Other Questions

Hospital Waiting Lists

Aindrias Moynihan


6. Deputy Aindrias Moynihan asked the Minister for Health his plans to reduce gynaecology waiting times in Cork University Hospital. [20992/16]

People in Cork are enduring the longest and slowest waiting list for gynaecological services at Cork University Maternity Hospital and this needs to be dealt with. Currently there are 3,858 people on the outpatient list, which is double the size of the list anywhere else in the country. Some 1,213 are waiting over a year and of those 371 are waiting for over a year and a half, which is almost as high as every other list combined. There is clearly a Cork problem that needs to be dealt with in the interests of these women.

I thank the Deputy for raising this important matter. I understand from data provided by the National Treatment Purchase Fund, NTPF, that at the end of June 2016 some 3,859 patients were waiting for gynaecology outpatient appointments and 458 were waiting for inpatient or day case gynaecology procedures at Cork University Hospital. While these figures represent a welcome reduction on figures at the end of June 2015, there is a need to address the issue of waiting lists in a much more focused manner.

The Deputy will appreciate that ensuring timely access to health services is a key challenge and concerted efforts are being and will continue to be made to improve the current situation. My Department is engaging with the HSE in regard to the development of an action plan for each hospital in order to address waiting times. Individual hospitals will be required to develop process improvement plans which will focus on improving chronological scheduling, validating waiting lists and ensuring that existing capacity is optimised and maximised, although I am not sure it always is, to be frank. The action plan will be implemented over the remainder of 2016. Within the HSE, a scheduled care governance group has been established to co-ordinate key initiatives in order to reduce waiting times and the number of patients awaiting treatment.

Given it is an issue his party feels strongly about, I draw the attention of the Deputy to A Programme for a Partnership Government, which commits to a minimum of €15 million in funding for the NTPF in 2017 to address waiting lists for those waiting longest, as part of a continued investment of a minimum of €50 million per year to reduce waiting times. My Department is currently engaging with the NTPF and the HSE to deliver on the programme's waiting list commitments. In fact, I met with the CEO and chairman of the NTPF in the past two to three weeks to put them on notice that they are very much being reactivated. I told them they should expect to receive a minimum of €15 million in budget 2017 in order to get on and do what they were doing - a very good job in terms of clearing waiting lists - and I asked their views in addition to the views of the HSE and the Department of Health on how best to maximise the €50 million that will become available for waiting list initiatives. I will look into the specific issues raised by the Deputy.

While these people are waiting on this massive list, it is seriously impacting their quality of life and is very distressing. The Minister referred to the NTPF, for which €15 million will be put in place in 2017. This is 2016. Since the beginning of the year, the number of people in Cork who are waiting over a year and a half for surgery has grown from zero to 39. By the time the NTPF has come into place, that number will have grown again and perhaps even doubled.

Has the Minister considered appointing additional consultants, given none has been appointed in the south-south west hospital group since this hospital was established seven years ago? In spite of the fact that 28 posts are advertised in the remainder of the country, the place with the largest waiting list and the most distressed women is left with no additional consultants. Has the Minister considered the possibility of using the under-used theatres that are available, given four were built and only one is being used for gynaecological services, while another is vacant? This needs to be dealt with in the interests of these highly distressed people, their families and those around them.

I thank the Deputy and take his point. It is cold comfort to people on waiting lists today to hear that the waiting list for this very procedure has fallen significantly in that hospital, given 4,622 people were waiting for this outpatient procedure in Cork University Hospital in June of last year and this is now down to 3,859. The figure is still much too high but it is a reduction, and I acknowledge the work being done by the hospital in that regard.

What people do not want from the Minister for Health is tea and sympathy; what they want from me is action. I have taken action and, in particular, I have taken four actions in regard to waiting lists. First, I have secured an additional €500 million for the health service, the overwhelming bulk of which will go to our acute hospitals, which will enable hospital managers in hospitals such as Cork University Hospital to do what they are well paid to do, which is to get on and manage and to do some of the things the Deputy is asking that they do. Second, I have put in place a small endoscopy initiative this year with the remaining funds available to the NTPF, which is something we can do now. Third, I have put the NTPF on notice that it is going to receive a minimum of €15 million in the budget in October. Fourth, we have a commitment in the programme for Government for at least €50 million for dedicated waiting list initiatives. I agree we have to tackle this but I must be realistic in terms of what can be done.

I thank the Minister for the outline of the actions he is taking. In the meantime, there needs to be a clear path for these highly distressed people who are languishing on waiting lists for far too long. What the Minister has outlined is helpful. However, is there some way of advancing the NTPF so that people will be able to enjoy the benefit of it this year and get off the waiting list?

With regard to consultants, unlike every other part of the country, the south and south-west, where the largest and most distressed group of people is located, does not seem to be getting anything and nothing is coming down the track. Will the Minister make appointments to relieve the pressure? The unused theatre should be available to relieve distress. There are people on waiting lists throughout the county and this is impacting their quality of life. For example, there have been delayed diagnoses of cancers due to the wait, which is seriously impacting quality of life.

I take very seriously the points made by the Deputy. It is very serious for people awaiting these procedures and people are waiting too long. This is why we need a concerted effort to tackle waiting lists and why all of us in this House need to work together in the Estimates process to make sure we adequately resource our health service and the NTPF, as well as our hospitals, to address these issues.

I will specifically raise with the hospital group CEO the issue the Deputy raises in regard to the unused theatres and the consultant posts, and I will pass on his comments in that regard. I reiterate that I have asked every single hospital to put in place an action plan for waiting lists. I have asked what they are going to do in their individual hospitals between now and the end of this year to get on top of waiting lists. We cannot have a situation where the Oireachtas last Thursday voted through an additional €500 million for the health service yet waiting lists continuing to rise. We need to make sure that when the money leaves the gates of Dáil Éireann, it is spent absolutely in the interests of patients and on some of the other very important issues the Deputy has highlighted.

Hospital Waiting Lists

Michael Moynihan


7. Deputy Michael Moynihan asked the Minister for Health the reason for the substantial increase between December 2015 and May 2016 in the number of outpatients waiting more than a year for a consultation in Cork University Hospital. [20984/16]

I raise the question of the substantial increase in the number of outpatients awaiting a consultation in Cork University Hospital. CUH. Is the Minister aware of the explosion in waiting times for outpatients and what plans will he outline in that regard? I want to tease through what can be done to try to reduce those figures.

I thank the Deputy for introducing the question. I have been made aware by him that the number of patients waiting over a year for an outpatient appointment in Cork University Hospital has increased since the end of last year. However, these increases must be seen in the context of the overall increased demand for care and increased overall activity and productivity in our health system. In fact, it was brought to my attention only today that 13,500 more elective surgeries have been carried out in the Irish health system this year than was the case last year, so we are seeing increased demand, increased activity and more procedures. Nonetheless, it is a key challenge for us to ensure timely access to health services and I am assured by the hospital group that those patients whose clinical needs are most urgent are prioritised.

The Deputy will be aware that improving waiting times for scheduled care is a priority for the HSE, my Department and, indeed, for the whole of Government, as I outlined to the Deputy's colleague. A Programme for a Partnership Government recognises the need for a sustained commitment to improving waiting times, with a particular focus on those waiting longest. To that end, it commits to €15 million in funding for the NTPF for an initiative targeted at those waiting longest as part of a continued investment of €50 million per year to reduce waiting lists.

I believe the policy of effectively deactivating the NTPF was a mistake.

We are beginning to see the consequences of this in terms of not having a ready made vehicle that can intervene in some of the particularly difficult situations highlighted by Deputy Moynihan. This is why we need to get it back up and running and the Deputy's party and my party agree on this.

The HSE has established a scheduled care governance group to co-ordinate key initiatives to reduce waiting times and the number of patients awaiting treatment. The Department is engaging with the HSE on the development of an action plan, asking each hospital what more it can do to address waiting times, to be rolled out over the remainder of 2016. I am conscious of the fact that for the first time in years the director general of the HSE has stated he has enough funding to deliver the service plan in front of him. Hospitals will be instructed to develop and implement process improvement plans, focusing on improving chronological scheduling, clerical and administrative validation of waiting lists and the optimisation of existing capacity. I expect this targeted approach, as well as the additional funding we now have available, will be of help to CUH in addressing the current backlogs.

The Minister is aware that last week serious life-saving surgery had to be cancelled as a result of the bed crisis at CUH. Everything is backed up. First consultations are backed up as are second consultations and when it comes to surgery, this is also backed up or stopped. Not only is this at Cork University Hospital but it is throughout the Cork region. In many instances, the waiting times for initial consultations have exploded. The Minister spoke about the head of the HSE stating there is enough funding. What is the Minister's thinking on getting to grips with the waiting lists for initial consultations? When a letter goes from a GP to a consultant seeking an appointment for whatever trauma or illness the patient has, what is the Department's direct plan of approach in conjunction with the HSE to ensure the patient is dealt with in a timely fashion?

I thank Deputy Moynihan who made me aware of the very difficult and serious case of somebody's surgery, which I have had investigated. The very honest answer to the question is that we have a health system which lost 12,000 staff during the years of economic recession in the country and we have put back 6,000 of 12,000 staff but we need not pat ourselves on the back because we need at least another 6,000 to get us back to where we were before the financial collapse. Continued investment in our public health service to ensure there is adequate capacity in terms of staffing numbers, consultant posts, as Deputy Moynihan's colleague mentioned, and front-line staff is absolutely the answer. This is in regard to the specific question about ensuring someone receives an initial consultation. If the person needs a procedure after this initial consultation, how do we make sure this can be done as quickly as possible? I do not think now should be the time for ideological debate. It needs to be a time for pragmatism. If we have a vehicle like the NTPF, which can assist and work alongside public hospitals, it can move along the backlog. I am absolutely committed to continuing to increase the number of front-line staff. This is why we are seeing some delays because we still need more front-line staff in our hospitals.

The initial consultation is the subject of the question and any necessary follow-up treatment or surgery is as a consequence of this. Targets were set for waiting times by previous Ministers for Health. Are these targets somewhere in the clouds? Are they real or imaginary targets? Is the Minister for Health setting higher targets to try to clear the list? The initial answer to the question was about the seriousness of the referrals but many seriously ill people are awaiting referrals and initial consultations. The Minister should not be under any illusion that the most serious cases are getting to the front at the start because this is not the case.

According to NTPF data, 60% of patients wait for less than six months for the required outpatient appointment or inpatient day case procedure. At present, 91% of patients wait less than the maximum waiting time of 15 months for inpatient or day case procedures and 92% wait less than 15 months for outpatient appointments. We need to continue to do better but we need to not tie ourselves up in knots about targets. We need to recognise that particular hospitals have particular backlogs and examine what interventions can take place there on the ground with proper management. This is the idea of the action plan.

There is another side to this, which is whether some of these procedures can take place outside of hospitals. An initiative we are carrying out is to ensure minor operations can be carried out by GPs in the primary care setting. At present, 24 GPs are participating in a programme which will see 10,000 minor operations redirected out of hospitals and back into primary care settings. Above and beyond this, there is also a diagnostic service, particularly with regard to ultrasounds, which is provided by GPs at ten sites nationally. There is a commitment in the programme for Government to support people in purchasing more diagnostic equipment to keep people out of hospitals and outpatient units in the first place and back in primary care.

Mental Health Services Provision

Mick Wallace


8. Deputy Mick Wallace asked the Minister for Health his proposals to end the practice of admitting children to adult mental health units and cope in an age-appropriate way with the rise in the number of children and young persons receiving acute inpatient mental health care; and if he will make a statement on the matter. [20611/16]

According to Mental Health Reform, 75% of mental health difficulties arise before the age of 25 and almost one in three young people has, at some time, experienced mental health difficulties but there are only 12 acute mental health inpatient beds for children in the south of the country. These are in Eist Linn in Cork. A young person who happens to experience a mental health crisis in Wexford may have to travel 200 km and might not even get a bed. Does the Government intend to do anything about this?

I thank the Deputy for raising this issue. He is right that many mental health problems arise at a very young age, sometimes a younger age than people like to speak about or even admit. Inappropriate admissions is a very sensitive issue. The reduction in the number of children admitted to adult psychiatric units continues to be a priority for the HSE's mental health services and it is a priority for me. It is something that has been raised on a weekly and daily basis.

Last week, I met the HSE specifically to review progress on this issue and to see what further improvements can be made in this regard. I will be progressing this with the HSE over the coming months, particularly in the context of opening additional child and adolescent mental health beds and enhancing community-based care for young people across the regions while additional mental health staffing comes onstream. I also intend to improve, where possible, the multidisciplinary approach at local level to ensure that existing best practice is standardised nationally. Bearing this in mind, the Deputy will have to see we have made significant improvements in recent years. In 2008, we had 247 admissions to adult units and this declined to 89. While we saw a small increase last year, we are starting to see it move in the right direction.

If we look at the figures, where a child has been admitted to an adult psychiatric unit or an inpatient unit, the length of stay has been kept to an absolute minimum. The child is generally 17 to 18 years of age and while I am not saying this is okay or appropriate, we need to continue to put a variety of measures in place to see these figures reduce. Our target is 95% and I would like it to reach 100%.

I am sure the Minister of State is aware that under A Vision for Change, the idea was to introduce community mental health teams to reduce the need for acute inpatient mental health care. As the head of the Psychiatric Nurses Association of Ireland, Mr. Des Kavanagh, recently stated, community-based mental health services remain a mere aspiration. Surely the Government must target this area much more. While we are complaining about the lack of facilities for inpatient mental health care, we all agree that unless the State is prepared to invest in community care and start actively working towards it now, we will not address the problems. I come from the county with the highest suicide rate in the country. This is directly linked to the fact we have more than 20% unemployment and more than 30% youth unemployment. Sadly, we do not have the necessary facilities for people at community care level or for inpatient care. For want of a better word, Wexford is a deprived county and problems in deprived areas, such as County Wexford, must be specifically addressed.

I agree with the Deputy that we are nowhere near where we need to be. As he rightly pointed out, we have four acute inpatient child and adult mental health services, CAMHS, units in Dublin, Cork and Galway. We have additional resources and facilities, which means we have 69 CAMHS teams.

While I admit they are not all full, we need to get to a position where the teams are full and we have an adequate number of staff. If one looks at the figures it will be seen that the overall demand for CAMHS is rising. In January 2,325 people were seeking the service while in May 2,612 were seeking it. While those figures have increased, if one looks at the number of children admitted to the HSE adult inpatient units, in April there were 12 but that figure has now decreased to six. In that regard, we are moving in the right direction, but a lot of work needs to be done. Specifically, A Vision for Change is being reviewed. A tender has gone out to carry out that review, which I hope will happen by the end of the year. That vision has not changed. We need to start moving towards a more community-based model.

With regard to the Connecting for Life document, which specifically deals with suicide, there is a youth pathfinder project team which is dedicated to implementing the youth element of that. We need to tackle the youth element of suicide and the problems arising at a younger age because if one tackles them at an earlier age, they are less likely to become problematic later.

I accept that there have been some improvements in certain areas. I note a statistic that in 2011, 31% of child admissions were to adult units, compared to 28% in 2015, so that is to be welcomed. Sadly, however, there continues to be a huge challenge in the area. I do not expect the Government to be able to solve everything overnight. In Wexford, for example, there are a lot of different groups involved in dealing with the challenges of mental health issues, many of which are charities. We have heard a lot of talk about charities in the past couple of weeks, but the HSE is outsourcing a lot of work to charities that it should be doing itself. We are trying to co-ordinate a range of groups and charities involved in mental health issues in Wexford at the moment. One group involved is in the Campile area. Two girls working in a pharmacy in Campile highlighted to me their shock at the number of young people coming into the pharmacy and accessing prescribed drugs to deal with mental health issues. It has grown dramatically. The State has to play a stronger role. The idea of the HSE outsourcing some of this to charities is not working very well. There has to be a hands-on and more active approach on the part of the State.

I will allow Deputy Kelly to make a short intervention before I come back to the Minister of State, if that is okay.

The admission of young people to adult facilities is a scandal. In fairness, funding is now ring-fenced for mental health arising from action taken by the Minister of State's predecessor. The figures are also being addressed. The Minister of State is doing her best and any support she needs she will certainly get from our side of the House because community intervention is necessary. However, I ask her to provide the House with the complete figures for the number of people accessing adult facilities, including where and by what region. Some one in five teens report moderate to severe depression in his or her final two years of being a teenager. A very good programme called the Jigsaw proposal was rolled out by Headstrong. I ask the Minister of State to support it and to advise the House about the roll-out of this proposal and its timelines. I understand a number of different areas are interested in it. Will she support their endeavours?

Regarding the figures, in 2015 there were a total of 356 child and adolescent mental health admissions, of which 73% were to age-appropriate units and 27% were to adult units. In May 2016, the most recent figures available, 97.2 of the bed days used were in child and adolescent inpatient units, which is an improvement of 95.4% on April. Our target is 95%. We are steadying out at the moment. I admit that any kind of inappropriate admission is not acceptable, which is why we need to continue to work on increasing our beds and staffing and to make sure that we have community-based care so that children do not need to go into acute services. In that regard, as I have already mentioned in the Chamber, the youth mental health task force, which I will announce next week, will tie in the voluntary, private, public and all the different sectors together to work together. I would very much like to get to the stage where we do not need charities to provide these services. We will have succeeded if we get to that stage, but we are a long way from there, so we need to work together. That is exactly what the youth mental health task force will aim to do.

Deputy Buckley, one very quick comment-----

What about Jigsaw? I apologise, but my question was not answered-----

I let the Deputy contribute. I want to let-----

A number of new Jigsaw programmes are coming down the line. It is not possible for every area and not every area wants or needs one. I was in Carlow only last week, which has an excellent service but it is not necessarily needed. If an area would like the service, those concerned need to work on that themselves. If they do not, then there are other services.

I want to put on the record of the House that I agree predominantly with Deputies Kelly and Wallace. Unfortunately, at one stage, my own town was known as the suicide capital of the world, so Deputy Wallace and I know where we are coming from. A Vision for Change is ten years old. Recently the PNA and the RCSI have said that A Vision for Change is still perfect. I could make the relevant points that have mostly been made already, but there is a growing fear out there within communities that the Government intends to scrap A Vision for Change and will seek to enter into a more privatised model using its own failure to implement reforms as an excuse. The people to whom I have spoken have said that this would be totally unacceptable. I wish to put on the record that we need to implement the plan. Let us not talk about reviews any more. I ask the Minister of State to implement the basic elements of A Vision for Change, such as the 24-7 crisis intervention and the five-day week changing to seven-day week intervention houses. At the moment there is not one crisis house in any community in this country.

The fundamentals of A Vision for Change have not changed and will not change. The review has to make sure that we do not just focus on mental illness; we need to focus on health and well-being and move more towards the community setting. The review is taking place and the tender has gone out. We hope that once the tender is approved and the review is finalised at the end of the year, in tandem with that we will still be implementing A Vision for Change. As I said, the document and the fundamentals have not changed, but we need to start moving towards a more preventative model, instead of the reliance on institutions. I believe we are doing this. I take on board what the Deputy says.

Hospital Waiting Lists

John Brassil


9. Deputy John Brassil asked the Minister for Health his plans to address the waiting times for cataract surgery in County Kerry. [20963/16]

I raise this topic because I was recently contacted by my local GP about an 84 year old man needing a cataract operation to continue caring for his wife, who has Alzheimer's disease. He needs the operation done to retain his driving licence. He is on a waiting list. It is endless and a continuous problem. Many other GPs have contacted me about this issue. It would take four years to clear the current waiting list. The services were transferred from Cork University Hospital to the South Infirmary and the waiting lists have gone from bad to worse. I ask that the Minister address this issue, which has a huge impact on the people in County Kerry.

I thank Deputy Brassil for raising this important matter with me. He has brought it to my attention personally as well. As I have said to some of the Deputy's colleagues, a key challenge for the health services is to continue to ensure timely access to them while at the same time recognising that there is a constant increased demand on them. In that regard, I have been assured that the HSE seeks to ensure that those whose clinical needs are most urgent are prioritised accordingly, while the needs of others are assessed in terms of those waiting the longest. Therefore, in the case referred to by the Deputy of an 84 year old gentleman, people should be able to look at that situation locally and clinically and see the importance of that procedure.

Improved waiting times for planned or scheduled care for all patients is a key priority for the HSE, my Department and the Government, and I will not repeat what I have said to some of the Deputy's colleagues already regarding our plans to reactivate the National Treatment Purchase Fund, NTPF, and to put additional resources into dedicated waiting list initiatives, involving a minimum of €50 million in the budget due to be delivered in October. Only this week my officials have been meeting with the NTPF and the HSE to draw up terms of reference to make sure that we are ready to roll out the programme as quickly as possible, once budget 2017 has been implemented.

On the Deputy's query regarding the position in County Kerry, while 155 patients with addresses in County Kerry are awaiting cataract procedures, the waiting list has decreased by 20% in the past 12 months. I am also informed that the South-South West Hospitals Group is developing a single ophthalmology service operating on two sites, to which the Deputy alluded, at University Hospital Waterford and the South Infirmary Victoria University Hospital, Cork. To particularly try to assist patients from County Kerry, the group is also exploring the introduction of an imaging system to enhance and streamline ophthalmology services for patients seen in County Kerry. I will ask the relevant officials to investigate the specific case if the Deputy will provide me with the details. Although there has been a reduction in the waiting list of approximately 20%, I accept that there is much more to be done.

I thank the Minister and will bring the case to his attention, given that it urgently needs attention. I will give him some figures, given that he likes to deal with facts. In 2015, 680 patients were seen in the South Infirmary Victoria University Hospital, of whom 98 were from County Kerry and 582 from County Cork. While I do not want to get into a turf war, the figures speak for themselves. While 14.4% of the patients were from County Kerry, 85.4%, or six times that number, were from County Cork. The population of County Kerry is 145,000, compared to 519,000, or three times that number, in County Cork. Given that the size of the ageing population in County Kerry is greater, the need should also be greater. However, we are only seeking parity and something is not adding up. People from County Cork are being seen quicker. The facts and figures speak for themselves. I ask the Minister to investigate the matter.

The Deputy will understand if I do not get into a turf war either. His leader probably would not appreciate my becoming involved in a Cork v. Kerry spat. The Deputy's point is very serious about ensuring equity of access to the health service. The idea of the hospital group structure is not to look at the local hospital or county but to take a geographically wider view. This is why the South-South West Hospitals Group has been established. It is considering an additional imaging system which could be put in place to enhance and streamline ophthalmology services for the people of County Kerry. There could be some benefit to it. There has been a significant reduction in the waiting list in counties Cork and Kerry being grouped together. I want to see a further reduction in waiting lists, which is why I intend to roll out a number of new waiting list initiatives shortly.

We are trying to improve services. The service has moved from one hospital to another. Perhaps it might be worth examining whether the reconfiguration of services has resulted in a reduction in waiting times. If it has not, it should. We must hold a department to account. I am sure there was much lobbying to have it provided in one facility. It is now in place and we need to get it working. Is the NTPF for inpatients only or does it also apply to outpatients? If it does not, perhaps we might have this discipline included in it.

I will do as the Deputy has asked and have the change in waiting times examined. I have had a very open conversation with the NTPF. Its terms of reference are broad. It exists to carry out specific tasks as are assigned to it by the Minister for Health of the day. I have asked that we have a conversation about other areas where it considers it could make a difference. The optimal position which we want to reach is one where the public health service meets the demands of public patients. However, I also acknowledge that the Deputy and a number of his colleagues on both sides of the House constantly raise the fact that there are a number of acute cases where patients have been waiting extraordinarily long times for procedures. Although they are often relatively basic procedures, they could make a major difference to their lives. If the NTPF is a useful and pragmatic way to address this issue, I am very open to it. I will have the issue examined.

A number of questions have been tabled in the names of Members who are not present. I remind Members that, unless they have designated somebody to take a question, I cannot take it and must pass over it.

Health Services

Maureen O'Sullivan


10. Deputy Maureen O'Sullivan asked the Minister for Health his views on whether proper protocols were followed in a case (details supplied); and his and the Health Service Executive's plans to amend guidelines and best practice standards to ensure persons at risk are dealt with promptly. [20612/16]

There are two aspects to my question, one of which relates to a particular individual. Because of what happened to the individual, the question is whether there is a need to amend the guidelines and best practice standards in order to ensure what happened to this individual will not happen to somebody else and that cases such as this which involve people at very high risk are dealt with more efficiently and promptly.

While it is the policy of the Health Service Executive not to comment on individual cases, I can confirm that the circumstances surrounding the case referred to by the Deputy are being examined by the HSE. On the specific issues raised by the Deputy, I am advised by the HSE that quality and patient safety are the responsibility of all staff and core to service provision across primary care services, including addiction services. The HSE addiction service is working towards implementation of the HIQA National Standards for Safer Better Healthcare, which provide for a strategic approach to improving safety, quality and reliability in national health services.

Services providing opioid substitution treatment operate from relevant clinical management guidelines and protocols, including the UK National Institute for Health and Care Excellence guidelines on methadone and buprenorphine for the management of opioid dependence, the relevant Irish College of General Practitioners guidelines and the national drugs rehabilitation framework. In line with these guidelines, the ongoing treatment of an individual involves regular assessment of risk and appropriate responses to any identified risk.

Arising from recommendations made in the introduction of the opioid treatment protocol of 2010, a clinical guideline for opiate substitution treatment has been drafted by a HSE-led committee which includes clinical expertise. These are the first national guidelines that specifically relate to opiate substitution treatment in HSE clinics and primary care settings. The guidelines are under consideration by the quality improvement division of the HSE and expected to be finalised shortly.

A national hospital discharge protocol for homelessness has been approved. The aim of the protocol is to ensure clear procedures are in place between health services, local authority homeless action teams and the voluntary sector. It is important that all discharges from acute and mental health care services of persons experiencing homelessness or at risk of homelessness are planned in order that the necessary accommodation and supports will be in place prior to discharge.

I thank the Minister of State. I have been trying to pursue the case for 18 months and obtain information. The answer I kept getting was that the services did not know where the person in question was. There is no doubt that the person was on a significant downward spiral and that her life was at major risk. However, she was attending various services, sometimes with extremely chaotic behaviour, for which I allow. She was in the care of the HSE from when she was aged under 18 years. Her two children were also in the care of the HSE. Given that she was registered as homeless, there were default addresses for her. She was attending a methadone clinic, a needle exchange clinic and her family doctor in Dublin 8. She was a regular patient at St. James's Hospital and James Connolly Memorial Hospital in Blanchardstown. She was in contact with her solicitor and although her solicitor was in touch with the HSE, it did not contact the solicitor to try to find out exactly where she was. Although nothing will bring her back, there must be reassurance that all measures were taken that could have averted her death. While there will always be questions of "what if" and "if only", her family needs to know that they have been covered and it needs the information.

As stated, this is being examined by the HSE. I understand the Deputy's frustration because I read some of the other notes on the case. Deputy O'Sullivan is right in that the person in question was receiving services in different centres throughout the city. Unfortunately, my reading of it is that she fell off the radar. There are certain circumstances surrounding this case that need to be examined. I hope the Deputy will be find it acceptable if I tell her that I will pursue it again with the HSE to try to get a further sense of the issues and of what exactly happened to this person. It is a very sad case.

I thank the Minister of State and note that I had a call from the HSE on this matter. It is important that we learn from this case. The lesson is about joined-up thinking. There has to be cohesion between HSE addiction services, The Drug Treatment Centre Board, primary care and homeless services, the family, and, if involved, the solicitor, particularly if it is a person who is at high risk and everyone knows it.

There is probably a need for a centralised database because people can go from one primary care area to another. There should be a record of where exactly they are to avoid confusion between the various areas. I accept this person was chaotic and moved about considerably. However, I believe - as I know the Minister of State does too - there is a possibility of recovery in every person who is in addiction. All the policies, plans and strategies sound great on paper but it is only when they are applied to a particular person that we see if they are working, can they work and where we need to go.

Home Help Service

Robert Troy


11. Deputy Robert Troy asked the Minister for Health his proposals to increase the number of hours under the home help scheme and the number of home care packages in counties Longford and Westmeath. [20977/16]

Deputy Troy has 30 seconds to introduce the question.

I think we will all agree that the best place for our elderly and people with a disability is in their homes. I have a grave concern about the provision and availability of home help hours. Will the Minister outline in detail the number of home help hours that are available in counties Longford and Westmeath?

I thank the Deputy for his question and agree that we will all live longer, healthier and happier lives if we live in and are part of our communities. The HSE provides a range of community-based services aimed at ensuring older people receive safe, timely and appropriate care and treatment at the lowest level of complexity and as close to home as possible.

Home support services in Longford and Westmeath, similar to the experience elsewhere throughout the country, are being stretched by demands from people for more hours at times outside of core hours, in the evenings and at weekends, which all cost more. Thankfully, the Government has been able to respond to this demand by providing an extra €40 million for home care in 2016. The targets for 2016 are being reviewed in light of these additional resources.

There is no doubt that home care needs more resources than are currently available. For this reason, the programme for Government commits to increasing funding for home care packages and home help year-on-year in the coming period. There is always more that can be done in these crucial areas but it represents a step in the right direction. I am happy that we have been able to respond to the problems that have arisen this year.

On the two counties mentioned, all I can say at the moment, having only voted through the Estimates last week and the additional €40 million in funding, is that the HSE is engaging with the local community healthcare organisations, CHOs, to see how this support can be provided. The additional support should be distributed where it is needed.

I do not know how the Minister of State can be happy to say she has responded to this issue. The hours in Longford-Westmeath have been cut. If someone who had ten hours passes away today, only 25% of those hours are reallocated. I can give the House three examples in my constituency. The first is of a gentleman who is wheelchair bound and whose wife, his primary carer, died of cancer three months ago. He has been approved additional home help hours to keep him out of a home, yet no additional home help hours became available.

The second is of a woman in her late 80s who was discharged out of St. Vincent's Hospital in Athlone and who has to be lifted in and out of bed in a hoist. She has only two sons. Where is the dignity in a woman in her 80s having to be cared for by her two sons? She has been approved home help hours but she has received none. She is facing the real possibility of having to go into a nursing home.

The third example is that of a gentleman in County Longford. This man is being fed through a percutaneous endoscopic gastrostomy, PEG, is confined to a wheelchair and is doubly incontinent. His sister took retirement to provide him with full-time care. He spent eight weeks in hospital. He has been approved home help hours but he has only received ten of the 20 hours approved. His sister was made swear an affidavit that she would take him out if he was taken in for two weeks' respite. The woman is at breaking point. She cannot take him home.

I do not know how the Minister of State can say she is happy that she has been able to respond.

We all recognise that there are serious problems in the system. When I say that I am happy, I mean that I am happy we have been able to allocate an additional €40 million in funding, which will help in the different cases mentioned by the Deputy. Unfortunately, we all know of similar cases within our constituencies. They are brought to my attention daily. As I pointed out, the Estimates were only voted on last week and it will take a number of weeks for this to make its way through the system. However, with that additional funding, the service plan for this year will be able to target 10.4 million home help hours, which will support 47,800 people. It is estimated that approximately 21,000 people will now benefit from the initial figure of 15,450 home care packages. It also means that we can increase our base for next year. While our base for home care help and packages was €331 million, it will increase to €371 million. We have given a commitment in the programme for a partnership Government to increase it year-on-year, so that figure will only get bigger. I am not happy with the current situation, but this is a step in the right direction and we need to continue moving in that direction.

Things are not getting better, they are getting worse. If additional hours are being made available and additional money is available, why is it that only 25% of existing hours which have been in place for the past six, 12 and 18 months is being reallocated? How is it fair that only 25% of existing hours is being reallocated? How is that equitable? How will it keep as many people in their own homes, which is something we want? If they are not supported, these people will end up in long-term nursing home care. This will cost more money in the long run.

It makes economic sense and good social sense to keep people in their homes. The Minister of State said that €40 million has become available. When will we see the benefits of it? When will the people of Longford-Westmeath to whom I referred get their home help hours? Saying we have made money available is no good, it does not wash for the people who need the hours now.

I will allow Deputy Alan Kelly to make one very quick comment, because two other Deputies are waiting to ask their questions. I ask him to keep it brief and will then go back to the Minister of State for a final contribution.

Deputy Troy is right. I welcome the €40 million, but there is a gap period and we are not seeing this funding on the ground. HSE officials tell me that when it is distributed it will only bring the hours back up to a certain level, which is only a drop in the ocean. That is what the Minister of State's officials are saying. I am telling her the truth.

I know of a lady in Newport who has dementia and a terminal illness. She is to get ten hours. It is an incredible scenario. I had to fight to get it increased from five hours to ten. My real point is that this is financially the most solid thing the Government could do. It costs €7,000 if a person is kept, bed blocking, in a hospital. It costs on average €1,500 to have someone in a nursing home versus €500 for the cost of a reasonable amount of home help. This is socially the right thing to do, but financially it is also the right thing to do. I ask the Minister of State to please go back and get adequate funding for this service.

The Minister of State has 30 seconds, but we need to move on.

I fully agree with the Deputies. We know that in the first quarter of last year there was a significant increase in requests for home help and home support. To ensure that number did not drop this year, funding was allocated which meant significant additional funding had to be allocated. This is the €40 million to which I have referred. I believe this will not just level out the same funding from last year but will see an increase. I am not saying it is enough.

The Minister has made it very clear that he has spoken to the different hospital groups to make sure they stay within their budgets. The more they stay within their budgets, the more it allows us to put more money into the home help service and home care packages, which will see a change in where the funding is being allocated and that will result in a saving all around.

I will take Question No. 13 before Question No. 12, with the agreement of the two Members who tabled those questions. Deputy Barry has 30 seconds to introduce his question.

Health Services Provision

Mick Barry


13. Deputy Mick Barry asked the Minister for Health his views on the continuing depth of involvement of religious organisations in providing State-funded health care, on the separation of church and State, and if he will make a statement on the matter. [21000/16]

Does that mean that Deputy Connolly will get an opportunity to speak after me?

Yes. There will be time for her question if we adhere rigidly to the time allocated.

I will do that and I appreciate this. My question is to ask the Minister for Health for his views on the continuing depth of involvement of religious organisations in providing State-funded health care, on the separation of church and State and if he will make a statement on the matter.

I thank Deputy Barry for his question. Voluntary and non-statutory service providers, including religious orders, have a long history of providing health and personal social services in Ireland and of receiving State funding to provide such services. I would like to acknowledge the significant contribution of all such providers to the delivery of these essential services. I remarked earlier in this House that were it not for some of those voluntary service providers, one wonders how many of our people would have been cared for throughout the years in this country in terms of disability services, mental health services and other services.

The HSE, however, has a statutory responsibility - one cannot delegate that - for the management and delivery of health and personal social services. As well as providing services directly, the HSE enters into service agreements or arrangements with service providers to provide such services on its behalf. As Minister for Health, my priority is ensuring that all of the resources available to the HSE are used in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the Irish public. To that end, the HSE has a formal national governance framework which governs grant funding to all service providers under sections 38 and 39 of the Health Act 2004. This framework seeks to make sure that governance systems are sufficiently robust and effective to ensure that both the HSE and the grant-funded agencies, be they religious orders, irrespective of denomination, or other voluntary or non-statutory service providers, meet their respective obligations. The most critical issue for me, regardless of whether the service provider is a religious organisation, is whether the service is being provided for which we the taxpayer, through our health service, are paying.

I do not have an ideological position on the involvement of religious organisations in the delivery of health care. I believe there is scope for diversity in the range of service providers delivering health care - that has always been the way in this country - but that service must be delivered and, let me be clear on this, in line with Government health policy, legislation and the responsibilities attaching to the use of public funding. Once an organisation is complying with our health policy, the Government's policy, the legislation passed by this House and the responsibilities attaching to the use of the public money, the matter of whether the service provider is a religious or non-religious organisation is not something that keeps me awake at night.

The Minister is right in saying there is a long history of provision of health care by such service providers but we are now in the 21st century. The Minister said the key issue is the whether the service is being provided, so let us get down to the nitty-gritty on that. I refer to an article in The Sunday Business Post of 9 May. The headline stated: "Catholic ethos restricting St. Vincent's Hospital from procedures." The article stated that doctors working at St. Vincent's Healthcare Group in Dublin are being restricted from carrying out procedures that are contrary to Catholic ethos. It stated that gynaecologists and urologists said they were not allowed to perform procedures such as vasectomies and tubal ligations for patients who want to permanently prevent pregnancy. It further stated that the doctors contradicted assurances given by management which had insisted there were no restrictions stopping its doctors from performing these procedures. Doctors at the Mater Misericordiae University Hospital in Dublin city centre said they faced the same restrictions. It also states that the Mater hospital and St. Vincent's hospital receive €450 million in State funding between them each year. Mr. John Thornhill, the President of the Irish Society of Urology said vasectomies were "not allowed in hospitals in the public sector with a Catholic ethos". Would the Minister care to comment on that?

As I said very clearly already, my responsibility as Minister for Health is to make sure that we are delivering the services that the Irish public require in terms of their health and well-being. My responsibility is to ensure that the funding this House approves for me to expend on the health service is disbursed by the HSE, either spent by it or disbursed to voluntary organisations, and that we get value for money and get the services that we pay for and require.

I set health policy on behalf of the Government; nobody else and no religious order sets health policy. Therefore, I feel very strongly, and I share Deputy Barry's view on this, that where the HSE or the taxpayer is funding the service, it is this House and this Government that set the policy and not any other house or any other type of governing body.

There is obviously an issue of conscientious objection and that may be the issue to which the Deputy is referring. That could potentially arise in the context of the provision of treatment and services in health care facilities run by religious organisations. The European Court of Justice has outlined that this conscientious objection remains a limited right derived from religious freedom that cannot lead to the restriction of the rights and freedoms of another person. However, a health care professional's conscientious objection absolutely does not absolve his or her duty of care to the patient. Therefore, he or she could not abandon the patient or cause the patient's care to suffer in situations where such a transfer would not be possible. This is in line with the approach outlined in the Medical Council's guide to professional conduct and ethics which facilitates the transfer of a patient from one doctor to another.

A dedicated State-funded service with the specific remit of catering to homeless pregnant women has been provided by a so-called pro-life organisation, Life Pregnancy Care, which recently branded itself as Anew, and now claims to be multidenominational. According to its audited financial statements for 2014 provided to the Companies Office in November 2015, its directors include Lorcan Price, who is also a director of the Pro Life Campaign. In 2014, the HSE gave Anew, formerly Life Pregnancy Care, nearly €0.5 million in funding, 83% of Anew's total budget. Would the Minister care to comment on that?

I will have a look at the information the Deputy has made available to me and I will revert to him directly on it. I recently met people involved in the Termination for Medical Reasons, TFMR, group, and we had a discussion on a number of issues regarding ensuring consistency in terms of access, particularly to bereavement counselling and procedures. I have undertaken in regard to bereavement standards to make sure that phrases such as "fatal foetal abnormality" feature as opposed to just phrases such as "life-limiting conditions". I am very clear on this view. I do not care too much, to be quite frank, once the service provider provides the service but I do not want any patient in this country not to be able to access a service that is in line with my policy as Minister for Health and the policy of this House and of the Government.

Mental Health Services Report

Catherine Connolly


12. Deputy Catherine Connolly asked the Minister for Health if he has commenced the promised review of A Vision for Change, when he will complete it, the composition of the review team, its terms of reference, and if he will make a statement on the matter. [20606/16]

Could the Minister confirm whether the promised review of A Vision of Change has begun, when it will be completed, its terms of reference, the composition of the review and so on?

A Vision for Change has guided national mental health policy over the past ten years and, as the Deputy rightly said, its term has come to an end. The Department published a request for tender last month to invite parties interested in undertaking a review of A Vision for Change to express an interest in doing so. The Department's requirements are for experts to review and analyse national and international evidence and best practice in the development and delivery of mental health services. The review should also identify sites of best practice, outlining reasoning and identify how these models can apply to the Irish context. The review is also expected to assess the current delivery of mental health services in Ireland having regard to international evidence and the implementation of A Vision for Change.

It is envisaged that the review will be completed later this year. The review will provide evidence to determine the policy direction for a revision of A Vision for Change and it will have regard to both human rights and health and well-being objectives. As I said in a response to Deputy Wallace earlier, we need to move away from specifically focusing on mental illness. When the review is completed, the Department will examine the output and will then decide on the need for a monitoring group to oversee any required policy changes.

The contract will be awarded on the basis of the most economically advantageous tender. It will be split into two sections. Fifty per cent of it will be based on cost, a further 30% will be based on the quality of proposed methodology and 20% will be based on demonstrated ability by way of previous experience on the part of the tenderer to carry out the work. I hope that the review will be finalised at the end of the year. The next step will be to see whether we need an oversight group to implement the changes that will have been recommended.

I welcome the fact that we have progressed to getting a timeframe. I am very disappointed that it will take until the end of the year. The term of A Vision for Change ran out in January; the ten years were up. A Vision for Change provided for an independent monitoring commission, which sat for two periods, 2006 to 2009 and 2009 to 2012. It has not sat since then. Will the Minister of State confirm whether it will sit in the meantime while we are waiting for the review to be completed. A Vision for Change was visionary ten years ago and it remains visionary. The difficulty is it has never been implemented. It foresaw that Governments would not implement it.

That is why they asked specifically for a review after ten years to see how effective it had been and, more importantly, for an independent monitoring group to run simultaneously to monitor whether it was implemented or not. Can the Minister of State confirm the situation in relation to the independent monitoring group?

I agree with the Deputy that progress has been slower than initially anticipated but it continues to be made in implementing the report's recommendations. As the Deputy rightly pointed out, the vision has not changed. While the review is under way, we are continuing to implement the report. In recent years, the Government has provided an additional €160 million in ring-fenced funding for mental health from 2012 to 2016. That has progressed the implementation to various degrees of the actual document. While the independent group to which the Deputy refers is currently not established, it is a question I have been raising and something I would like to consider once the review is finalised at the end of the year. We need to take that time. While it might seem like a long time, it is something I could come back to the Deputy on, depending on the recommendations. We need some form of oversight committee to put in place a timeline to ensure that we are progressing at adequate speed.

While I welcome what the Minister of State said, "slow and inconsistent" was the opinion of the Mental Health Commission and the finding of the independent monitoring group. The last time the group sat was 2012 and yet the Minister of State stands up and tells me what money has gone into it. While I welcome the investment, there is no independent group to tell us how effectively it is being used and whether it is being used at all in the most efficient way possible. That was all anticipated. Now we are going forward with another review that is going to take the whole year. To me it is unacceptable. All of this was laid down in 2006 and even then it was not in a vacuum. It was based on a report going back to 1984 on planning for the future. It is extraordinary that we find ourselves in 2016 with the tender only now going out and the review group. It will not be ready until the end of the year while in the meantime, the Minister of State cannot tell me whether an independent group will be set up to monitor what has happened to date. That was part of the original recommendation. All of that said, the plan should be taken together and not piecemeal.

To reiterate, it is my view that we should have some form of oversight committee. While the review may seem like a long time, if we wait until the end of the year to implement the committee, it will have oversight of what we have implemented to date and of the recommendations being put in place by the review committee itself. We must continue to focus on moving towards a more community-based environment for our mental health services. For my part, that means working with the mental health review commission and a lot of the other organisations which have provided significant oversight on this and rightly pointed out where we are failing, where we are not and where we need to improve. It is important that I continue to work with them in that regard. My view is that once the review is completed, there should be some form of oversight committee or board.

Written Answers are published on the Oireachtas website.