Vol. 830 No. 3
6. Deputy Joan Collins asked the Minister for Health the reason persons (details supplied) have not been included in the transfer of patients to the Mater Private Hospital; the cost to the Health Service Executive of dealing with this situation to date; and if he will indicate when the serious issue of orthopaedic services in Tallaght hospital will be addressed. [6705/14]
I thank the Minister for taking this question, as I have been trying to follow up this issue for over a year. A number of people have come to us querying access to spinal surgery in Tallaght. Last May, we received a letter from the chief executive indicating that a patient had been waiting for seven months for a procedure. There was an apology for this and the letter indicated that the hospital had lost two spinal surgeons. As there was significant demand, an appointment could not be given, but it was indicated that if funding was given by the HSE for the spinal services as requested, the hospital would be in a position to move patients more quickly through the system. Will the Minister provide an update on that issue and the transfer of the patients to the Mater Private?
I have been advised by the HSE that Tallaght hospital has entered into a service level agreement with the Mater Private Hospital, approved by the HSE, for the provision of spinal surgery. Under this agreement, 630 patients who had been awaiting an outpatient spinal appointment for more than 12 months were transferred to the Mater Private and will be reviewed by specialist surgeons there. In addition, 31 non-complex deformity spinal patients who were waiting longer than eight months for surgery have had their procedure carried out in the Mater Private under this agreement and a further 42 complex deformity spinal patients are being reviewed by the Mater Private to assess their surgical requirements. I am advised that the cost of this as approved by the HSE is €346,500.
With regard to the two patients referred to by the Deputy, the HSE has advised that outpatient appointments with the treating clinician at Tallaght hospital were scheduled for these patients on 6 February and 10 February, and that both patients attended and are being actively managed. These patients had not been waiting longer than the target time of 12 months. The hospital in Tallaght has recently appointed a second consultant orthopaedic surgeon who specialises in pelvic acetabular trauma. In addition, a new upper limb orthopaedic surgeon has been recruited and is due to take up post in a number of weeks. Tallaght hospital is also working with the Mater Misericordiae University Hospital and the HSE to explore solutions that can address spinal service needs across both hospitals and this process will be informed by the ongoing work of the national clinical care programme for orthopaedics in developing a national model of care for spinal patients.
I thank the Minister for his reply and it is good to hear that there will be two spinal surgeries. The issue has been ongoing for a year and the Minister should have been aware of it. The chief executive indicated that the hospital had applied for surgeons through the HSE and there were problems. One of the people referred to by the Minister, I hope, was on the list for seven months last May, meaning that the person has been waiting at least a year and a half for an appointment with the hospital. I am glad to hear we are moving nonetheless. Given the cost involved, it is not a great result that these people have had to be moved to the Mater Private, but it is good that patients will be seen, which is the main issue. I will be keeping an eye on the matter over the next period.
We all agree that the priority is for patients to be seen as quickly as possible, and sometimes that requires us to use public funding to purchase services in the private sector. I do not have an ideological or other issue with that but I want to see the issue fixed in the public sector. I should point out to the Deputy that it takes quite a while to get a consultant surgeon, a consultant respiratory physician or any other consultant. They are generally working elsewhere and have contracts of employment. The job they apply for here would only be advertised once it is approved, and after that there would be an interview process. Following that, people often have to work out their contracts as they would not want to leave their employers high and dry and they must give reasonable notice. On average, it takes anywhere between nine and 18 months to get a consultant into a post once approved. It seems a long time but that is the reality with which we deal.
I should put to bed, as I indicated earlier, the idea that somehow we are having grave difficulty in this regard. In specific areas and in some specialties there are difficulties recruiting consultants but, as I mentioned, there are well over 100 extra consultants in the system compared with a few years ago.
I wish to clarify the grouping of questions. My question, No. 37, is related.
That is not a matter for the Chair. Does the Deputy wish to put a supplementary question as Deputy Joan Collins does not wish to do so?
What is being done to address the overall serious position of Tallaght hospital? I notice the recent statement by the Irish Nurses and Midwives Organisation calling for more nurses to be appointed. It has reflected on the 2012 HIQA report and the current situation, which is described as being worse. These are front-line staff. The 2012 HIQA report was quite alarming, to put it mildly, but we have been advised that the current position is worse. The statement indicates "the hospital is dangerous and staff fear that another adverse event will happen". Is the recruitment embargo a factor? I believe it is. Will more nurses be appointed to Tallaght hospital?
I accept the Deputy is concerned about the embargo, which is not an unreasonable position. I have made it clear that over 700 nurses were recruited last year. The embargo - or employment control framework - remains in place but, as I have stated on many occasions, it has never been implemented so rigidly as to not allow us recruit where we felt it was necessary.
One of the big problems in the health service is the skill mix. I have asked why some model four hospitals - the big tertiary hospitals - have nine nurses per health care assistant but in others it is 2.8 nurses per health care assistant. Why are consultants doing work that advance nurse practitioners or GPs could be doing? I hope we are all familiar with the fact that in orthopaedics, to which the Deputy's question relates, as physiotherapists review all the referrals, over 50% can be dealt with by a physiotherapist and a patient does not have to see the consultant surgeon. We are changing many things.
Deputy Finian McGrath has tabled Question No. 7 but he is not here. I know he has had a bereavement, as a relative in Galway has died. I extend my sympathies to him.
8. Deputy Seán Kyne asked the Minister for Health the progress in implementing the new policy system to empower persons with a disability or their families to choose educational options, particularly post graduation from secondary level and in consideration of the serious and distressing delays experienced in summer and autumn of 2013 and previous years. [6851/14]
I ask the Minister the progress on implementing the new policy to empower persons with disabilities or their families to choose educational options, particularly post-graduation from school.
This is good news but unfortunately the issue does not get much publicity or air time. I share the Deputy's concern about issues in recent years relating to the provision of day services and training places to young people with disabilities leaving school. For that reason, I asked the Health Service Executive to put new structures in place to ensure available places are identified as early as possible and a more effective communications process is put in place with young people and their families. The placement of 850 school leavers and 482 rehabilitative or life-skills training graduates last year, within limited resources, was a significant achievement by the HSE and the service providers. My colleague, the Minister for Health, advised the HSE that priority was to be given in the 2014 national service plan to the provision of new services for school leavers requiring specific supports. Accordingly, an additional €7 million has been earmarked to address priority needs for new places for school leavers and for those graduating from rehabilitative or life-skills training.
The HSE established a national oversight group in October last year that includes umbrella organisations representing disability agencies.
The group identified the need for a new centralised regional application process and arrangements for implementing the new process are in train. The HSE is liaising with disability agencies and the National Council for Special Education to supply the necessary information on this process to families. The deadline for applications was 1 February, however, some flexibility will be give as the application process is in its first year. Supports required for each individual will be identified and agreed and a communications process with all stakeholders will be put in place by the end of March. Young people and their parents will be advised by the end of June 2014 of the placement which will be available to them.
We made the argument this happens every year and should come as no surprise so we needed to plan for it, which is exactly what we did.
I thank the Minister of State for her reply and I compliment her on the new initiative. I appreciate we discussed this in the House in 2012 and 2013, particularly with regard to my area of Galway, and there were inordinate delays in those years. All parents and children are now satisfied they have a place but unfortunately it was protracted. It was September or early October before some children were sorted in Galway. I am confident the new initiative will rectify this. I also welcome the additional funding and decentralised registration process. Is the Minister of State confident that by June all parents will know what will be available for their children?
This is the first year and there will always be little hiccups in the initial stages. I am confident even if we do not reach the deadline in March or June it will be a far more stable process and people will be reassured their loved ones, and in some instances they are not children, will have an appropriate place in June, July, August and September. We decided if these people were to apply for third level courses they would do so at this time of the year or late last year. It is about knowing what is coming down the track and the needs of the individual, and ensuring these needs are met. I am very confident not alone this year but in coming years the system will work well and the uncertainty which existed in the past will be removed.
I am very hopeful about the new system and I am sure it goes without saying the Minister of State will continue to liaise with the national oversight group to ensure we make progress and families are not put through the same stress as they were in other years.
10. Deputy David Stanton asked the Minister for Health the position regarding the epilepsy monitoring unit in Cork University Hospital; when this unit will open; and if he will make a statement on the matter. [6796/14]
I wish to ascertain the position on the proposed epilepsy monitoring unit at Cork University Hospital. When will it open and how many beds will it contain?
The epilepsy national clinical care programme provides for the commissioning of a regional epilepsy monitoring unit to be based in Cork University Hospital. This unit will provide accessible comprehensive care for patients in the southern area, particularly those with acutely unstable and disabling chronic epilepsy.
The executive management board of Cork University Hospital allocated ward 3A as a suitable location for the epilepsy monitoring unit to be shared with the facility for stroke services. Funding of €140,000 was provided for the infrastructural upgrade of ward 3A and a further €217,000 was provided for the purchase of the required epilepsy monitoring equipment.
The HSE has advised that commissioning of the unit requires the recruitment of additional nursing and allied health professional staff. Recruitment of nursing staff has, I understand, been particularly challenging, but I am assured the recruitment process is in the final stages, and candidates who were successful at interview are now being offered contracts of employment.
I have also been assured the unit is now equipped and will open no later than 31 March 2014 and I look forward to seeing the Deputy there.
I thank the Minister for his response.
This matter was raised at a meeting of the Joint Oireachtas Committee on Health and Children on Tuesday when Dr. Colin Doherty, the national clinical lead for the epilepsy programme, was before the committee. He indicated he was at a loss to understand this because he had been a direct participant in advertising and interviewing during the recruitment process. He could not in any way explain the inordinate delay in closing the appointments. It baffles him. He stated the national epilepsy care programme and the HSE had provided funding for the seven nursing staff required to deliver the programme and, for what he described as unclear reasons, nothing has happened. Cork University Hospital has already invested more than €500,000 in equipment which is awaiting staff.
Cad é an ceist?
The ceist is will the Minister try-----
The time is up.
What is happening this morning? With respect I ask Deputy Stanton to allow me to finish.
With respect, the time is up. Ask a question.
We have. It is a very serious matter when the clinical lead outlines the difficulties. Will the Minister establish why the delay has taken place and why we have not already seen the appointments in Cork in line with all of the other areas, and ensure we will not have a repetition of such delays for such an important service?
With respect, what is truly important is to ensure patients have this excellent service available to them in Cork. Last week I was in Beaumont Hospital at the opening of its new unit where I met the staff there and some of the patients. It is a state of the art unit with the latest technological equipment available and the staff will now be able to diagnose with much greater accuracy the forms of epilepsy people have and will therefore be able to treat with much greater effect these conditions. As a professional who dealt with many people who have this condition I can tell the Deputy one drug after another was tried in the hope that one might work. Now we have a much more scientific way of addressing these issues and seeing whether stereotactic surgery would alleviate problems completely.
I met a gentleman there who is related to a Member of the House who was very happy to tell us his life has been transformed in the past two years. He is now epilepsy free and can go where he wishes and does not need to plan the day around his condition. It is like a new lease of life for him. I thank all of the doctors and nurses working in the units and the lead, Dr. Colin Doherty, who does outstanding work on our behalf in this regard. The delays are not something on which I have intimate knowledge but I know some issues arose with regard to staffing which have been resolved and we look forward to the unit opening in Cork and delivering care there.
11. Deputy Charlie McConalogue asked the Minister for Health the steps he has taken to address the shortage of non-consultant hospital doctors at Letterkenny General Hospital, County Donegal; and if he will make a statement on the matter. [6842/14]
What steps is the Minister taking to address the shortage of non-consultant hospital doctors in Letterkenny General Hospital in County Donegal?
I thank the Deputy for the question. The number of non-consultant hospital doctors, NCHDs, in the public health system has increased by more than 200 in recent years and now exceeds 4,900. However, there are international shortages of NCHDs in certain categories and specialties. There are also some hospitals, such as Letterkenny, to which it has been difficult to attract NCHDs, for a range of reasons including training opportunities and rural location. We must live with this fact and do everything we can to address it.
Letterkenny General Hospital had an NCHD complement of 105 whole-time equivalents prior to the drive to support implementation of the European working time directive. To facilitate the implementation of the directive, it has received approval to employ a further 16 whole-time equivalents, increasing the total approved NCHD complement to 121.
Since July 2013, there have been ongoing efforts to recruit doctors for the January 2014 intake of NCHDs to ensure recruitment of all 121 whole-time equivalents. Unfortunately, due to national and international shortages of NCHDs, Letterkenny General Hospital, as of 11 February, has 26.5 vacant posts.
However, 14 of these posts are covered by agency locum non-consultant hospital doctors employed on a temporary basis to ensure continuation of service delivery at the hospital. Efforts are continuing to recruit additional NCHDs to the existing vacant posts.
Particular difficulties are being experienced in Letterkenny General Hospital regarding the recruitment of NCHDs in general medicine, and this is replicated in many hospitals nationally. There at 8.5 whole-time equivalent posts vacant in the general medicine specialty, comprising 7.5 registrar and one senior house officer posts. The recruitment and retention of non-consultant hospital doctors is required to support service delivery, address reliance on agency locums and facilitate the achievement of compliance with the European working time directive.
Last summer I set up a group under the chairmanship of Professor Brian MacCraith to undertake a strategic review of medical training and career structure.
Additional information not given on the floor of the House
The group is to make recommendations aimed at improving the retention of medical graduates in the public health system, planning for future service needs and achieving the maximum benefit from investment in medical education and training. The group provided an interim report in December 2013 with a focus on training. It is examining career structures and pathways following training with a view to submitting a report by the end of March 2014. In addition, the HSE is considering the establishment of a new service grade of non-consultant hospital doctor. The establishment of the hospital groups will also assist hospitals such as Letterkenny as the revised structures will facilitate the use of resources across the group. Indeed, the current shortages at Letterkenny are being considered in the context of the NCHD resources available to the west and north-west hospital group.
I thank the Minister for his reply. He has referred to national and international shortages in the supply of non-consultant hospital doctors. He has stated that shortages are particularly acute in regional and more peripheral hospitals such as Letterkenny General Hospital. His response is that this is something with which we must live. His response does not provide specific solutions which is what I asked for in my question. He has outlined that where there should be 121 NCHD posts in Letterkenny General Hospital. Currently 26.5 posts are vacant, with 14 being filled by agency doctors, no doubt at a more significant cost than the full-time posts.
The hospital normally had ten medical registrars but currently there are 8.5 posts. To comply with the working time directive, that number needs to increase to 15 posts. On many days recently there were significant backlogs in the accident and emergency department with people on trolleys, and neither Sligo nor Altnagelvin were able to take the overflow. The public had to live with that difficulty
I will come back to the Deputy.
It is not acceptable that the medium-term solution is that we must continue to live with it.
I must call the Minister.
I will finish on this point. I ask the Minister to elaborate on what steps he can take to address that situation to ensure it does not continue for the next few years.
As the Deputy has acknowledged, we have approved more posts for Letterkenny. The reality is there is a difficulty in recruiting but we continue to recruit actively and to use agency locums to ensure we provide a safe service for the people of Letterkenny. I congratulate the staff of Letterkenny General Hospital and the wider hospital group which provided support from Galway from Bill Maher and his team and the board. I also acknowledge the help from Altnagelvin during the flooding. The unit is fit to re-open and we look forward to seeing the Deputy at the opening. Letterkenny General Hospital is a critical part of our health service and it will be supported. I have no doubt we will be able to attract more doctors to Letterkenny by means of rotation within the hospital group. This is one of the benefits of the hospital group because staff will not be recruited to work in Letterkenny specifically but will be recruited for the north-west hospital group and will go on rotation between the hospitals during the course of their training. This system will also make available to Letterkenny and the people of Donegal a greater level of expertise than was the case heretofore.
I concur with the Minister and I thank him for his comments about the staff. What they and the management of the hospital have achieved has been heroic and amazing. The flooding of the hospital was one of the biggest disasters at any hospital in the history of the State. The accident and emergency department at Letterkenny General Hospital is the seventh busiest in the country, which shows the demands on the service. The hospital has had difficulty in recruiting the staff it needs and the numbers of staff which have been approved. This demonstrates the job of work faced by the hospital in dealing with its daily workload. We need to have solutions from the Minister. He has outlined that the number of NCHD posts has been increased to 126, but the real difficulty is in recruitment. The Minister has indicated there may be potential for rotation in the new hospital group. Whether the solution is in the system of rotation or else international recruitment in the medium term until there is more supply from this country, we need to see solutions quickly. We cannot continue with the current situation because it will mean more delays in the accident and emergency department which is unacceptable for patients in Donegal.
The Deputy will be aware from earlier responses to questions that the model of care needs to change in both hospitals and in general practice. We need to move away from this episodic illness approach to a system of prevention and chronic illness management in primary care. The Minister of State, Deputy Alex White, is dealing with this aspect and he is in consultation with the GP organisations, for which I thank him. It is the case that NCHDs are doing work that could just as well be done by other health care professionals. I alluded to the skill mix where nurses are performing duties which health care assistants could undertake, doctors are doing work that advanced nurse practitioners could undertake, and both professions are doing work that would be better done by physiotherapists or speech and language therapists or other allied health care professionals. We must address this by innovative ways of using the resources available to us, which in my view will be more cost-effective and result in better outcomes for patients and would also be more rewarding for the professionals involved.
12. Deputy David Stanton asked the Minister for Health the position regarding the dedicated stroke unit in Cork University Hospital; when this unit will be open; and if he will make a statement on the matter. [6795/14]
There is much concern about the delay in opening the stroke unit in Cork University Hospital. I understand a date has been set but I want to get confirmation from the Minister that this is the case and that the unit will open without further delay.
I look forward to going to Cork but I will have to get a passport from the Minister of State, Deputy Kathleen Lynch, before I set foot in Cork.
Cork University Hospital provides a full, comprehensive range of stroke related services, including neuro-radiology, which includes intra-arterial thrombolysis. In plain language that means administering a drug to break up a clot causing the blockage. Other services will include acute neurology and elderly care medicine. To enhance this service delivery further, the executive management board allocated a ward to provide a dedicated stroke unit. Funding was provided by the national clinical stroke programme to enable some infrastructural upgrade on the ward.
To develop further the multidisciplinary role within the stroke service in CUH, the clinical programme also provided the necessary funding to recruit the following staff: one full-time clinical nurse specialist for stroke care, a 0.5 whole-time equivalent speech and language therapist, and a 0.5 whole-time physiotherapist. I am advised by the HSE that the infrastructural upgrade of the ward has been completed and that the staff for the unit have been recruited. The hospital is putting the final measures in place to open the stroke unit which will provide 12 beds for the stroke service. The opening is scheduled for Monday, 10 March 2014.
The HSE national clinical care programmes provide a national, strategic and co-ordinated approach to a wide range of clinical services. The objective of the stroke clinical programme is to provide rapid access to high quality stroke services, to save lives and to prevent strokes. The Deputy may be interested to note that I prioritised an improvement in thrombolysis rates and a target was set to increase the rate of safe thrombolysis from 1% to 7.5% by the end of 2013. I am pleased to say the HSE has recently reported a national stroke thrombolysis rate of 10.5% for the third quarter of 2013, which exceeds targets and is comparable to rates internationally. I am informed Ireland has moved from the bottom of the European league table to the very top in an 18 month period. This is having a real impact on patient safety and quality of life. Access to safe stroke thrombolysis is provided in 23 hospitals throughout the country, 24 hours, seven days a week. Ambulance access protocols are also in place whereby acute stroke patients are taken to the nearest hospital providing around-the-clock thrombolysis.
This is what the health service is supposed to do which is delivering better outcomes for patients. This is a very clear example of how the men and women who work in our health service have achieved that.
I thank the Minister for that very good news that the unit will open on 10 March. Has he information on how many patients will use that unit? Will the Minister personally perform the opening ceremony on 10 March?
I would not have that level of detail available to me here but I know that in the past, we talked about saving one life per week and avoiding three people per week going into long-term care as a consequence of this initiative. Those figures have almost doubled and I look forward to an ever-increasing number of people receiving better outcomes from our health service, specifically in this area. In the past, a stroke very much brought a close to the kind of life people were able to lead. My father suffered a stroke and was left blind for the remaining 14 years of his life. The advent of this technology and service is something which is real and tangible and to the betterment of our people and our service.
I thank the Minister.
13. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the way he can reconcile the programme for Government commitment that investment in the supply of more and better care for older persons in the community and in residential settings will be a priority of this Government and that additional funding will be provided each year for the care of older persons, including more residential places, with the Health Service Executive 2014 service plan which provides for no new residential places in 2014; and if he will make a statement on the matter. [6918/14]
How can the Minister reconcile a programme for Government commitment in regard to supports and the provision of beds in nursing home facilities for older people and the fact there is no new moneys in the 2014 HSE service plan for this very purpose?
I thank the Deputy for tabling the question. We are looking at this issue intensively because we recognise the need in the future will be greater. I would like to assure the Deputy that the needs of our older people are, and will remain, a very high priority for me and the Government and that the resources that are available will be applied to provide the best possible mix of supports and services. Government policy is aimed at ensuring older people receive safe, timely and appropriate care and treatment at the lowest level of complexity, as close to home as possible and that they are facilitated and supported to stay in their own homes and communities for as long as it is viable. This is in line with the views expressed consistently by older people themselves.
Accordingly in 2014, there is an enhanced focus on home and community supports. Although the budget for long-term residential care has been reduced by €35 million to €939 million, it should be noted that €23 million of this reduction is being directly transferred to the community side. This allocation will strengthen community provision and allow more people to stay in their own homes for longer. While it is estimated that 900 fewer people will be supported in long-term residential care, this will be counterbalanced on the community side, where the €23 million will be used to fund the following: 190 intensive care packages to benefit 250 people annually; 25 intermediate-transitional care beds to benefit 650 people; 20 beds for complex cases to benefit 130 people; and maintaining the current level of public short stay beds provision of 1,860 beds which provide respite, rehabilitation and step down services. We are implementing the type of transformation we are trying to implement in mental health and disability in regard to older people and it is something about which we must be very conscious and sensitive.
More older people are occupying acute hospital beds for longer as they await ever-scarcer nursing home places. The consequences of that are very clear in terms of straitened health budgets and beds in the acute hospital system. Has the Minister of State established the number of patients of senior years who have been retained in acute hospital settings beyond their medical care need, many for inordinate periods of time? I know of cases where it has been months because of the shortage of beds in our public nursing home network.
The dreadful term "bed blockers" is used by some but I find it offensive. These people are not there by choice and would much rather be in their homes if that was an option but clearly it is not and that is why they are waiting for residential care. It is a hugely important issue not only for the people concerned but for the hospital system because I have been told - the Minister of State can contradict me again - we are talking of the order of perhaps 600 beds at any given time. The number may fluctuate somewhat but one is talking about a huge number of beds across our already straitened acute hospital network. This needs to be addressed.
I share the Deputy's concerns. It is offensive to people as they age to have a tag put on them which is clearly not of their own making. The number is not 600, although it is a substantial one. The number ranges from between 400 and 460 at any one time and we all know the significance of that in terms of the cost of an acute hospital bed.
The reason we are putting in the 25 intermediate-transitional care beds, which will benefit 650 people, and the 20 beds for cases that are more complex, which will benefit 130 people, is for the very reason the Deputy stated, that we should take a serious look at how we move people on. It is about transferring people to transitional beds and giving them the type of physiotherapy, the type of supports they need in order to transition back to their own community and the high-spec intensive care packages to support them in their own community.
We are very conscious that we need to do things differently and that the need will increase but we are convinced that if we do this properly, the outcome will be much better, not only for the State and the taxpayer but for the people who need the care and support.
Will the Minister of State indicate when she expects these additional packages and additional bed opportunities to be in place? It comes back to the point that acute hospital beds are being occupied by people whose real need is long-term residential care. I fully support care in the community. Make no mistake, if those people could return home, many of them would make that choice. I know some of the people of whom we speak. There is no doubt in my mind that a significant number of the 460 - the Minister of State said it is not 600 but the number clearly fluctuates - want to be in a different setting but they know a residential care place is the only future they have left. What the Minister of State announced is only tipping at it. The figure clearly demonstrates that much more needs to be done. The benefits would be considerable and it would be an investment.
I am not convinced that all those in beds in acute hospitals would necessarily need to go into long-term care, although a proportion would need to do so. However, we believe that with the right interventions, such as physiotherapy, and with the home care packages and supports, many more people could live long and well in their own communities. The Deputy and I know the old saying that the journey of 1,000 miles begins with a single step. We are beginning to change the service and to recognise the needs. We have to start somewhere and this is where we are starting. The provisions will be in place this year.
We are extraordinarily lucky to have Mr. Pat Healy as director. He has an in-depth knowledge of this whole area, has been involved in it throughout his career and has realised where the blockages and the difficulties are and is now beginning to address them in a way we have not seen before.
