€395m to prioritise new health services for older people, people with disabilities, and in mental health
The Minister for Health and Children, Mary Harney T.D., today announced the full details of a major package of investment in key health services as part of Budget 2007.
In full year terms, the €395m additional spending will include:
- €255m for services for older people;
- €75m for services for people with disabilities;
- €25m for mental health services;
- €40m for a variety of new primary care services, including €7m for sexual assault and domestic violence services
The Minister said, “Nearly €15 billion next year will provide an enormous range of health services for the whole population.
I believe there is general support for the Government’s decisions in this Budget to give the very highest priority within that funding to services for older people, to services for people with disabilities and to those in need of mental health care.
The new funding will also facilitate some specific service developments that I have been keen to support, such as Sexual Assault Treatment Centres, including the development of a forensic nurse training programme.”
Services for older people
“Last year, we funded the largest ever expansion in services for older people with a full year cost of €150m. This year, we have gone a step further, with a full year package of €255m. In two years we have added over €400m to services for older people.
I am committed to ensuring that older people receive as much care as possible in their homes; that high standards are set and enforced in all residential care settings; and that the cost of residential care is always affordable and never an anxiety.
The Government are taking three actions this December in support of these objectives. First, we are funding a major expansion of services in the Budget package; second, we will shortly publish the Health Bill 2006 that will include a new independent, nursing home inspectorate; and third, we are bringing forward a re-organisation of the financing of long term care, which I will announce in the coming days.
The additional community based supports being provided for in this Budget include:
- 2,000 extra home care packages;
- 780,000 extra hours of home help;
- 1,100 extra day places; and
- 800 extra residential care beds.
These new services build on the successful implementation of the 2006 package. We aimed to treble home care packages to 3,000, and we exceeded that. We also delivered over 1 million additional home help hours.
I want to emphasise that these services provide real, tangible improvements in people’s lives. They get little attention, but they represent practical, immediate improvements in health care for people.
Home care packages are tailored to each person’s individual needs. They are a key part of supporting people with moderate dependency needs in the community.”
In addition, provision will be made for a VAT exemption on private companies providing Home Care packages. (Further details: Appendix 1)
Services for people with disabilities
“The Government is again making good on its commitment to our multi-annual programme of investment in services for people with disabilities.
I am pleased to confirm that €75m is being allocated for extra residential places, respite care and day services for people with a disability and to help implement key provisions of the Disability Act.” (Further details: Appendix 2)
“In mental health services, €25m will be spent on key areas including child and adolescent psychiatry, suicide prevention and other initiatives to implement A Vision for Change.
My colleague, Minister of State Tim O’Malley will outline the detailed improvements that this funding will support.”
“We are now providing a further €20m to develop up to 100 new multidisciplinary primary care teams. This will bring the total number of such teams to 200. It shows that the Government is meeting its commitment in Towards 2016 to establish 300 Primary Care Teams by 2008; 400 by 2009; and 500 by 2011.
An additional €5m is also being provided to develop services for persons suffering from chronic diseases. This will allow for the introduction of a pilot self-care, nurse-led programme for 20,000 patients, the extension of a diabetic retinopathy screening programme to two additional regions, and implementation of recommendations by the Sudden Cardiac Death Task Force particularly in regard to first response and resuscitation training.”
Sexual Assault and Treatment Services
“There are many areas of health where prioritised and focused funding can provide real change. This year, I am very pleased to announce funding that will improve our sexual assault treatment services.
€2.5m additional funding will allow two additional sexual assault treatment units to be developed in Galway and the Midland area of the HSE. It will also support the introduction of forensic nurse training.
An additional €4.5m funding is also being provided to improve services to the victims of sexual and/or domestic violence.”
Social Inclusion Initiatives
€8 million is being provided to support improved services under the National Drugs Strategy, for people suffering from HIV/Aids and for Travellers. (Further details Appendix 3)
Appendix 1 – Services for Older People: €255m
The main features of the package are:
Community Services (€82m)
- 2,000 extra Home Care Packages, benefiting 4,000 people, at a cost of €55m
- 780,000 additional Home Help hours at a cost of €18m
- 1,100 more day places at a cost of €3.5m
- €5m for expanded palliative care services
- €0.5m for sheltered housing
- €88m for the cost of 2,300 additional public and private long-stay beds in the period 2006 to 2008. This comprises
- €28m for the full-year implementation of 1,050 beds provided in 2006;
- €32m in 2007 and €22m in 2008 for the provision of an extra 1,250 beds in 2007 and 2008; and
- €6m to strengthen nursing home inspections.
Nursing Home Subvention Scheme
- €85m to support improvements in subvention in 2007 (details to be announced later, not included in this Appendix).
Home Support and Community Based Services
Home Care Packages (€55m)
In 2006, a total of 2,000 extra Home Care Packages were provided. A similar increase in the number of packages will be provided in 2007, benefiting some 4,000 people. This is a key element in helping older people to remain in their own homes.
Home Helps (€18m)
An extra €18m will fund the cost of some 780,000 additional home help hours in 2007. A revised model of service delivery is also being implemented, involving home help organisers, public health nurses and other professional staff.
Day Care (€3.5m)
Building on the progress made in 2006, there will be a further 1,100 day places per week in day care centres. New places will be created and the opening hours of some existing places will be extended to evenings and weekends. It is important to bear in mind that a number of people can benefit from each day/respite place because each individual uses it for only part of the week.
Nursing Home Inspections (€6m)
A national standardised approach to nursing home inspections is being implemented, together with the establishment of full-time dedicated teams. There will also be training and other developmental work. To continue the work initiated in 2006 an additional €3m will be allocated in both 2007 and 2008.
Palliative Care (€5m)
The provision of an additional €5m will allow important service improvements in specialist in-patient palliative care services, home and community services, paediatric care, and database and service intelligence needs. The HSE will work with the newly established Development Committees to determine priorities and allocations.
Sheltered Housing (€0.5m)
An additional €0.5m is being allocated to progress the development of sheltered housing for older people. This is in line with the work of an interdepartmental committee on long term care.
Long-Stay Care (€88m)
While the emphasis will continue to be on providing the supports that help older people remain in their own home, additional long-stay residential places will be required in the coming years to meet the needs of an ageing population. More residential places are also planned to ensure that older people do not have to remain unnecessarily long in acute hospitals.
In 2007 the HSE plans to provide some 350 extra beds by way of contract with the private sector. Of these, 220 will be in the greater Dublin area, 100 in the south and 40 in the western region. The running costs will be €12m for the full year.
In addition, the HSE proposes to expand public capacity by some 446 beds in 2007 and a further 414 beds in 2008, i.e. a total of 860 beds. The running costs in a full year will be €42m.
This means, the HSE will provide a total of nearly 800 additional long-stay beds during 2007 – 350 private and 446 public and a further 400 beds in 2008.
The HSE contracted with the private nursing home sector to provide a total of 1,050 extra beds in 2006. These were concentrated in the areas of highest need, i.e. Dublin and the south east. A total of €28m is being allocated to cover the full-year cost in 2007 of these developments.
Appendix 2 – Services for People with a Disability: €75m
The €75m incorporates the 2007 element of the Government’s multi-annual investment programme for the National Disability Strategy which is committed to providing some €900m over the period 2005 – 2009.
The HSE has been asked to target the additional funding on the areas of greatest need so as to reduce significant regional disparities in service provision.
Intellectual Disability and Autism (€41m)
The funding will provide:
- 255 new residential places;
- 85 new respite places; and
- 535 new day service places.
A similar number of extra places were provided during 2006 as part of a programme to develop key services and meet emerging needs.
The funding includes €2.2m for the transfer of persons with an intellectual disability from settings which are inappropriate to their needs.
Physical and Sensory Disability Services (€12m)
The funding will provide:
- 80 new residential places; and
- 250,000 additional hours of personal assistance/home supports.
Disability Act and Sectoral Plan (€15m)
The Disability Act 2005 and the Education for Persons with Special Education Needs (Epsen) Act 2004 will impose important obligations on the health sector. The Department of Health and Children published its Sectoral Plan in July 2006, alongside those of five other Departments, which describes how these obligations will be met.
A total of €15m will be provided in 2007 to meet the commitments relating to children with physical, sensory and intellectual disabilities and autism. Part II of the Disability Act will commence in respect of children aged 0-5 years on 1 June 2007. This involves preparing an assessment of need and a service statement for each child, together with a formal appeals process. Establishing the statutory framework required to implement the Disability Act (e.g. Assessment Officers, Liaison Officers, complaints and redress mechanisms) will be a priority in 2007.
Core Funding Deficits (€5m)
€5m is being provided to address identified cases of core funding deficits in voluntary organisations in 2007. A total of €10m was provided for this purpose in 2006.
Rehabilitation Training (€2m)
Provision is being made for €2m for an increase in the Rehabilitation Training Capitation Rate to maintain parity with increases in FAS training rates.
An additional €25m is also being provided for mental health services. Details of the improved services which this funding will support will be provided separately by Minister of State O’Malley.
Appendix 3 – Primary Care and Social Inclusion: €40m
Primary Care Teams (€20m)
This additional €20m will support the development of a further 100 multidisciplinary primary care teams in development. This will involve the recruitment of about 300 new front-line professionals such as physiotherapists, occupational therapists and nurses who will work with GPs to meet people’s health and social care needs in the community. This is on top of the funding which was provided in 2006 and in the 2007 AEV to establish the first 100 such teams.
Chronic Diseases (€5m)
€2.5m is being provided to develop a nurse delivered self-care programme for chronic disease tailored to the patient’s particular condition. These programmes have been shown to be effective in other countries in reducing hospitalisation rates, attendance at A&E and overall to improve the quality of care for a variety of diseases as well as increasing patient satisfaction. The initial phase of the programme will be population based, involving 500,000 individuals. From this, approximately 20,000 patients will be identified, suffering from diseases including diabetes, heart failure, coronary heart disease and chronic obstructive pulmonary disease (chronic bronchitis). Preliminary work will begin in January 2007 and it is anticipated that patient recruitment will begin in September 2007.
€1m is being provided for diabetic retinopathy screening. Diabetic retinopathy is the main cause of blindness in adults. Screening can prevent eye disease and there is already an initial screening programme in the north-west region. This programme will be extended to all regions on a phased basis. In 2007, it will be extended to two new geographic areas, one rural and one urban. The funding will allow for the acquisition of the two additional sites, the provision of equipment, training and facilities and the recruitment of an ophthalmologist, ophthalmic nurse specialist and an ophthalmic technician.
€1.5m is being provided to prioritise two areas of activity:
- Implementation of the Sudden Cardiac Death Task Force Report: The priority will be to enhance the first response and resuscitation training and then to provide education and promote awareness.
- An initiative on heart failure: There is good evidence that heart failure programmes can reduce hospitalisation and improve quality of life. A current HSE audit of facilities and services indicates variation in provision. The HSE plan is to improve hospital and ambulatory care as part of a wider approach to the management of chronic disease. The HSE plan is to focus on a number of hospitals (4) and communities to initiate this work.
Sexual Assault Treatment Units (€2.5m)
The funding will allow for –
- the development of two new Sexual Assault Treatment Units (SATUs) in the Midland are of the HSE and Galway;
- the provision of adequate on-call GP services for both the existing and the new units;
- the development of a forensic nurse training programme facilitating the intake of the first group of students in 2007;
In addition, a number of measures will be taken to standardise the operation of the units across the country. The will allow for the development of standard forms, procedures, contracts and data gathering which will help towards the ongoing development of a responsive Sexual Assault Treatment Service.
Domestic Violence/Rape Crisis Centres (€4.5m)
- This funding will enable a significant increase in service levels to those who provide services to the victims of sexual and/or domestic violence.
- Many of these services are provided by NGOs, members of two networks Rape Crisis Network of Ireland (RCNI) and the National Network of Women’s Refuges and Support Services (NNWRSS).
- The extra funding will allow for a better response rate to those in crisis who contact these services seeking practical and/or emotional support.
- There has been no increase in funding to these services for the past 3 years and a number of organisations are operating with a significant shortfall in resources – this increase will allow them to address this shortfall and to plan for expanded services, in consultation with the HSE.
- Increased funding will also assist with HSE initiatives which include the improved training of GPs and other front line Health Sector staff in recognising and responding appropriately to the needs of those who present at their services who may have been subjected to sexual and/or domestic violence.
Social inclusion €8m
Specific funding has also been provided in Budget 2007 to cover a number of aspects of social inclusion.
This includes €6 million to address health-related aspects of the National Drugs Strategy:
- To continue implementation of the report on treatment services for under 18 year olds presenting with serious drug problems; this will include building up the consultant-led multidisciplinary teams in this area.
- To expand harm reduction services including needle exchange; This will help counter the incidence of HIV and Hepatitis C among intravenous drug users.
- For polydrug services including cocaine to meet changing patterns of drug use. This will enable the necessary reorientation and expansion of treatment services and the skilling up of HSE staff to meet these changing needs.
- A specific initiative for Homeless persons.
The Minister has also allocated €1 million to expand services in relation to HIV and sexually transmitted diseases, including funding to support a campaign against stigma and discrimination. This will help progress implementation of The Report of the Care and Management Sub-Committee of the National AIDS Strategy Committee (NASC) on HIV/STI services in Ireland which sets out a long term programme of expansion of services in the face of continuing incidence of HIV and rapid increases in people presenting to STI services.
€1 million has been allocated for Traveller Health including to facilitate the commencement in 2007 of the All Ireland Study on Traveller Health. The emphasis will be on implementation of the recommendations of the Traveller Health Strategy