Other Questions

Ambulance Service Response Times

Denis Naughten


6. Deputy Denis Naughten asked the Minister for Health the progress that has been made in the Health Service Executive west region since the introduction of standardised ambulance response times; the steps being taken to improve ambulance response times in the region; and if he will make a statement on the matter. [53981/13]

Fewer than one in two ambulances in the west are meeting the HIQA target at the scene of a life-threatening incident. The west has the only three HSE-identified ambulance black spots in the country. It seems no provision will be made in the HSE service plan to provide manpower to address the staff shortages at those locations in the coming year.

Response times vary significantly regionally, and reliance on response times alone to measure pre-hospital emergency services is of limited value. We are, therefore, moving to complement time-based indicators with clinical outcome indicators for better assessment of modern ambulance work.

As the Deputy knows, the west is geographically challenging, with 61,500 emergency and urgent responses in Galway, Mayo and Roscommon alone in 2012. This challenge is, however, being met through staff development, fleet and control investment and resource management. Steps to improve response times include faster mobilisation, improved dispatching, better use of community responders and the roll-out of on-duty rostering in 2014.

In addition, the intermediate care service, which provides inter-hospital and retrieval services, freeing up existing emergency resources for emergency calls, is being expanded. Eight new intermediate care ambulances and over 70 staff were provided in the west and north-west in 2013. The availability of the emergency aeromedical service also frees up ambulances, with an estimated land resource gain of 560 vehicle hours and 1,100 crew hours a year. A recent review of this shows it is having a very positive effect and should be continued.

In 2014, Castlebar ambulance control will move to the national control centre at Ballyshannon, so crews can be dispatched across the region. The national ambulance service will also deliver a more dynamic service where ambulances move to different locations during a shift, based on predictive analysis of the best location at any time. This will ensure better geographical cover, response times and patient outcomes. The national ambulance service also proposes to undertake a capacity review for current and future needs in each region, including the west. This will examine areas including staff numbers, skill mix, which is very important, and resource locations, and will inform the further development of pre-hospital care in the west and across the State for the benefit of communities and patients.

I thank the Minister for his response. The review is welcome. The problem is that this is kicking the can down the road. At present, in the west, 13 ambulance shifts a month are being taken off the road because there are not the staff to man those ambulances. We have the only three HSE-identified ambulance black spots in the west at Tuam, at Mulranny and at Loughglynn, County Roscommon. We need 30 staff to man those effectively. Can the Minister indicate that those resources will be made available in 2014?

The ongoing development of the national ambulance service is providing a robust platform to continue to improve the performance against response time standards. The reality is we are looking at a very new type of service. It is not just the ambulance arriving-----

It is not arriving.

-----it is the ability of the paramedic or the first responder to arrive. In addition, the air ambulance service is a huge support for the on-ground services.

I do not have information on the figures to which the Deputy alludes.

We will investigate further and come back to him in response to the specific issue he raises about Tuam, Mulranny and the third place he mentioned.

Will the Minister look into one other matter for me? Within the past month, on one particular day, all of the Roscommon ambulances were parked outside Galway University Hospital, along with those that provide cover in Roscommon - the Ballinasloe, Castlebar and Loughrea ambulances. Every single one of them was parked outside Galway University Hospital on one day in the past month. In light of that, where stands the commitment given to the people of Roscommon at the time of the closure of the accident and emergency department that they would have adequate ambulance cover to replace that department?

I will have to check out why that would or could happen. In the past a similar situation arose in Dublin, with up to eight ambulances parked outside hospitals at a given moment with people being tended to by the paramedics and some hospital staff because there was no room in the emergency departments. Thankfully, that situation does not arise any more. I will find out why all the ambulances the Deputy mentioned could have been parked outside for a long time.

I am concerned that the geographic area is left without cover.

That would not be acceptable. We have to find out why, once the ambulances have arrived at a hospital, they are not released immediately to be available for any other emergencies that might arise. Ambulances should not be left parked outside hospitals for any length of time. That is not their purpose or function. We have the technology to forewarn and give all the clinical details over the radio before the ambulance ever hits the hospital in order that the staff at the hospital are aware of the clinical problems with which they will be presented and be in the best position to help the patient concerned.

The time has expired. We will move on to question No. 7.

Deputy Ó Caoláin should read the Standing Orders. I am applying the new Standing Orders for Question Time. Each Deputy has up to 30 seconds to introduce the question. The Minister has two minutes to respond. There is a minute for a supplementary question from the Deputy who has asked the question. The Minister replying has a minute to reply to that supplementary question. There is a further minute if the Deputy so wishes and the Minister has a minute. That is six minutes. That is the idea for trying to get through the questions. There are other people here waiting to ask questions. It is not my fault. The time is up.

Hospital Waiting Lists

Billy Kelleher


7. Deputy Billy Kelleher asked the Minister for Health the action he will take to reverse the 18.6% year-on-year increase in day case and inpatient waiting lists; and if he will make a statement on the matter. [54086/13]

What action will the Minister take to reverse the 18% increase year-on-year in inpatient waiting lists? The Minister has laid a heavy emphasis, and staked his career, on driving down waiting lists. This waiting list, however, is going in the wrong direction. What specific measures will be included in the HSE service plan, which is being announced elsewhere at the moment, to address and arrest the increase in those waiting lists?

In July 2011, when the special delivery unit, SDU, was set up, a total of 6,277 patients were waiting more than nine months for inpatient or day-case treatment. By the end of 2012, that number had been reduced by 98% for adults waiting over nine months for inpatient or day-case treatment and by 95% for children waiting over 20 weeks for such treatment. That is a fact. As an older lady said to me in my previous life as a GP, "The truth is not fragile, Doctor. It won’t break."

The early months of 2013, as anticipated, brought higher levels of emergency department admissions which, in turn, had a knock-on effect on scheduled care. However, the SDU, together with the National Treatment Purchase Fund, NTPF, and the HSE undertook a range of measures to address this, working closely with hospitals to analyse performance, to agree action plans and extra support as necessary and to ensure hospital capacity is being optimised.

Since August we have reduced the number of adults waiting over eight months by 78% from 6,800 on 22 August to 1,485 on 12 December. This represents a reduction from 13.5% to 3.2% in the total number of adults waiting for treatment. Similarly, we have reduced the numbers of children waiting over 20 weeks by 35%, from 883 to 576, in the same period. This represents 1.2% of the total number of children awaiting treatment. All hospitals have commenced necessary action plans to get as close as possible to the national wait time target of eight months by 31 December, and further decreases in the numbers waiting are anticipated before year end. The work continues even up to the end of the year, after Christmas, to ensure that those waiting for treatment get it and those who have been waiting the longest are treated first.

I accept that the truth is not fragile and will not break, but the Minister’s accountancy, logarithms and algorithms are very fragile because they simply belie the fact that there is an increase in the number of people waiting on day-case and inpatient waiting lists. Responses to recent questions that we have tabled and the publication by the NTPF of waiting lists show an increase in the number of people on waiting lists. The Minister can look at it whatever way he likes; even the number of children waiting has increased dramatically year on year. We waited months for the September figure to be published. We had to drag it out of the Department and eventually it was published. The Minister can deny for a while, but not forever, that there is an increase that has to be addressed in the context of the HSE service plan being announced elsewhere. Otherwise, people will wait longer than they already do.

The Deputy seems to be caught in the old ways of thinking. He assumes it is a simple one-and-one-is-two job.

One and one always make two.

The situation requires a change in the way we do business. If we do the same things the same way the whole time there will be no change. That is what went on for 14 years when the Deputy’s party was in government, despite its quadrupling the spend on health. With reduced funds and staff, we are making significant improvements. The Deputy is simply wrong. The fact is that the waiting lists have been reduced enormously. The Deputy chooses to compare September figures, but let us look at the end of December and we will talk about this in the new year. I do not know where he gets his 18.6% figure because it does not relate to any information I have.

Even as we speak the work is ongoing. Yes, it presents a real problem and a challenge because, unlike the Deputy, we counted the number of people awaiting an outpatient appointment and we are reducing those numbers. As a consequence we will need more inpatient treatment, which will put the pressure on, but the system is dealing with that in an equitable and fair way, looking after those who are waiting longest first, once the urgent cases and cancer cases have been dealt with.

I will give the Minister one simple statistic. In September 2013 there were 49,496 people on the inpatient and day-case list. If the Minister does the sums, as he claims to be good at doing, that is up 7,764 on the same month in 2012, which is 18.6%. There are increases in certain areas. In Our Lady's Hospital for Sick Children, Crumlin, and Children's University Hospital, Temple Street, inordinate delays are developing. That is happening as we speak. I am highlighting the issue. I am not trying to pretend I am a better mathematician than the Minister or otherwise, but the statistics and the figures do not lie and the NTPF’s published figures show an incremental increase in day case and inpatient waiting lists.

The Deputy can choose the month of September if he wishes. We are now in December. I have met Mr. Ian Carter, who is in charge of the hospitals and inpatient-----

The figures will be worse if I choose December.

I have the up-to-date figures and they are not remotely like those the Deputy talks about. There have been huge decreases in the numbers of people waiting.

When we came into power in 2011 there were tens of thousands of people waiting longer than a year. Some had waited longer than two years for treatment. We met the one-year target and the nine-month target and we will meet the eight-month target this year. We might be 1% or 2% off at the end but in the main it will be met. We have achieved that with a 20% reduction in the budget and a 10% reduction in staffing levels, as well as the doom and gloom coming from the far benches, with people saying that catastrophe will occur no matter what we do.

Thankfully, the mindset of the men and women who work in the health service is not of that nature.

Thankfully, that is the case, particularly when one considers they had to listen to doom and gloom from the Minister when he was spokesperson some years ago.

I congratulate them again and take the opportunity to wish them a happy Christmas.

Health Insurance Data

Lucinda Creighton


8. Deputy Lucinda Creighton asked the Minister for Health the policy measures he has taken to level the playing field in the health insurance market between competitors that have low levels of elderly policy holders and those that have none; and if he will make a statement on the matter. [54121/13]

The VHI has over 65% of all private health insurance policyholders between the ages of 60 and 69, 70% of all policyholders between 70 and 79 and 80% over the age of 80. What has the Minister done since coming into power in 2011 to level the playing field in this regard? What has he done to ensure all health insurers play their part in taking on older policyholders?

I thank the Deputy for her question because it is an area very much to the core of what the Government is doing in health insurance. There are three legs to this stool, namely the Department of Health, the Health Service Executive, HSE, and the private health insurers. The Deputy is correct that there is a much greater proportion of older people in the VHI. For example, Laya Healthcare has 22% of the market but only 8% of those over 70 and 80.

We have introduced the risk equalisation scheme.

Which Fine Gael opposed when it was in opposition.

There was much debate about this several weeks ago. The scheme is effective to the point that it compensates for 78% of those over the age of 70 and 85% for those over 80, rates which were 73% and 82% respectively last year. The plan is to get it to a rate of 90% in terms of its effectiveness in compensating insurers who have older people on their books.

Let us call a spade a spade. If there were great unfairness or overcompensation, we would not see the disparity between the VHI with such a high preponderance of older clients as opposed to the other players in the market. There is a concern that insurers will try to segment the market by bringing in new products. For example, VHI took off cataracts, knee and hip replacement procedures from its plan B which was aimed at dissuading older people from buying the policy. There are nearly 270 different insurance policies available which is set to confuse consumers. The Health Insurance Authority, HIA, will be beefed up considerably to deal with these issues in the market place. The risk equalisation scheme is the mechanism the Government uses to ensure a level playing field in the market.

I thank the Minister for his reply but take issue with the assertion that risk equalisation has been effective. The figures show clearly that the opposite is the case. At this stage, it has become apparent that this idea of levying and subsidising is not actually working. Has the Minister considered a proper regulatory framework which would oblige all health insurers to take a reasonable proportion of older insured patients? If he does not, there never will be a shift from the VHI.

On entering office, the Minister commissioned a study by Matheson and Goodbody into the various options for the VHI, including its break-up. Bizarrely, the chief executive of the VHI informed me at the health committee two weeks ago that he has never seen this report. Has the Minister seen the report? Members should also see this report.

There have been several reports on the VHI, many of them done by the Department’s actuarial advisers, Milliman. These are the reports the VHI and the Department would take up. I have seen the Matheson report too.

The risk equalisation scheme is working. It seeks to compensate insurers for the cost of older policyholders who tend to be sicker and use health services more. We have to be careful, however, that it does not overcompensate. That is why the rate is set and it is agreed with the European Commission that if an insurer makes profits of more 12% three years running, then it is seen as overcompensation and the moneys are taken back from them to be put into the health insurance fund. As this scheme becomes more effective, the other insurers will see it will be worth their while and profitable to take on older policyholders.

We are operating on the basis of aspiration rather than concrete or tangible evidence of risk equalisation working. The fact no consideration has been given to any alteration of the regulatory regime seems to rule out an important and relevant option. While it is some relief that the Minister has seen the Matheson report, it is bizarre that the chief effective officer of the VHI has not seen it. Will the Minister share that report with the House, so that those interested in this topic will be able to analyse some of its proposals, particularly as we move towards universal health insurance? I cannot understand why the report is suppressed.

The suggestion of forcing through regulation that a certain number of people of a particular age group must be insured would raise all sorts of problems with competition law. In any event, the carrot is always better than the stick. The VHI is positive about the risk equalisation scheme while the other insurers are negative. If they were so concerned about the tariffs applied in the scheme, then they would take on more older people. I believe they will in the future.

There is much planning ongoing on how to beef up the HIA to allow it regulate the market to reduce the number of policies available because they are just causing confusion.

People renewing their insurance should visit the website www.hia.ie which has good comparative information available on what are the best plans suited to them.

Will the Minister publish the Matheson report?

Proposed Legislation

Joan Collins


9. Deputy Joan Collins asked the Minister for Health if he will legislate for access to a termination of pregnancy here when a woman is diagnosed with a fatal foetal abnormality. [54012/13]

When a woman finds herself pregnant, it can be a joyous and wonderful occasion. On the other hand, it can be sad and a bad situation for a woman or a couple, particularly those who find early in the pregnancy that their child has a fatal foetal abnormality. It is a dark place as we know from the stories couples and women affected told to us and the Minister. When the Minister met with them he gave them much sympathy. However, sympathy is not what they want. They want-----

Sorry, Deputy, you are way over time.

-----the Minister to introduce legislation to address this area.

It is a terrible tragedy for any couple which finds the chances of survival for their baby are not realistic.

The diagnosis of a fatal foetal abnormality has to be one of the worst pieces of news that any pregnant mother can get.

However, termination of pregnancy in Ireland is permitted only in very limited circumstances, that is, only if it is established, as a matter of probability, that there is a real and substantial risk to the life, as distinct from the health, of the mother and that this real and substantial risk can only be averted by the termination of her pregnancy. These are the X case criteria. The Protection of Life during Pregnancy Bill 2013 was recently enacted, the purpose of which is to restate the general prohibition on abortion in Ireland while regulating access to lawful termination of pregnancy in accordance with the X case and the judgment of the European Court of Human rights in the A, B, and C v Ireland case, and also in accordance with the Constitution.

The purpose of the Act is not to confer new rights to termination of pregnancy, but only to provide for existing rights, that is, within the constitutional provisions and the Supreme Court judgment in the X case. Therefore, fatal foetal abnormalities are not covered in the Act as grounds for termination.

Officials in my Department have liaised with the HSE crisis pregnancy programme to facilitate a meeting with a group representing women who have received such a diagnosis in relation to relevant crisis pregnancy counselling and post-abortion counselling options currently available, and ways to improve the standard of service nationwide. This group has now made contact with the crisis pregnancy programme and they are due to meet shortly.

It is not acceptable that we are still sending women in this situation to other countries to terminate a fatal foetal abnormality. We know that these women are going to Europe to challenge this, because they feel that as the foetus cannot live outside the womb, it is not covered under the legislation to which the Minister refers. I do not think we should wait for Europe to tell us again to deal with issues related to the health of women. In the North, women have also come forward about the issue and the Assembly is examining whether its legislation can be changed, in order to support women who want a termination in their country. Rather than waiting for Europe to tell us what to do, the Minister should be investigating how we can bring legislation forward to deal with it.

I do not wish to be specious, but Europe did not tell us to change the law; Europe pointed out to us that we needed to clarify the law for women and for the practitioners who provide them the service. That was the purpose of the Protection of Life during Pregnancy Act 2013.

The best advice available to me on this issue, which is a very sensitive, sad and tragic situation, is that it would require a constitutional referendum to change the Constitution. Clearly, this is a very difficult area and the HSE is engaging with the pregnancy counselling agency on it.

I think it was the UN that issued a direction to Ireland to deal with the A, B, C and D cases. The D case certainly highlighted that we have to deal with the issue of fatal foetal abnormalities. Women have to go to court in Europe to deal with these health issues. They are not just about terminations; they are health issues for women. That is not acceptable. These women have approached the Minister already and have indicated where they could allow for termination of pregnancies for fatal foetal abnormalities through the Constitution, and I think we should be dealing with that.

I understand the Deputy's concerns. I met with the group representing women whose pregnancies have been found likely not to result in a baby that can survive. It is a very difficult issue and we will continue to meet with them to find the best solutions that we can under the current legislation.

I would like to ask a quick question on this. Can the Minister confirm if the Bill has now been introduced in full? Has it been enacted? Is it actually now in practice across the health services?

The Bill has not been commenced yet. The panels have been formed by the HSE and I hope to be able to do so by the end of the week.

Written Answers follow Adjournment.