the delivery of home care services, in line with its National Service Plan 2010. This commits the Executive to provide 12 million home-help hours nationally this year to over 54,000 people. The target for 2010 for home-help hours is unchanged over the 2009 figure. In addition to the mainstream home-help provision, the current plan is designed to deliver home care packages to around 9,600 people at any one time, or to some 13,000 clients over the course of the year, and to cater for the provision of around 21,300 day/respite care places. In the period 2006 to 2008, over €425m was provided to the HSE under the National Disability Strategy Multi-Annual Investment Programme for the provision of additional specialist health and personal social services for people with a disability. In 2009, the HSE provided 3.2 million hours of personal assistant/home care services to people with a disability. In Budget 2010 additional funding of €19.5m was provided to the Executive to respond to demographic growth in demand for emergency residential placements, additional day places, and personal assistant/home support hours. The current HSE Service Plan commits the Executive to providing the same level of service as in 2009, in other words, 3.2 million hours, and an additional 140,000 hours of personal assistant/home care services for people with a disability. The Government will continue to support carers and the people they care for within the resources available. Deputy Bernard J. Durkan (FG): asked the Minister for Social Protection the steps he proposes to take to eliminate the backlog of appeals for various payments operated by his Department; Minister for Social Protection (Deputy Éamon Ó Cuív): I am advised by the Social Welfare Appeals Office that, as of 15 November 2010, there were 20,344 cases being processed through various stages of the appeals system. It is not possible to give the monetary value involved in these cases. There has been a significant increase in the numbers of appeals being made to the Social Welfare Appeals Office. Currently it is anticipated that some 33,000 appeals will be received for 2010, which is compared to roughly 15,000 a year in the years up to and including 2007. The scale of the increase has resulted in significant delays in the processing of appeals. Overall, the average time taken to process a summary decision is 28 weeks, while the average time to process an oral hearing is 44.5 weeks. These processing times are calculated from the registration date of the appeal to the date of its finalisation and include all activities during this period including time spent in the Department for comments by the Deciding Officer on the grounds of appeal put forward by the appellant and any further investigation, examination or assessment by the Department’s Inspectors and Medical Assessors that is deemed necessary. A considerable period of time is added to the process when an oral hearing is required because of the logistics involved in this process. During 2009, 59% of all appeal cases were dealt with by way of oral hearing but, due to some of the initiatives outlined below, this has been reduced to 31% in 2010 to date. In order to be fair to all appellants, the vetting of appeals and the arranging of oral hearings are dealt with in chronological order. Since January 2009, 3 additional Appeals Officers have been assigned to the Office, as well as 4 additional staff to the administration area. In addition, it was decided to use experienced retired Appeals Officers strictly on a short term basis to supplement the current resources and eight of these officers have been operating on a part-time basis since July. In addition to the provision of more staff, more emphasis is now being placed on dealing with appeals on a summary basis so as to increase productivity, a project to improve the business processes in the office was undertaken which has resulted in a number of improvements being implemented and significant enhancements have been made to the office’s IT and phone systems. As a result of all of these initiatives, a total of 22,995 appeals have been finalised until the end of October in comparison to 14,278 in the same period in 2009. I am assured by the Chief Appeals Officer that she is keeping current processes under continuous review with a view to achieving a more effective throughput of appeals, while ensuring that any progress does not conflict with due process in terms of the rights of appellants and adherence to the requirements of natural justice.
Deputy Seán Barrett (FG): asked the Minister for Community, Equality and Gaeltacht Affairs when he will be signing the UN Convention on the Rights of People with Disabilities; Minister of State at the Department of Community; Equality and Gaeltacht Affairs (Deputy John Moloney): Ireland was in the first group of countries to sign, subject to ratification, theUN Convention of the Rights of People with Disabilities when it opened for signature on 30March 2007.It is the Government’s intention to ratify the Convention as quickly as possible, taking intoaccount the need to ensure that all necessary legislative and administrative requirements underthe Convention are being met. Ireland does not tend to become party to treaties until it is firstin a position to comply with the obligations imposed by the treaty in question, including byamending domestic law as necessary.The ongoing implementation of our National Disability Strategy in many respects comprehendsmany of the provisions of the Convention. In addition, the Inter-Departmental Committeeon the UNCRPD monitors the remaining legislative and administrative actions required toenable the State to ratify the Convention. The Committee has developed a programme onwhich work is progressing to address the matters that need to be aligned with the UNCRPD.One of the key requirements in this regard is mental capacity legislation, which is the responsibilityof the Department of Justice and Law Reform. As indicated in the Government’s LegislationProgramme, it is intended that the Mental Capacity Bill will be published in the currentDáil session. The passage of this Bill will add substantially to the overall progress on implementationof the requirements towards ratification of the Convention. Deputy James Bannon (FG): asked the Minister for Community, Equality and Gaeltacht Affairs if he will appoint an ombudsman for persons with disabilities to ensure that those in need of assistance will be able to avail of same; Minister of State at the Department of Community; Equality and Gaeltacht Affairs (Deputy John Moloney): The Government has no plans to appoint an ombudsman for persons withdisabilities at this time. It is considered that existing mechanisms for investigation of complaintsin relation to the provision of public service to people with disabilities are operating effectively.The ombudsmans have ample existing powers to review cases of dissatisfaction brought forwardby individual clients of disability services. The National Disability Authority also has animportant role in the provision of independent expert advice to the Government, in enhancingaccess to services including any complaints processes already in place. In addition, the Equality Tribunal is a forum where complaints under equality legislation in respect of both the publicand private sectors may be lodged and the Equality Authority is available for advice andpossible legal assistance in relation to such complaints.
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Inclusion
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