New medical cards, Accident and Emergency improvements and disability services priorities in €11bn health vote
Tánaiste and Minister for Health and Children, Mary Harney, T.D. announces Health Estimate 2005
The Tánaiste and Minister for Health and Children, Mary Harney T.D., today set out her priorities for new health initiatives in 2005. These include
- 230,000 more people having access to free GP services, with new medical cards and a new ‘doctor visit’ medical card. 1.38 million people will now have access to free GP care.
- 10 wide ranging actions to improve Accident and Emergency services, including fully staffed Acute Medical Units in major hospitals.
- new services for people with disabilities delivered by over 1,000 new frontline professionals to begin implementation of the Disability Bill.
Total current spending on health is rising by €950m to €10.5bn, an increase of 9.9 per cent.
In addition to these three priorities
- all new units in hospitals will be opened with current funding of €50m
- waiting times for patients will be reduced further by €20m additional funding for the National Treatment Purchase Fund.
- cancer services will continue to be expanded.
The Tánaiste said, ‘We have to prioritise if we are to get results. This year’s health estimate was drawn up with clear priorities that will make a real difference in people’s experience of health care.
‘I want to use resources to benefit as many people on lower incomes as possible. Parents on low incomes should not have to worry about the cost of bringing their child to a doctor. These new measures will take away that worry for many thousands of parents.
‘Our medical card initiative will enable up to 230,000 additional people from lower income households to go to their GP, free of charge. People will be able to get the advice and reassurance they need from their GP and, in many cases, no additional costs will arise.
‘I also want parents of children with illnesses that persist from year to year to be assured that they will not have reapply for a medical card each year and to go through the anxiety of wondering if their medical card will continue.’
Accident and Emergency
‘Our ten Accident and Emergency actions will help patients and their families well beyond the Accident and Emergency departments. Many of these action will help older people particularly. Patients will be assisted into nursing homes or home care settings; they will be seen in new Acute Medical Units; they will be able to see a GP out of hours; and they will get their tests faster.
‘In order to keep the focus on results, I intend to appoint one person to lead the implementation of these actions which involve a lot of people working together across our services.
People with Disabilities
‘People with disabilities will receive new services from more than 1,000 new frontline staff to be recruited next year.
‘We are setting a new high water mark of over €2 billion from the health vote to fund services for people with disabilities. Additional current funding is €205 million, an increase of more than 10 per cent. This will be used for services covering intellectual disability, physical and sensory disability and mental health.
‘The government is determined to make good our commitment to bring disability services to a new level through the Disability Bill. This is an important start. The full programme will become clear on Budget day, when capital funding is included.’
National Treatment Purchase Fund
‘The National Treatment Purchase Fund has been very successful in reducing waiting times for patients. I am confident that with a total budget of €64 million next year, patients will wait for shorter times for their operations.
Top political commitment
‘Overall, 300 new beds will be available next year in public hospitals, in addition to those that will be opened in new Acute Medical Units.
‘I want to encourage the maximum involvement of the private sector in providing healthcare in Ireland, both on the capital and services side.
‘The Government is giving a top priority to health by allocating €11 billion to health next year. This is an increase of 9.9 per cent in current spending on health. The full amount of capital investment will be finalised in the Budget.
‘This is a very substantial commitment within a prudent economic and budgetary strategy.
‘We are going to make this funding work for more and better services. And we can only do that by matching substantial new funding with a fast pace of reform.
‘With the Estimates now agreed and published, I will be bringing forward the reforms we need to make this funding work best for patients.’
Appendix 1: Medical Cards Extension
The government believes people should not be discouraged from visiting their GP, or especially from bringing their children to the GP, because of cost.
The Tánaiste has designed this initiative with two elements:
- First, increasing the medical card income guidelines in order to increase the numbers becoming eligible for medical cards, and
- Second, providing free access to GP services to individuals and families who would be above the revised medical card income guidelines.
1. New medical card income guidelines
The general income guidelines for current medical cards will be increased by 7.5 per cent. The new income guidelines will become effective from 1 January, 2005.
Additionally, in order to help low income families with children particularly, the income allowance for each of the first two children will be increased by 20 per cent and the allowance for the third and subsequent children will be increased by 30 per cent.
This is a new, and higher, income disregard for third and subsequent children.
In this way, the government is giving particular emphasis to helping parents and children to access primary care.
The costs of rent / mortgages and travel to work over 26 and 23 per week are exempted from calculation of means. This means that the effective income limits are higher than the nominal limits for anyone paying rent or work-related travel costs.
Based on the best available calculations of incomes, it is expected that these changes will result in approximately 30,000 new people becoming eligible for medical cards.
2. ‘Doctor visit’ Cards
In addition to increasing the existing medical card income limits, the government will also provide free access to GP services for people whose income is 25 per cent over the new guidelines. In effect, this is a 34.5 per cent increase over the existing medical card guidelines.
It is estimated that this policy initiative will result in approximately 200,000 people becoming eligible for free doctor visits.
This will help overcoming barriers to accessing GP services for many individuals and families who will be above the new medical card income guidelines. The proposal will enable people to access through their GP a range of medical services in the public hospital system at no cost.
These two initiatives combined will also assist in removing poverty traps and disincentives to people taking up work or progressing to better paying work.
In order to give effect to this initiative, new legislation will be necessary. Proposals for the necessary enabling legislation will be brought forward in the coming weeks. This initiative will come into effect as soon as possible in 2005.
The calculations of the numbers of new people to become eligible are estimates. There is a some margin of error within them in terms of actual incomes. If incomes rise higher than expected next year, some people will cease to become eligible for medical cards. If incomes increase less than anticipated, more people than expected will become eligible.
The government’s policy remains, therefore, as stated in the Programme for Government, to extend eligibility for medical cards, rather than to achieve coverage of a certain percentage of the population or to issue a specific number of medical cards.
In regard to prescriptions, the Drugs Payment Scheme will continue to protect people from excessive costs.
The health board CEOs have, in the past, exercised discretionary powers in granting medical cards to those in special need where the income guidelines have been exceeded. About 70,000 cards are provided in this way. The Tánaiste will be asking the incoming Health Service Executive to draw up a transparent policy governing discretionary medical cards.
The practice of ensuring that no one is disadvantaged by virtue of social welfare increases in retaining or applying for a medical card will also continue.
Parents of children with chronic illnesses will no longer be required to re-apply each year for a medical card.
Appendix 2: 10 actions to improve Accident and Emergency services
The problems of Accident and Emergency are problems of the whole health service. These 10 actions are designed as a package to take a “whole system” approach to improving patients’ experience of healthcare and particularly of Accident and Emergency.
They will be funded by €70 million in new current expenditure. Some of the actions are aimed at minimising the need for people to go to Accident and Emergency. Others are designed to free up beds in hospital for people awaiting admission:
- The development and expansion of minor injury units, chest pain clinics and respiratory clinics in hospitals to relieve pressure on Accident and Emergency departments.
- The provision of a second MRI at Beaumont Hospital
- The provision of acute medical units for non-surgical patients at Tallaght, St. Vincent’s and Beaumont Hospitals.
- The transfer of 100 high dependency patients to suitable private nursing home care. The scope for using greater numbers of private nursing home beds to alleviate pressure on acute hospitals will also be actively pursued
- Negotiation with the private sector to meet the needs of 500 people annually for intermediate care of up to six weeks. These are older people who are awaiting discharge to nursing home care or back to their own home with appropriate supports.
- Expanded home care packages to support 500 additional older people at home.
- Provision of more out of hours GP services in order to keep people’s need to attend Accident and Emergency to a minimum.
- Dedicated cleaning services and security measures for Accident and Emergency departments.
- The further expansion of palliative care facilities.
- Measures to enhance direct access for GPs to diagnostic services
In addition, hospitals will be requested to prioritise the delivery of Accident and Emergency services and to prioritise Accident and Emergency admissions. Each hospital will be required to undertake a detailed analysis of their patient flows in order to identify patient profiles, bottlenecks and improved ways of treating patients.
The Tánaiste also intends asking the incoming National Hospitals Office and individual hospitals to review the management and delivery of emergency services at hospital level to ensure that services are effectively managed and delivered.
‘I want to underline that the availability of any additional resources to a hospital will be dependant on that hospital showing its ability to rise to the challenge of addressing patient needs in a timely and efficient manner.’
Appendix 3: Disability services
€205 million to set new high water mark of €2 billion
A total of €205m in additional current funding will enhance services for people with disabilities next year. This includes increases for new service development and pay.
Services for people with Intellectual Disability and those with Autism
An additional sum of €40m is being allocated to services to Persons with Intellectual Disability and those with Autism In 2005.
This new funding will –
- provide 270 additional residential places;
- put in place approximately 90 extra respite places;
- provide around 400 new day places;
- improve specialist support services for people with major challenging behaviour;
- provide €2m to meet costs associated with moving individuals to more appropriate placements.
Services for Persons with Physical or Sensory Disabilities
An additional sum of €15m is being allocated to provide:
- About 60 new places for people with significant disabilities who are currently placed in inappropriate settings;
- About 200,000 extra hours of home support and personal assistance in line with the current philosophy of independent living for people with disabilities;
- Additional funding of €3m for aids and appliances;
- Approximately 90 extra rehabilitative training places;
- Additional funding to voluntary organisations.
Mental Health Services
An additional sum of €15m is being allocated to:
- provide and staff an additional 14 beds at the Central Mental Hospital;
- further develop child and adolescent treatment services
- expand community-based adult mental health teams;
- provide additional community residential places;
- open new mental health facilities;
- support voluntary organisations.
Appendix 4: Additional provisions in the 2005 Estimate
New hospital units
€50 million has been provided for the commissioning of a number of new units in acute and non acute facilities throughout the country which have been funded under the National Development Plan. These units set out in an attached list.
National Treatment Purchase Fund
An additional €20 million is being provided for the National Treatment Purchase Fund. This will bring the total available to the Fund in 2005 to €64 million. To date, the Fund has facilitated the treatment of 21,000 patients and waiting times have been reduced greatly. The additional funding will allow the Fund to arrange treatment for 17,000 patients in 2005, which is 30% above the estimated figure for 2004. The primary focus of the Fund is to arrange treatment for those waiting longest and to reduce waiting lists and waiting times for in-patient and day case treatments in acute hospitals.
The Fund, in cooperation with hospital authorities, is reviewing its information system requirements in order to allow earlier identification of patients eligible to be treated under its auspices.
The Tánaiste also intends to meet with the Chairperson of the NTPF and Department officials to examine any potential for well-defined and practicable initiatives by the Fund to address the longest waiting times for outpatient appointments in certain disciplines.
In addition to the increase in the number of Medical Cards, referred to above, further funding of €142 million is being made available to meet the increased cost of the GMS. This represents an increase of 12 per cent.
It is, however, necessary to increase the current threshold of the Drugs Payments Scheme from €78 per month to €85 per month – a 9 per cent increase. This will yield a saving of approximately €7.5 million and will help fund the service
Mental Health Commission
The Mental Health Commission will receive an additional €10 million
Public service pay
The effects in 2005 of Sustaining Progress and Benchmarking for public servants in the health sector and a number of technical adjustments to the Health Vote. Pay costs form a very significant part of overall expenditure in a labour intensive sector like health. The pay-bill, inclusive of benchmarking, will require an additional €480 million in 2005. This figure includes Sustaining Progress in 2005 of €238 million. This additional out-lay must be seen as an investment in quality skilled personnel.
In the interests of equity, it is Government policy to gradually eliminate the effective subsidy for private stays in public hospital beds and relieve the general taxpayers of the burden of carrying these costs.
There will be an increase of 25 per cent in the charges raised by hospitals from private beds. This income goes towards supporting services in public hospitals and is part, therefore, of their budgets. It does not flow through the health vote.
Even with this increase, the cost of providing services to private patients in the major hospitals remains significantly greater than the income from the private insurance companies, in many cases. The increase being implemented is aimed at closing that gap.
There will also be an increase of €10 in the statutory in-patient bed charge for non-medical card holders, bringing it to €55 per night (to a maximum of 10 nights a year).
The combination of bed charge increases will yield about €50 million a year. The effect on the Consumer Price Index is calculated to be 0.1 per cent.
Government policy is also to encourage competition in private health insurance to increase consumer choice and to put downward pressure on prices. There are now three competing insurance companies in the market.
Accident and Emergency Charges
Accident and Emergency charges are also being increased by €10 to €55.
This increase will facilitate more appropriate attendances at Accident and Emergency units by reducing an incentive for people to attend Accident and Emergency when they might appropriately receive services from General Practitioners.
New Units 2004
|Region||Organisation Name||Description of Project|
|Eastern Regional Health Authority||James Connolly Memorial Hospital||Full commissioning new hospital incl.12 beds, 2 theatres|
|James Connolly Memorial Hospital||Acute Psychiatric Unit|
|Naas General Hospital||Full Commissioning of new hospital (including 62 beds)|
|Our Lady’s Hospital, Crumlin||Two additional operating theatres / Day unit|
|St. James’s Hospital||Full commissioning of Phase 1H New hospital (incl 62 beds, 2 theatres)|
|Midland Health Board||Midland Regional Hosp at Mullingar||12 bed assessment unit|
|Birr||Commissioning 20 additional beds in Community Nursing Unit|
|Midland Regional Hospital at Portlaoise||Acute Psychiatric Unit|
|Mid Western Health Board||Limerick Regional Hospital||Commissioning of 2 new theatres and supporting infrastructure|
|North Western Health Board||Letterkenny General Hospital||New Maternity Suite/Theatre opening phased basis|
|South Eastern Health Board||South Tipperary Hospital, Clonmel||Amalgamation of Surgical Services on Clonmel site|
|Wexford||Full Commissioning of new Day Hospital|
|Southern Health Board||Cork University Hospital||New and expanded Accident and Emergency Department|
|Cork University Hospital||Commission 2 new Linacs for Radiotherapy Unit|
|South Infirmary/Royal Victoria||Additional 17 Beds in Medical Rehabilitation Unit|
|Western Health Board||Mayo General Hospital||Full commissioning orthopaedic service|
|Mayo General Hospital||Phase II – Elderly Unit (15 Beds)|
|Portiuncula General Hospital||3 new medical beds and 2 ICU beds|
|Roscommon County Hospital||Full commissioning new Accident and Emergency +Medical Assessment Unit (9 new beds)|
|University College Hospital Galway||Orthopaedic Trauma/Intensive care|
|University College Hospital Galway||Commission new Radiotherapy Unit|