Dáil Éireann debate -
Thursday, 3 Dec 2015

Vol. 899 No. 2

Other Questions

Hospital Waiting Lists

Joan Collins

Question:

6. Deputy Joan Collins asked the Minister for Health further to the reply to Parliamentary Question No. 16 of 22 October 2015 in which he stated that he had put in place maximum permissible waiting times for inpatient, day-case and outpatient treatment of 18 months by 30 June and 15 months by year end, why there are 13 patients waiting for spinal surgery, two of whom have come to this Deputy's attention, who are waiting since July 2014 in Galway University Hospital; his views on whether scoliosis patients with 70% to 80% spinal curvature should be subject to these waiting times; if there should be a maximum permissible waiting time of three to six months for these patients; and if he will make a statement on the matter. [42902/15]

Deputy Joan Collins

I have raised this issue over a number of months, going back to last year and even before then.

I am very involved in Crumlin Hospital. As it is in my constituency I have known many patients who have gone through it, particularly when there were cutbacks in 2010 and 2011. At the time, the then-Minister, Deputy James Reilly, said he would defend scoliosis patients and ensure the waiting lists would be reduced. I ask the Minister to reply to my question and then I will come back to address something he said earlier.

Deputy Leo Varadkar

The Government is working to ensure that long waiting times for scoliosis surgery are reduced. The focus is on additional resources and capacity so that more operations can be carried out every year. I have been assured by University Hospital Galway it is working to ensure that the necessary resources and arrangements are in place to address the needs of patients with scoliosis and to urgently tackle waiting lists. These include appropriate bed availability, access to diagnostics, purchase of specialist spinal equipment and access to theatre. Within the last three months, two consultant orthopaedic surgeons, comprising one replacement and one additional post, have been appointed at University Hospital Gaway to support this service. In the short term, Galway is working to assign five dedicated beds to support the service and when the new ward block which is under construction is completed, this will increase to eight dedicated beds. Unfortunately, the block will not be finished for approximately 18 months. I understand that there are seven patients at Galway who are currently breaching the maximum permissible waiting time of 15 months and that the hospital is working with the special delivery unit, or SDU, to secure their early treatment, including examining the potential to refer these patients out for surgery.

In addition to the measures underway in Galway, significant progress is being made in respect of those awaiting scoliosis surgery at Our Lady's Hospital in Crumlin. The volume of such surgeries for patients on the Crumlin list has been doubled this year. As such, it is hoped that twice as many operations will be carried out this year than were carried out last year. The HSE's acute hospitals division is continuing to work with the children's hospital group, the Saolta hospital group and individual hospitals to provide guidance and support and, where appropriate, to engage with all parties who can contribute to improving access to spinal surgery.

Deputy Joan Collins

There were nine patients waiting for scoliosis operations in University Hospital Galway in May this year and only one had surgery. We are now told that there are 13 patients on the list and that three have had a surgery since. That is not acceptable. I know two people who do not mind me saying their names and in fact have asked me to do so. Aisling has a 70% curvature of her spine and has been on the waiting list since July 2014. She is still waiting for an operation. She says she can hardly breathe and that her organs are under a great deal of stress yet she is still waiting. What is happening there? These are two people I know. The other person is a young girl named Sophie who has an 80% curvature of her spine. I received a note from her mother the other day to say that Sophie has been prescribed anti-depressants and continues to worsen. For two weeks, she has been out of school where she is an honours student. She is still waiting for surgery. This is not acceptable. I expect that all the patients who have been on the list for longer than three or six months should be sent to other hospitals or, as the Minister said, to London or wherever the operation can be carried out. That is why I have asked the question. The consultant is available to do it.

Deputy Leo Varadkar

We discussed this on an earlier question. I am not sure if the Deputy was here. As I said, the constraints in carrying out complex surgery depend on a number of things including theatre time being available, theatre nurses being available, an appropriately qualified consultant orthopaedic surgeon being available to carry out the operation and a number of other factors. What is being done is a doubling of the number of surgeries being carried out, if possible. Other hospitals are taking patients. Temple Street, for example, has taken three patients by moving some lists to Saturday working. The Royal National Orthopaedic Hospital at Stanmore, London, has been asked to help out and it carried out an out-patient clinic in Crumlin on Friday, 27 November 2015. The clinic had 15 patients and Stanmore accepted 11, five of whom are long waiters. There were two families who decided not to progress with surgery on the basis of second opinions while two will be followed up with outpatient appointments in Crumlin. This accounts for the remaining four long waiters greater than 15 months. The opportunity to send patients to Stanmore with its shorter waiting times allows Crumlin to free up theatre capacity for complex patients.

Deputy Joan Collins

There is no excuse for a person waiting 17 months for an operation. It is 15 months for Aisling who had to get rods taken out of her back previously. Since then, she has been waiting for surgery. She is in terrible pain. The Minister cannot stand over this. He must address University Hospital Galway, albeit not so much Crumlin where issues have moved on and he is trying to deal with it. I want to be able to put down a question in one month's time on University Hospital Galway to which the Minister will reply that eight or nine of the 13 patients have been addressed and that no patient will have to wait for a scoliosis surgery for more than three months. Anything else is unacceptable. The Minister is getting away with it.

Deputy Leo Varadkar

I welcome the fact that Deputy Joan Collins acknowledges the efforts and the progress being made in Crumlin. I will also take a particular interest in scoliosis surgery at University Hospital Galway. That interest will not be in an individual case but in all cases.

Deputy Joan Collins

They are waiting 17 months and 15 months, respectively.

Deputy Leo Varadkar

It is not right that we as politicians should prioritise one individual over another. I acknowledge that the Deputy is not suggesting that and, as such, the interest I take will be in all cases not individual cases.

I am advised from Galway that within the last three months, two consultant orthopaedic surgeons, comprising one replacement and one additional post, have been appointed at University Hospital Gaway. While the hospital has limited capacity to undertake the elective aspect of the service, it is actively working to develop the elements required to support the service including in-patient beds, high-end equipment, theatre capacity and staffing from within existing resources. In the short term, Galway is working to assign five dedicated beds to support this service. When the new ward block which is under construction is completed, this will increase to eight dedicated beds.

There are ten patients in Galway awaiting scoliosis spinal surgery of whom seven have been waiting for more than 15 months. As I say, the hospital is working with the SDU to explore the potential to refer these patients to another hospital for surgery whether in Dublin or, potentially, overseas if that is an option.

Primary Care Centres Provision

Terence Flanagan

Question:

7. Deputy Terence Flanagan asked the Minister for Health the status of the provision of primary care centres at Coolock and Darndale and at Edenmore in Dublin Bay North; and if he will make a statement on the matter. [42713/15]

Deputy Terence Flanagan

I ask the Minister for an update on the roll-out of primary care centres, in particular two centres at Coolock-Darndale and Edenmore, respectively. There is a great deal of pressure on Beaumont Hospital at this time of the year in particular. If there were progress on the primary care centres, it would take a lot of that pressure off the hospital.

Deputy Kathleen Lynch

The development of primary care remains central to the Government's objective of delivering a high-quality, integrated and cost-effective health care service at community level. This involves shifting the balance of care from a hospital-centred service to one located in the community to enable people easily to access a broad spectrum of services at local level. The development of primary care centres is taking place through a combination of direct build by the State, public private partnerships, or PPPs, and operational leasing. The facilities will house GP and community nursing teams and offer additional services including physiotherapy, social work, counselling and occupational therapy.

The Coolock-Darndale primary care centre is one of 14 locations to be delivered under a single PPP project. Following a detailed tender evaluation process, the National Development Finance Agency announced the Prime-Balfour Beatty consortium as the preferred tenderer in May 2015. Subject to successful completion of financial and contractual arrangements, it is expected that construction work will commence in early 2016 and that the primary care centres, including the Coolock-Darndale centre, will be delivered during 2017.

With regard to the proposed primary care centre at Edenmore, the HSE proposes to use the operational lease mechanism. In November 2014, the HSE sought expressions of interest from interested parties for primary care centres to be delivered using the operational lease mechanism. Edenmore was one of 73 locations advertised and expressions of interest were received for this location. Following the third stage selection process, heads of terms have recently been agreed with the selected provider. In line with the normal property approval protocol of the HSE, the project will be submitted to the HSE's property review group for approval.

A major programme to develop primary care centres has been considerably advanced and I look forward in the period ahead to further developments, including those at Coolock and Darndale and in Edenmore. I hope this is of help to the Deputy.

Deputy Terence Flanagan

I thank the Minister of State for the response. When does she expect the Edenmore centre to come on stream? She mentioned construction for the Coolock-Darndale centre specifically being delivered in early 2017, but what is the status of the Edenmore centre? What level of review has been done in respect of those primary care centres which have actually come on stream? Are they carrying out their functions well and are there plans to take further pressure off hospitals directly?

In terms of the original plan, what percentage of what the Minister of State said she would deliver has been delivered at this stage? In Beaumont Hospital INMO members will work to rule on 16 December. It is very frightening. They are doing great work in a hospital which is hugely understaffed.

An Ceann Comhairle

I will let the Deputy back in again.

Deputy Terence Flanagan

If the Minister of State delivers the primary care centres, it will certainly take a lot of pressure off the hospital directly.

An Ceann Comhairle

There are other Deputies who are waiting to ask questions.

Deputy Kathleen Lynch

The number of primary care centres being built is ahead of profile and the process is working extremely well. We are proposing to build even more under an operational lease which also has to go through a process. The issue is not just about buildings, it is also about ensuring GPs in a certain area are prepared to co-operate and avail of the facility. Then and only then will other services be provided in the centre. A lot of preparatory work has to be done in advance of providing the buildings. There are some areas where that co-operation is not forthcoming, for example, where GPs have already formed a co-operative and put substantial moneys into their own practice.

Deputy Terence Flanagan

That is welcome, but the issue of Beaumont Hospital is directly related and is in the same catchment area. There are 43 nursing vacancies across 14 units. It is an issue that has been referred to already this morning.

An Ceann Comhairle

That is a separate question.

Deputy Terence Flanagan

What is the Minister of State doing to ensure these vacancies will be filled in a timely manner? The INMO has stated beds will have to be closed because of the shortage of staff in the hospital and the severe pressure under which staff are working. That fact has to be appreciated. The Minister of State should ensure these two primary care centres are rolled out in a timely manner.

Deputy Kathleen Lynch

The only way hospitals will have respite is, for instance, if various chronic illnesses are treated in primary care centres. That should give us some breathing space. Minor surgeries will be performed in primary care centres more often in 2016 than in 2015. There were 20 in 2015 and the proposal is to have 80 in 2016. There will always be vacancies for nurses, junior doctors and consultants. The difficulty is in attracting people into the system. We had to reduce the number employed and everyone knows why - the economy had collapsed - but we are trying to reverse that trend. There will, however, always be vacancies within acute units and hospitals. People who qualify like to travel, but we are hoping that once they have got the travel bug out of their system, they will come home and see Ireland as an attractive place in which to work.

General Medical Services Scheme

Caoimhghín Ó Caoláin

Question:

8. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he acknowledges the level of uncertainty and the lack of clarity pertaining to the practice of general practitioners charging medical card holders for blood tests; if he is aware that General Medical Service patients are being charged, despite the fact that under the Health Act 1970, it is stated a general practitioner may not charge the patient if the patient is eligible for free general medical services, including in the event that a patient needs bloods to be taken to either assist in the process of diagnosis or monitor a diagnosed condition; his plans to address the level of ambiguity and confusion among medical card holders and general practitioners alike; and if he will make a statement on the matter. [42904/15]

Deputy Caoimhghín Ó Caoláin

I seek to establish the level of the Minister of State's awareness of the uncertainty and the lack of clarity surrounding general practitioners charging medical card holders for blood tests. What steps are being taken to eliminate the ambiguity in this matter?

Deputy Kathleen Lynch

I thank the Deputy for raising this issue. While most GPs provide phlebotomy services for their medical card and GP visit card patients without charge, I am aware that there have been instances where some GPs have charged such patients for these services. It is not acceptable for patients in these categories to be subject to a charge for procedures associated with routine diagnosis and treatment.

The HSE, as the body which contracts GPs for the provision of services for GMS and GP visit card patients, has written on a number of occasions to contract holders, most recently in March 2014, clarifying the position on phlebotomy services. All written complaints about GPs charging for such services have been investigated by the HSE. In any case where a patient has been charged by his or her GP for phlebotomy services, the HSE will, where appropriate, arrange for a refund of the amount concerned.

The Department of Health and the HSE are cognisant of the need for a new agreed contract with GPs that will help modernise the health service and develop a strengthened primary care sector. Negotiations are under way with the Irish Medical Organisation. The appropriate arrangements for phlebotomy services and to deal with differences of interpretation will be considered in this context. The process also provides an opportunity to ensure maximum clarity on the scope and nature of the service to be provided, including the taking of blood for diagnostic purposes or in connection with the treatment or monitoring of an ongoing condition. Notwithstanding these engagements, the contractual position is as outlined by the Deputy and the HSE has and will continue to take action where medical card or GP visit card patients are charged inappropriately.

Deputy Caoimhghín Ó Caoláin

I concur and believe it is quite clear and specific under the Health Act 1970, as amended, that GPs should not be charging general medical scheme card holders for blood tests. However, the evidence is not just anecdotal that we know that this is happening. This notification is now appearing-----

An Ceann Comhairle

We do not display notices in the Chamber.

Deputy Caoimhghín Ó Caoláin

----in general practices-----

An Ceann Comhairle

Is the Deputy listening to me?

Deputy Caoimhghín Ó Caoláin

-----that reads very clearly, "Important notification". I will read it. It states that from 1 January 2016-----

An Ceann Comhairle

I have told the Deputy that he must not display notices in the Chamber. He is here long enough to know this.

Deputy Caoimhghín Ó Caoláin

I beg your pardon. I am reading it.

An Ceann Comhairle

I beg the Deputy's pardon.

Deputy Caoimhghín Ó Caoláin

I am reading something as I am quite entitled to do. It has been a belligerent morning and most odd. The notice reads: "From January 1st 2016 it will be necessary to charge all patients who have medical cards a fee of €15 for blood tests".

An Ceann Comhairle

We are over time.

Deputy Caoimhghín Ó Caoláin

I ask the Minister of State to note that this is now appearing in general practices as a notification of intent.

An Ceann Comhairle

I call on the Minister of State to reply very quickly.

Deputy Caoimhghín Ó Caoláin

It confirms what we know already.

An Ceann Comhairle

It was not the Deputy's fault, but we were ten minutes late starting.

Deputy Kathleen Lynch

I thank the Deputy for that information, but I, again, point out that under paragraph 27 of the GMS contract, a medical practitioner shall not demand or accept any payment or consideration whatsoever in reward for services provided by him or her or for travelling or other expenses incurred by him or her for the use of any premises, equipment or instruments in making the service available. I will bring what the Deputy has outlined to the notice of the HSE once again.

Deputy Caoimhghín Ó Caoláin

I ask the Minister of State to note that I have highlighted the fact that there are a number of general practices which intend to make this policy as and from 1 January 20016, a short number of weeks away. It is imperative that we deal with the matter because we will see an escalation as a consequence of that statement of intent. The people who have to deal with it are the Minister and the Minister of State. It has to be made clear to all general practitioners that this is not allowable or acceptable.

Deputy Kathleen Lynch

The contract is very clear and explicit. I will bring the information the Deputy has produced to the notice of the HSE and we will make sure it is acted on.

Hospital Staff Recruitment

Seán Kyne

Question:

9. Deputy Seán Kyne asked the Minister for Health the proportion of the several hundred additional staff recruited to hospitals in 2015 to date who have been assigned to emergency departments; and the projected numbers to be recruited to the acute hospitals in the next 12 months. [42949/15]

Deputy Seán Kyne

The question is about the several hundred additional nursing staff who have been recruited to hospitals in 2015. How many of them have been assigned to emergency departments and what is the projected number to be recruited to acute hospitals in the next 12 months?

Deputy Leo Varadkar

In the past eight years a general moratorium on recruitment and promotion, coupled with an employment control framework, has contributed to a fall in employment across the public health sector and the wider public service. Arising from budget 2015, restrictions on the employment of additional staff were eased in 2015.

In December 2014 I convened the emergency department task force to provide a focus and momentum in dealing with the challenges presented by overcrowding. In 2015, €117 million in additional funding was allocated specifically to address overcrowding in emergency departments, including through the ongoing recruitment of front-line staff.

It is recognised that the solution to the problem of emergency department overcrowding is to be found through putting in place alternatives to hospital admission and services which facilitate earlier discharge, as well as in addressing the efficiency and capacity of hospitals in delivering acute treatment. Accordingly, the solution requires improvements in both the wider hospital beyond the emergency department, as well as in primary and social care and community services.

Health Service Executive figures show there was a 8% reduction in overcrowding in November compared to November last year. While the INMO, Irish Nurses and Midwives Organisation, figures show a 4% increase, they also show a significant improvement in the second half of November. This contrasts with the position throughout the year when we were running 24% ahead of the figure in the preceding year. This morning there were 244 patients on trolleys, 110 for more than nine hours. That is 23% lower than the figure this day last year.

A total of 4,643 staff members have been recruited by hospital groups in the past year. They include replacement staff. The increase in the number of whole-time equivalent staff during the same period was approximately 2,500. Of the staff recruited, 254 have been assigned to emergency departments.

The HSE is finalising its national service plan for 2016, meaning that it is not possible at this stage to predict the additional emergency department staff numbers for 2016. However, hospitals have authority to deploy staff in the most effective way possible within agreed funding levels.

Deputy Seán Kyne

I thank the Minister for his reply. I note an additional 41 nurses have been appointed to University Hospital Galway since October 2014. An additional 146 staff were recruited overall to the hospital, including 29 non-consultant hospital doctors, six consultants and 19 allied health professionals. Because of overcrowding and the concerns about the emergency department in the hospital which hit the headlines during Leaders’ Questions yesterday, I welcome the Minister’s statement on proceeding to design stage in 2016 for a new emergency department at the hospital. Will he provide more clarity in this regard? As the Taoiseach said yesterday, the facilities are not fit for purpose. Having visited the emergency department recently, I know that the Minister agrees with the Taoiseach’s statement yesterday.

Deputy Leo Varadkar

I do not have the detailed staff figures for University Hospital Galway. In the Saolta group there has been an increase of 689 staff this year, 38 of whom were assigned to emergency departments.

Many emergency departments are old and out of date and there has been considerable investment in them in recent years. There is a new emergency department in Wexford. The one in Kilkenny has just been completed and will be opened in the next few months. A new emergency department in the Mater Hospital was opened in 2013. Construction is under way on the new emergency department in Limerick. There is an extended emergency department in Tallaght hospital. The emergency department in Clonmel is being upgraded, while an extended department is under construction in Mullingar. The planning application for the national children's hospital new emergency department and satellite centres is before An Bord Pleanála. It is fair to say that in the past five years there has been more investment than ever in new and extended emergency departments. The difficulty is that much of the health infrastructure remains old, some of it is 200 years old. One cannot replace all of it overnight and it will take some time to do so.

It is acknowledged that even if there was no overcrowding in Galway, the emergency department is out of date and needs to be replaced. The intention is to proceed to design and planning stage in 2016 to allow work to proceed in the years to come. Just because it is not specifically mentioned in the six-year capital plan does not mean that it is not going to happen. The capital plan refers to national projects and programmes, not individual wards or departments in hospitals across the country.

Deputy Seán Kyne

I welcome the clarification, as there has been misinformation or slightly skewed information. I welcome the Minister’s intention to proceed to design stage in 2016 for a new emergency department in Galway. Obviously, there is a nursing shortfall, which I understand is worldwide. Will the Minister clarify the provision of additional facilities in Galway such as the 75-bed ward which is under construction, the 30 extra beds planned for the old physio ward which are due for delivery in early spring and the 14 beds to be provided in Merlin Park University Hospital in May? These additional facilities will help to ease overcrowding in the coming months. The emergency department is still a significant issue and the staff in it do a tremendous job in difficult circumstances.

Deputy Leo Varadkar

Specifically on the position in Galway, I do not have the official figures, but the most recent figures from the INMO showed that there were 480 patients on trolleys at some point during November in University Hospital Galway, down from 536 in the same month last year. The additional beds in Merlin Park University Hospital probably helped in that regard. More is being done. Up to 30 beds will be provided in the old physio and social work department which is under construction. I am hoping it will be opened in December. If not, it will be opened in the new year. The new 75-bed block is under construction and will mainly consist of individual beds in individual rooms, providing for a much more modern standard of hospital accommodation. It will be completed in 2017. It is intended to proceed to planning and design stage for the new emergency department in 2016. As I said, even if there was no overcrowding in the emergency department in Galway, the facility is out of date and needs to be replaced and modernised.

An Ceann Comhairle

I am afraid the clock has beaten us. Unfortunately, we were ten minutes late starting.

Deputy Thomas P. Broughan

May I ask just one supplementary question on emergency departments? The Minister has listed all of the improvements to emergency departments. Is he expecting a feasibility study this month to provide a new emergency department at Beaumont Hospital to be included in his Department’s capital budget?

Deputy Leo Varadkar

Yes, I referred to the new and extended emergency departments completed in the past few years. Beaumont Hospital is carrying out a feasibility study of the location, size and cost of a new emergency department. The report is expected shortly. All of these investments are expected to improve the experience of the thousands of people who attend emergency departments every day.

Written Answers follow Adjournment.