Written Answers. - Hospital Services.
Bernard J. Durkan
Question:
67
Mr. Durkan
asked the
Minister for Health and Children
the extent to which hospital staffing at all levels is adequate to meet requirements now and in the future; and if he will make a statement on the matter.
[22591/03]
There are a number of important initiatives currently under way to meet the human resource needs of the health services. The implementation of these developments will make an important contribution to strengthening the capacity of the health services to recruit and retain the high calibre professionals required in all disciplines to fill challenging and demanding roles central to the delivery of quality health and social care services to the public. Before setting out these initiatives in detail, it is important to emphasise that staffing requirements overall must be viewed in the context of the very substantial increases in employment levels achieved in the health services over the past several years.
The chief executive officer of each individual health board has responsibility for the management of the workforce, including the appropriate staffing mix and the precise grades of staff employed within that board, in line with service plan priorities, subject to overall employment levels remaining within the authorised ceiling. The Deputy may wish to note that there were a total of 95,679 persons in wholetime equivalent (WTE) terms recorded in the annual health service personnel census at end-2002. This is an increase of nearly 28,000 staff or almost 41% since 1997, bringing the current authorised employment ceiling to 96,000 in 2002 (excluding home helps).
The Deputy may wish to note that comparing employment levels at end-2002 to those five years previously, there are 22% (+6,049) more nurses, 36% more medical/dental personnel (+1,799) and over double the amount of health and social care professionals (+6,608) employed in the health services.
This is a considerable achievement which reflects the success of the steps taken to increase the attractiveness of employment in the health services and also the ongoing measures being taken in areas experiencing shortages of fully trained and qualified staff.
Developments such as pay increases, improvements in career structure and enhanced opportunities for professional and career development have all played a part in increasing staffing levels. The implementation of the pay recommendations of the public service benchmarking body will make a further contribution to recruitment and improved retention. Overseas recruitment by health agencies has, over recent years, also contributed significantly to meeting the workforce needs of the health services, particularly in professions where qualified staff are scarce.
The Health Service Employers Agency (HSEA) undertakes quarterly surveys of nursing vacancies, the latest of which is for the year ending 30 June 2003.
The main points of the survey are: there were 1,224 extra nurses employed in the health service in the year ending 30 June 2003; 931 nurses were recruited from abroad in the year ending 30 June 2003; 294 nurses work every day in the hospitals as agency nurses; the vacancy rate now stands at 2.75% nationally.
Last year, 1,640 nursing training places are available, 58% higher than the number available in 1998. In addition, there are now in excess of 800 places available on specialist postgraduate courses including accident and emergency, coronary care and oncology. A comprehensive package of incentives, including payment of fees and other financial supports, are available to nurses undertaking these courses. It is clear from these figures that the recruitment and retention measures I introduced are proving to be very effective.
The latest survey of numbers from the Health Services Employers Agency (HSEA) show that, out of a total complement of 3,974 filled non-consultant hospital doctor posts as at 30 September 2003, there are 21 vacancies, giving a vacancy rate of just 0.53%. These statistics clearly show that we have the lowest vacancy rate ever among the NCHD cohort this year. Comhairle na nOspidéal is the statutory body set up under the Health Act 1970 to regulate the number and type of appointments of hospital consultants in the Irish public health service. According to Comhairle na nOspidéal, in September 2003 the number of approved permanent hospital consultant posts in the public sector was 1,792, an increase of 61 posts since 1 January 2003.
There has been a significant reduction in the number of adults waiting longest for in-patient treatment. The total number of children waiting for more than six months for in-patient treatment in the nine target specialties has fallen by 56% in the period June 2002 to March 2003. The total number of adults waiting more than 12 months for in-patient treatment in the nine target specialties has fallen by 35% in the same period.
The national treatment purchase fund is used for the purpose of treating public patients who have been waiting longest for treatment. To date, more than 7,200 patients have received treatment under the NTPF. The fund has identified capacity to treat up to 800 patients per month predominantly in Ireland and in four hospitals in the UK. The NTPF will continue to identify capacity to treat those public patients who have been waiting longest for treatment. Some €31 million has been made available to the NTPF in 2003.
In-patient and day-case discharges from acute hospitals amounted to 958,000 (provisional) in 2002. This figure represents approximately 2,600 patients per day being discharged for each day of the year and is an overall increase of more than 4% on the number of discharges in 2001. There was an increase of over 12% in the number of day cases between 2001 and 2002. It is expected that about 1 million in-patients and day cases will be treated this year in acute hospitals.
I have announced a €40 million investment package aimed at alleviating service pressures and maintaining services to patients, particularly in the acute hospital sector, over the winter period 2000/2001. The investment package was targeted at a number of areas, including the recruitment of additional accident and emergency consultants and consultant anaesthetists. To date, an additional 20 accident and emergency consultants and 18 consultant anaesthetists have been appointed under this initiative. Additional appointments are being progressed by the health boards and the ERHA.
The Health Service Employers Agency engaged consultants to conduct a staffing review of accident and emergency hospital units, focussing on nursing resources. My officials and nursing unions received copies of the draft final report on 7 October 2003 and are currently studying its contents. The consultants will make a presentation on their findings in the near future to key people involved in the provision of accident and emergency services. It is expected that the staffing review will be discussed at the next meeting of the accident and emergency forum in December.
On 18 June this year, the Government announced the most extensive reform programme for the health system in over 30 years. The programme's focus is improved patient care, better value for taxpayers' money and improved health care management. The reform programme includes measures which will impact on every element of the health system and work has been ongoing in recent months to plan in detail, in conjunction with widespread consultation, the programme of change envisaged. The report of the National Task Force on Medical Staffing (Hanly report), which has been completed and is due to be launched shortly, will also make an important contribution to planning how the health services should provide a high-quality, consultant-provided service. The task force has set out a series of principles for the organisation and delivery of hospital services nationally while making detailed recommendations regarding the organisation of acute hospital services in two regions. This will harness the strengths of all hospitals so that they can best meet the needs of patients. The task force proposes that while emergency care must be concentrated in major hospitals, reorganisation of hospital medical staffing and acute hospital services offers the potential for a wider range of safe, effective and high-quality care to be offered in smaller or local hospitals.
It is anticipated that these will provide an increasing volume of elective procedures and the kind of multi-specialist day and out-patient care that is currently performed in larger hospitals. These services would give people local access to a wider range of hospital services and, where needed, allow them to recuperate much nearer home. The core of their services would include minor injury and illness units, high quality diagnostic services, outpatient clinics, day procedures, pre and post-natal maternity services, intermediate care and rehabilitation and convalescence beds.
I am also conscious that, in view of the large numbers of staff employed and the unique nature of the services being delivered, it is imperative that a coherent, strategic approach to workforce and human resource planning be developed further and aligned closely with strategic objectives and the service planning process. Planning for the development of new and existing services in the future must be soundly based on a robust and realistic assessment of the skill and human resource needs to deliver these services. The issue of skill mix is also of paramount importance in meeting human resource needs. Enhanced skills mix by matching skills to service needs benefits patients and empowers health personnel to reach their full potential and optimise their contribution to quality care.
I am, however, well aware that, in addition to effective planning to ensure the continued availability of a qualified, competent workforce, it is also necessary for the health service to become an employer of choice to further improve potential for recruitment and retention. While the record number of staff recruited into the health service in the past number of years shows the progress that has been made in this regard, even more can be achieved. Having recruited and developed such a large number of staff over recent years, it is a priority to retain them by offering a challenging and rewarding career path. In the human capital and skills intensive health sector, retention has been identified as a key issue in better people management. The implementation of the action plan for people management has a crucial role to play in improving retention and reducing turnover of skilled staff, while providing the opportunity for each member of the workforce in the health sector, to maximise their contribution to the creation of a quality and pati ent-centred health service in line with the objectives of the health strategy.
Joan Burton
Question:
68
Ms Burton
asked the
Minister for Health and Children
if his attention has been drawn to the serious concerns expressed by staff at Peamount Hospital at the decision to relocate tuberculosis care from the hospital; the consultation which has taken place between the hospital and the ERHA and his Department on this matter; and if he will make a statement on the matter.
[22539/03]
The 1996 report of the working party on Tuberculosis made recommendations on which my Department's TB strategy for the prevention and treatment of the disease is based. The recommendations covered a range of issues including epidemiology, surveillance, screening, preventative therapy, clinical management and laboratory diagnosis. Arising from the report, the National Tuberculosis Committee was established to advise on a detailed national strategy for the control and management of tuberculosis. The committee meets when necessary to review all issues concerning the control and management of tuberculosis.
Data provided by the National Disease Surveillance Centre in relation to the number of cases of tuberculosis in Ireland from 1992 to 2002, inclusive, are as follows:
|
1992
|
1993
|
1994
|
1995
|
1996
|
1997
|
1998
|
1999
|
2000
|
2001
|
2002
|
|
ERHA
|
201
|
148
|
167
|
154
|
113
|
128
|
152
|
180
|
143
|
173
|
156
|
|
MHB
|
38
|
22
|
30
|
18
|
17
|
19
|
10
|
15
|
16
|
7
|
18
|
|
MWHB
|
65
|
50
|
55
|
48
|
56
|
40
|
47
|
54
|
47
|
24
|
26
|
|
NEHB
|
30
|
30
|
35
|
26
|
37
|
28
|
29
|
25
|
21
|
38
|
24
|
|
NWHB
|
33
|
78
|
19
|
24
|
15
|
22
|
19
|
19
|
9
|
13
|
12
|
|
SEHB
|
47
|
64
|
43
|
37
|
27
|
50
|
35
|
31
|
41
|
17
|
52
|
|
SHB
|
114
|
127
|
95
|
112
|
123
|
90
|
78
|
75
|
80
|
72
|
79
|
|
WHB
|
76
|
79
|
80
|
39
|
46
|
39
|
54
|
70
|
38
|
34
|
33
|
|
Total
|
604
|
598
|
524
|
458
|
434
|
416
|
424
|
469
|
395
|
378
|
400
|
*Data for 2002 are provisional.
The TB incidence rate for 2002 was 10.2 per 100,000, as compared to an incidence rate of 17.1 per 100,000 in 1992.
Responsibility for the provision of health services at Peamount Hospital rests with the Eastern Regional Health Authority (ERHA).
In July 2000, Comhairle na nOspidéal made a number of recommendations on the future organisation and delivery of respiratory and tuberculosis services. Comhairle recognised the valuable role which Peamount Hospital has played for many years. However, in line with major advances in medical treatment, it recommended that the optimal in-patient care of patients with respiratory diseases, including tuberculosis, is more appropriate to local acute general hospitals, staffed by consultant respiratory physicians and other consultants supported by an array of investigative facilities. Peamount Hospital was not regarded by Comhairle na nOspidéal as an appropriate location for the treatment of TB patients, especially those requiring ventilation and specialised treatment for other symptoms (heart disease, HIV, etc.) who may present with TB.
Comhairle na nOspidéal subsequently appointed a committee to advance the implementation of the 2000 report. The report of this committee, which endorsed the recommendations in the earlier Comhairle report, was adopted by Comhairle in April 2003. Specifically the committee recommended that Peamount Hospital play an active role in the provision of a range of non-acute support services, including pulmonary rehabilitation, within the South-Western Area Health Board. For example, it recommends that patients who have been treated in the nearby St. James's Hospital and other major acute hospitals, and who require on-going rehabilitative care, could be transferred to Peamount Hospital for completion of their care.
My Department is advised by the ERHA that, in addition to the Comhairle advice on this issue, the board of Peamount Hospital has developed a strategic plan for the development of the hospital over the next five years. The hospital employed external support to assist them in this process and advise of developments in the wider health care environment. My Department has received representations from and on behalf of staff at Peamount Hospital arising from this review of services. The strategy adopted by the board proposes considerable enhancement of existing services and development of new services in the areas of rehabilitation and continuing care of older people, persons with intellectual disabilities and adults with neurological or pulmonary illness. The implications for the acute respiratory services currently provided at the hospital are being assessed, following which it is understood there will be further consultation with a range of relevant parties. The authority will participate fully in this process to ensure that the interests of, and potential benefits to, patients of the region are fully realised.
