Other Questions

Neuro-Rehabilitation Services

Billy Kelleher


6. Deputy Billy Kelleher asked the Minister for Health when he will be publishing a plan for advancing neuro-rehabilitation services in the community; and if he will make a statement on the matter. [38011/16]

When will the Minister for Health publish a plan for advancing neuro-rehabilitation services in the community? By any stretch of the imagination, when we consider the level of service available to people with stroke, acquired brain injury, multiple sclerosis and Parkinson's disease, we are light years away from what is necessary. In the context of a capital development plan next year, the assessment of the number of beds that will be required is also a key area that should be taken into account in the bed capacity review.

A Programme for a Partnership Government includes a commitment to publish "a plan for advancing neuro-rehabilitation services in the community."

It is recognised that the situation with regard to accessing specialist neuro-rehabilitation services needs to be reviewed. Significant steps towards finding a resolution were taken with the publication in 2011 of the national policy and strategy for the provision of neuro-rehabilitation services Ireland 2011-2015. The rehabilitation medicine programme has also been developed within the clinical strategy and programmes directorate of the Health Service Executive, HSE

A national steering group, chaired by the head of the HSE’s disability reform team, has completed an implementation framework in respect of the recommendations from the national policy and strategy. Membership of this group includes representation from the HSE national clinical programmes for rehabilitation medicine and neurology, HSE primary care, the Department of Health, therapy professions and the Neurological Alliance of Ireland. The group is currently considering feedback on the framework, which was circulated to wider stakeholder interest groups. The HSE intends to finalise and progress implementation of the framework for the neuro-rehabilitation strategy in 2017.

In addition, capital funding is committed for the redevelopment of the National Rehabilitation Hospital in Dún Laoghaire. This funding will provide a new purpose-built 120-bed hospital with integrated therapy and support services at the Dún Laoghaire campus. It is expected that construction will commence in 2017.

The Minister of State is aware of the shortage but I want to put on the record that 25,000 people a year require some form of rehabilitative services. Most of them struggle just to get the basic services. Ireland should have 270 beds for its population but we have less than half that number, and none outside Dublin. We have been campaigning for a long time - in the context of rehabilitative support beds - for services to be located outside Dublin. There should be four regional inpatient specialist rehabilitation services but we have none. There are huge deficiencies in that regard and it is urgent that the matter be addressed.

Will the Minister of State outline the steps he is taking to ensure that the implementation plan for the national neuro-rehabilitation strategy will be fit for purpose and address the concerns of the Neurological Alliance of Ireland and its member organisations? Will he clarify whether new funding will be made available in 2017 to develop the neuro-rehabilitation services in the community? Will he outline the plans that are in place to invest in the development of neuro-rehabilitation services in acute hospitals in 2017, specifically in the South/South West Hospital Group? Following his commitment to publish the neuro-rehabilitation plan in the first quarter of next year, can he confirm that will still happen? Those are my questions. I do not expect the Minister of State to reply to them in full detail.

I will deal with all the questions. I totally accept that we have to develop services for people in those situations. I have met many of them. I spoke at one of the group's annual general meetings a few months ago so I am fully aware of the issues Deputy Kelleher has raised, which are very important. We need to improve and expand services but, as the Deputy knows, that work has commenced already. I mentioned the National Rehabilitation Hospital in Dún Laoghaire but there is also a new rehabilitation unit at Roscommon hospital, and other services are being rolled out throughout the country. The Minister and I have identified the provision of services throughout the country as an important issue in terms of developing the HSE service plan. We are doing our best to ensure that those type of services are developed.

The Minister recently met representatives of the Neurological Alliance of Ireland, who are members of the steering group, along with Councillor Natalie Treacy, whose mother has an acquired brain injury. We are very aware of the situation on the ground. We are aware also of the need to develop the services. We have started on that but we need to do more, which we will do in 2017.

Could I press the Minister of State on a date for the implementation plan? He mentioned my colleague, Councillor Natalie Treacy, and the Neurological Alliance of Ireland. Sinn Féin fully supports the We Need Our Heads Examined campaign but we need a date by which we will start seeing some movement on this issue and also confirmation that dedicated funding will be allocated, and what that funding will run to. With regard to the new unit at Roscommon hospital, how many beds is it anticipated will be provided? How many hours of rehabilitative care will be provided in the unit?

On the objectives and the funding, those are already included in the HSE service plan, which is currently being finalised. We will put a priority on that. I would see us start to move on developing, opening and investing in new services as early as possible in 2017. I will have to revert to the Deputy on the number of beds involved because it is important I give her accurate information.

That would be great.

Our objective is to start moving on this as early as possible in 2017.

I have asked the questions and I thank the Minister of State for the answers but the broader issue is that there must be some regional development of services. We cannot have them located in just one area of the country, which puts huge pressure on families that have to travel long distances over a protracted period. Many families do not have much hope that their loved ones will even get access to services and that debilitates them. I ask the Minister to bring forward the implementation plan as quickly as possible. We will try to support him in getting resources to ensure they have a meaningful impact on people's quality of life.

I take Deputy Kelleher's point that we need to develop services in the regions. As I mentioned earlier, the new rehabilitation unit at Roscommon hospital is a major start.

We must ensure that we support these families. They are in a difficult position and we cannot have them travelling for services in Dublin when they are from different parts of the country. We need to be radical. We need to work closely with the organisations that are putting forward these suggestions. We need to get working on this and implement as much as possible in 2017.

Maternity Services

Anne Rabbitte


7. Deputy Anne Rabbitte asked the Minister for Health if he will provide a report on maternity services in University Hospital Galway following the departure of two key members of staff in recent months. [38043/16]

Will the Minister provide us with a report on the maternity services at University Hospital Galway following the loss of two key members of staff in recent months? The context of the question is these two key members of staff were recruited after the death of Ms Savita Halappanavar. I look forward to the Minister's comments.

I thank Deputy Rabbitte for this important question.

Regarding the two vacancies in the University Hospital Galway maternity service, the Saolta University Healthcare Group has advised that these vacancies have arisen due to the resignation of the director of midwifery in the autumn, and the untimely passing of the assistant director of midwifery earlier this year.

I am advised by the Saolta group that interviews have been scheduled for the assistant director of midwifery position, while the director of midwifery role is currently being advertised. I agree with the Deputy's sentiments that we would like to see these posts filled as quickly as possible. The point Deputy Rabbitte makes is important in terms of ensuring that we continue to learn from the past and keep in place the resources that are there. Pending the filling of these posts, the Saolta group director of nursing and midwifery has assumed responsibility for maternity services at the hospital. Furthermore, in line with the recommendations issued in respect of maternity services at the Midlands Regional Hospital, Portlaoise, a director of midwifery is being appointed for all maternity sites within the Saolta group. The group has advised that all applicable recommendations arising out of the recent review of maternity services in Galway have either been fully implemented or are being implemented on an ongoing basis.

The publication of Ireland’s first national maternity strategy earlier this year demonstrates a new and enhanced focus on maternity care at both policy and service delivery level. It provides a roadmap for how we can improve maternity and neonatal care in the years ahead in order to promote and assure safe, standardised and high quality care. I am confident that this new strategy is a landmark moment for maternity services and a much-needed one, and it will provide support and impetus to the development of maternity services across the country, including in Galway University Hospital.

I have described 2016 as a landmark year for maternity services. The reason I did that is that we now have the first ever national maternity strategy. It is the year in which we will see the new HIQA standards for national maternity services, which I have just signed off and which will be launched this month. It is also the year in which we have seen the publication of bereavement standards for when something sadly goes wrong in pregnancy, with input from women themselves and from midwives, and it is the year, thankfully, in which we will see the National Maternity Hospital finally move to a state-of-the-art site at St. Vincent's.

I thank the Minister for his response. It is important to acknowledge the untimely passing of the assistant director. In relation to the other lady who resigned her post, that was unfortunate because there was a schedule of works for completion.

I wonder if the Minister has received feedback. In relation to the Saolta report, he said that a certain number of the recommendations have been actioned. Are many still outstanding from the time of Ms Savita Halappanavar's passing? Are they all being actioned?

The Minister spoke of many milestones that have been hit this year. Will the report on Portiuncula Hospital in Ballinasloe be completed soon also?

In relation to Portiuncula, I will revert to the Deputy. I intend to visit that hospital, as well as Galway University Hospital, this month. I hope the Deputy can join me then and we can explore these issues further.

I take the Deputy's point on the importance of these appointments. It is really important that the posts are filled as quickly as possible and I am satisfied that the Saolta group is going about doing that. As I said, the interviews are under way for one and the post of director of midwifery is now advertised.

I have been assured by the Saolta group that all of the local recommendations arising from the HSE patient safety review and all of the coroner's applicable local recommendations have either been implemented or are subject to an implementation plan where ongoing implementation is occurring. I will ask the HSE and the Saolta group to revert to the Deputy with more specific information on each of those actions.

The department of obstetrics and gynaecology at University Hospital Galway serves the population of Galway city and county, but also the surrounding areas of Roscommon, north Clare and south Mayo. It provides a range of general and specialist gynaecology and maternity services, including feto-maternal medicine for high risk pregnancies, while also catering for low-risk pregnant women. It provides a wide range of services, including fertility outpatient services. The unit has a state-of-the-art neonatal intensive care unit following a major refurbishment project in 2011. The department is also a partner with the CervicalCheck programme and runs a busy colposcopy service.

I look forward to visiting it and having a chance, at first hand, to see these services and to be updated that all of these recommendations are well under way, as I have been assured they are. I will ask the HSE to revert to the Deputy with specific information on the status of each of those recommendations.

I thank the Minister for his kind invitation to join him in Portiuncula and Galway hospitals, which he intends to visit in the next month. His visits will be welcome.

In addition to everything the Minister said, it is also important to acknowledge the hard work the nurses are doing. They are delivering a fantastic service and it would be remiss of me not to acknowledge it.

Deputy Rabbitte's point is really important. I have visited many of our maternity hospitals and maternity units over the past six months where so many staff are working extraordinarily hard. While, sadly, we have had tragedies in our maternity services and we must constantly strive to do better, and I have outlined what we will do better, we must also acknowledge the dedication particularly of the midwives. I was so impressed to see the amount of their free time midwives gave, perhaps after working night duties, in coming to meetings to help write the bereavement standards for when something goes wrong during a pregnancy. I fully endorse the Deputy's comments and look forward to meeting those staff directly in Galway this month.

Question No. 8 replied to with Written Answers.

Mental Health Services Staff

James Browne


9. Deputy James Browne asked the Minister for Health the measures he is taking to address the fact that just 6% of the recommended A Vision for Change staffing levels in adult mental health intellectual disability services are in post; and if he will make a statement on the matter. [38015/16]

Just 6% of the recommended A Vision for Change staffing levels in adult mental health intellectual disability services are in post. Can the Minister of State outline what measures she is taking to address this fact and make a statement on the matter?

I thank the Deputy for raising this issue and for giving me the opportunity to outline what is happening and where we are at present.

A Vision for Change recommended one consultant-led mental health intellectual disability team per 150,000 population. This equates to 31 teams, each consisting of a consultant psychiatrist, a doctor in training, two psychologists, two clinical nurse specialists, an administrator and registered nurses with specialist training. Each of those teams would equate to ten staff, that is, 310 in total.

Recognising the significant need to develop, in particular, the mental health intellectual disability teams for both adults and children, and while I understand we are only talking about adults, in 2014 a mapping of the service provision by the HSE's mental health division showed that this service was largely consultant-only provided through teams, voluntary agencies or within the HSE services. The national clinical lead for the mental health division developed a proposal to reorganise and expand the service in line with the A Vision for Change model. With the additional programme for Government funding, approximately 100 posts have been allocated to this area in the past three years. These posts are in various stages of recruitment with some already in place. This number alone represents over 20% of the recommended posts in A Vision for Change.

Currently, regarding consultants, there are 17.5 consultants for adults, 12.5 of whom are currently working with small teams following the allocation referred to earlier. These are not all full teams, but that is a problem we all will agree we are trying to address. A further 5.5 consultants with small teams have been allocated and are currently being recruited. This means that 74% of consultants recommended in A Vision for Change are either in place or soon to be in place working with their teams. While some progress has been made and recruitment of posts is ongoing, the service nationally remains below recommended levels.

In light of ongoing difficulties in recruiting consultants trained in this speciality, the HSE's mental health division has worked with the HSE national doctors training programme and the College of Psychiatrists of Ireland to modernise qualifications for these posts in line with practice internationally. This is already improving recruitment, as is the funding of a higher specialist training post in child mental health intellectual disabilities.

As the Minister of State will be aware, mental disorders are commonly experienced by persons with intellectual disabilities. Studies put the occurrence rate at 40%. A person with intellectual disabilities is, therefore, considerably more likely to have an additional mental disorder than the average person from the general population.

This is not necessarily surprising. However, 300 posts for adult mental health and intellectual disability are recommended in A Vision for Change, yet only 17.5 consultants are in post, which is only 6% of the recommended staffing level. There are only 3% of the recommended 150 posts for child and adolescent mental health and intellectual disability. Can the Minister comment on that?

I agree with the Deputy. We are talking about people who require specialist attention and help. The Deputy talks particularly about consultants but obviously those consultants are working with team members as well. I fully acknowledge that we still have a massive amount of work to do and that we remain below the recommended levels. The 17.5 consultants are working with teams that include psychologists, clinical nurse specialists, registered nurses and doctors in training. The 5.5 consultants currently being recruited will be working with teams as well. In the case of the children's teams, we currently have 4.9 consultants working with small teams and a further 5.5 consultants are being allocated. There is a significant problem with recruiting nurses, particularly in this area. We have added 60 nurse training places for this year and that will increase to 70 next year. Over the next four years that will increase by 45% in total. That is taking into account maternity leave, retirements and so forth. I agree we have a huge amount of work to do and that we are below average. However, a huge amount of work has taken place in the last number of years and that will continue.

As the Minister said, a significant amount of work must be done if the standards in A Vision for Change are going to be implemented. The Minister will have to be extremely ambitious to achieve that. Some type of special protocols or plans will have to be put in place to achieve it. Otherwise, it is difficult to see how it can be done. Can the Minister set out timeline targets or processes to ensure the requirements in A Vision for Change will be met?

I realise this area is of particular interest to the Deputy. The most important issue is that we plan. We will face difficulties in recruiting staff across the board until we build up those numbers. That is the reason certain measures have been taken. It is the reason we have brought back the community allowance and we are increasing the number of placements. We have almost €10 million in additional funding to increase wages as well. In addition, last June the Department funded a development clinical lead to work with our national clinical lead. That is to support the services in line with A Vision for Change once these consultant posts have been allocated. That means looking at data and activity data in the various areas to identify where there are immediate needs and where those in most need receive the support straight away. I cannot give the Deputy definite timeframes. This is a priority so these posts will be filled as soon as possible. We will deal with this.

Question No. 10 replied to with Written Answers.

Hospital Waiting Lists

John Lahart


11. Deputy John Lahart asked the Minister for Health the reason, in October 2016, that 362 persons had been on the inpatient and day case waiting lists in Tallaght Hospital for more than 18 months. [38039/16]

Why, a month ago, had 362 people been on the inpatient and day case waiting list in Tallaght Hospital for more than 18 months? Will the Minister make a statement on that?

The Government is committed to improving waiting times for patients. It is the waiting time rather than the headline figure that is the Deputy's focus, and it is an important point. While recognising that the demand for acute hospital services has increased the important issue for patients is how long they wait.

The latest National Treatment Purchase Fund, NTPF, inpatient and day case waiting list figures indicate that the total number of people on the waiting list for Tallaght Hospital is 4,415 and 92% of these, or 4,053 people, are waiting less than 18 months for their inpatient or day case appointment. The HSE has advised that most of the patients waiting over 18 months are orthopaedic and ENT patients and the hospital is working with the HSE to ensure that the majority of these patients will have their procedures scheduled or completed by year end.

In August, I asked the HSE to develop a waiting list action plan for 2016 to reduce by year end the number of patients waiting over 18 months on the inpatient and day case waiting list. Since then, approximately 6,500 patients have been removed nationally from the waiting list. Additional funding of €11.25 million has been allocated under the winter initiative to support patient treatment under this action plan. This has seen some people's procedures outsourced to other facilities when there is no capacity within a certain hospital.

Budget 2017 provides for the treatment of our longest-waiting patients. A sum of €20 million is being allocated to the NTPF in 2017, rising to €55 million in 2018. I met the chair and CEO of the NTPF last Tuesday and I have granted approval to its proposal which outlines the use of a first tranche of funding, in the region of €5 million, for an initiative focusing on day case procedures. I will shortly ask the HSE to develop a waiting list action plan for 2017 working collaboratively with the NTPF to address inpatient, day case and outpatient waiting times, including at Tallaght Hospital. We finally have ring-fenced funding for waiting list initiatives. Such funding was lacking in recent years.

I am grateful for the Minister's reply. We are in real danger of getting lost in statistics, but I welcome the figures and particularly the announcement concerning the National Treatment Purchase Fund. The Minister will accept that there were 4,415 on the inpatient day case list for Tallaght Hospital in October. He will also accept that it was an increase of 1,732 or a whopping almost 65% - there is another statistic - in two and a half years. It is unacceptably high. Of these, over 350 have been waiting for more than 18 months and 612 are waiting a year to 18 months. Let us stop with the statistics for a moment, because the Minister will pile on the narrative in terms of the money and how many millions or thousands of euro he is putting into it and obviously the Opposition spokespeople will focus on the numbers. However, if we take it to an individual level, what does the Minister say to somebody who has been waiting 18 months, and is still waiting, for a treatment? In particular, will he make some type of connection between their wait and the role of the National Treatment Purchase Fund?

I would tell them that it is utterly unacceptable. That is the reason I believe the House is united in its view, and it is my view, that every cent we target on waiting lists must be focused on the longest waiters. Thankfully we are now spending specific money on waiting lists, be it the €20 million for the NTPF in 2017, the further €55 million earmarked for 2018 or the €11 million on the HSE waiting list action plan. These are statistics but they represent real money. There will always be waiting lists in every health service. The issue is when somebody is waiting for an unacceptably long period. The reason I was quoting statistics was that while the question referred to people waiting over 18 months I believed there was an onus on me to point out that 92% of people on the list in Tallaght are waiting less than 18 months. The 8% is 362 patients, to make that real. That is a long wait for people. The HSE has advised me that the majority of those patients are in the orthopaedic or ear, nose and throat, ENT, areas. The hospital is working with the HSE to ensure that the majority of these patients will have their procedures scheduled or completed before the year ends, so that number should drop significantly in Tallaght. The hospital is also in the process of recruiting additional orthopaedic and ENT consultants. These are tangible benefits that should help the Deputy's constituents who are waiting a long time.

They will help the Minister's constituents as well.

The additional recruitment is welcome news. The Minister's party was not a great champion of the NTPF but there appears to be an acceptance that it has a role, particularly in the short to medium term. Will the Minister comment on a statement made by Mr. Tony O'Brien at a meeting of the Committee on the Future of Healthcare yesterday? He spoke of a 5% to 6% increase in presentations to emergency departments year on year and the impact this is having on the acute hospital system and, in particular, on the bed capacity currently available to carry out elective work. He appeared to be implying that we will be coping with emergency intake as opposed to standard intake into the near future. What is the Minister's view?

I see merit in the NTPF, regardless of past political debates. I acknowledge that the Deputy's party established it. If I was to be objective, in the past perhaps the NTPF cherry-picked patients somewhat, and the point the Deputy and I would agree on is that this time it must target those waiting the longest. That has to be the difference.

With regard to the increase in attendances and the impact it is having on bed capacity and the like, the attendances at emergency departments have increased by approximately 5% so far this year to date. It is a very significant extra capacity for our health service to develop. In other countries a number of those people would not be seen in an emergency department because services would be provided within the community.

That is why I genuinely believe the answer to this lies in a new general practitioner, GP, contract. It will be hard fought and not easily won. We are operating off a contract that is 44 years old and we will begin the engagement before the end of this year between GPs, the HSE and the Department of Health on what a new, modern fit-for-purpose GP contract would look like. The more people that we can treat in the community the fewer people will need to go the acute hospitals. That will free up the beds for the people who need to be in the acute hospitals. That is not a criticism of people attending emergency departments, as sometimes they have nowhere else to go, but we need to do more in the area of primary care.

I answered Deputy Kelleher's earlier question about the bed capacity review, which will give us an accurate view of what we need to do in regard to future bed capacity. It needs to examine bed capacity not only in the acute hospitals but across the health service and that will be done in time for the Government's mid-term capital review, which will take place in the middle of next year, so that we know what the ask of health is at that stage.

We will move on to Question No. 12 in the name of Deputy Aindrias Moynihan.

Hospital Waiting Lists

Michael McGrath


10. Deputy Michael McGrath asked the Minister for Health the measures that will be put in place to assist the 4,038 persons waiting more than 18 months for an outpatient appointment in Cork hospitals; and if he will make a statement on the matter. [38058/16]

Aindrias Moynihan


12. Deputy Aindrias Moynihan asked the Minister for Health the measures being taken to obtain outpatient appointments for the 11,468 persons waiting more than a year in Cork hospitals in October 2016. [38033/16]

A total of 11,468 people have been waiting for outpatient appointments in Cork for more than a year. That is across a range of specialties. Earlier this year, I raised with the Minister the position regarding gynaecological services in Cork, which has the largest waiting list for those services and which is far ahead of anywhere else in the country. Women in need of those services are being left for well over a year and a year. They need action.

I propose to take Questions Nos. 10 and 12 together.

I thank Deputy Moynihan for tabling that important question. Similar to Deputy Lahart's question, I would begin by pointing out that we have seen a significant level of underinvestment, perhaps due to the difficult challenging economic years, in addressing waiting lists. There is a direct correlation between under-investing in waiting list initiatives and the impact on the size of waiting lists. We are rectifying that now with the co-operation of people across this House by putting ring-fenced funds into the National Treatment Purchase Fund, NTPF, and into dedicated initiatives within the public health service.

I would also make the point that this time last year approximately 25,000 people a month were being referred by GPs for outpatient appointments. That number has risen to approximately 35,000 a month, so there is a massive increase in capacity in terms of the number of the outpatient appointments being sought.

We are committed to improving waiting times for patients. While recognising that demand for acute hospital services has increased, the important issue for patients is, as the Deputy said, how long they wait. According to the October waiting list data published by the NTPF, nearly 80% of patients on the outpatient waiting list for hospitals in Cork are waiting fewer than 12 months and 93% are waiting fewer than 18 months so I just need to put them into some context.

In August, I asked the HSE to develop a waiting list action plan for 2016 to reduce by year end the number of patients waiting over 18 months for an inpatient or day-case procedure. Since then, we have seen approximately 6,500 patients being removed from that national waiting list. It has clearly had an impact.

Regarding outpatient waiting lists in particular, the HSE recently launched the strategy for design of integrated outpatient services 2016-20. It seeks to improve waiting times for outpatient services by enhancing patient referral pathways and utilising technology to enable better planning.

As I told the Deputy's colleague, this year's budget provides moneys specifically for the treatment of our longest-waiting patients, and this will benefit patients in Cork hospitals as well. Deputy Aindrias Moynihan has referred specifically to the issue of gynaecological services, which extends beyond the answer I have given the Deputy. I want to make it clear that I am concerned by what I read about the waiting times and the concerns that have been expressed by a number of Cork representatives, including the Deputy. I have asked the HSE for a report on the maternity services and gynaecological services in Cork. I also intend to visit the hospital concerned in the coming weeks to meet directly with management and clinicians on these issues.

While people are languishing on waiting lists they have diminished quality of life. Their distress and anxiety must be unimaginable. There is significant suffering and it is cruelly compounded by that long wait. Those outpatient waiting lists are causing delayed diagnosis of cancers and other serious conditions. While we can consider the different statistics, I am seeing the real people who are calling into my clinic, the person hobbling who has been waiting two years to have a hip operation, etc. Also, in the case of gynaecological services, I dealt with a woman who was in the bathroom in a puddle of blood and I had to phone for an ambulance for her. She was on a waiting list for well over a year and had to repeatedly go to the accident and emergency department until she finally received treatment. It is not acceptable.

When I raised the issue of the gynaecological services in Cork with the Minister earlier this year, I pointed out to him the unused theatres in Cork and that theatre in that hospital remains unused. I pointed out to him earlier this year the need for additional consultants in Cork. Of the 28 who were appointed, no consultant was appointed in Cork and there still is not a consultant on the ground, even though the Minister has figures for one to take up position sometime next year. When I raised the issue of the gynaecological services in Cork with the Minister last summer, there were 1,213 waiting for those services for more than a year. That number has risen to 1,628. There needs to be action, not reports. Services need to be delivered for those people in Cork.

There does, there will be and there are. That is seen by the increased level of investment in the health service, which is being translated as we speak into a HSE service plan which will see more funding going into the health service in 2017 than in 2016, which is more funding than ever before. I am not suggesting in any way, shape or form that we can rectify all of the challenges and issues in one budget or in one short period of time. We must have context when we quote figures. When a Minister quotes statistics, people will say do not drown us in statistics, and that is a valid point, but 80% of people in Cork are waiting fewer than 52 weeks for an appointment. The position is not acceptable for the 20% but let us not suggest that everybody is waiting over 12 months or over 18 months. People are clinically prioritised. The Deputy spoke about important issues like cancer and clinical decisions are made in regard to prioritisation of lists, which is important.

The South-South West Hospital Group, which is the group for Cork, has advised me that both it and Cork's hospital management teams continue to work together on solutions to reduce outpatients waiting lists. Clinical capacity is being increased and managed by different initiatives such as extra consultant clinics, musculoskeletal physiotherapy clinics, chronological booking to make sure people who are waiting the longest are being seen first, an ongoing validation of waiting lists, and an IT solution to improve communication with patients and help reduce the extraordinarily high rate of "do not attends" where people have an outpatient appointment and do not attend. We had 400,000 last year, which is a massive number. This is currently at pilot stage in Cork; it will commence this month to try to reduce the number of "do not attends". The South-South West Hospital Group also has a dedicated scheduled care manager who co-ordinates and manages all waiting lists across the hospital group in co-ordination with hospital managers. I take seriously the points Deputy Aindrias Moynihan has raised. I have already been in Cork University Hospital but I specifically want to visit it with a focus on its maternity and gynaecological services, and I will do that in the coming weeks.

I thank the Minister for those details. For each of those people, and their families, who are on that waiting list suffering significantly, there is a fear of a delayed diagnosis of cancers and other conditions. We have already seen the different reports. We know there was plan for a one-stop-shop for gynaecological services in Cork. That needs to be acted on. When I raised this issue with the Minister in the summer, we discussed the possibility of the NTPF. Can it be advanced to aid those people who are still on those waiting lists, suffering and left in limbo?

I will certainly ask that this be considered in the context of the NTPF funding. It has €20 million for expenditure in 2017. I have approved the first €5 million of that which is for day-case procedures largely because we can get through quite a volume of day-case procedures which takes pressure off the acute hospitals and allows them to do other procedures as well. I have asked the HSE for a specific report on gynaecological services in Cork and on what I have been reading in regard to them. I am happy to share that with the Deputy as soon as I receive it.

The Ceann Comhairle is satisfied that Deputy Kelleher can take Deputy Michael McGrath's Question No. 10 in his absence. The answer to it is same as that for Question No. 12.

They were taken together.

Can I ask a supplementary question?

Yes, a supplementary question.

This question asks the Minister what he will put in place to assist the 4,038 persons waiting more than 18 months for an outpatient appointment in Cork hospitals and if he will make a statement on the matter. We have been highlighting this for some time. Deputy Aindrias Moynihan has been consistently raising the issue of the problems with gynaecological services in Cork. To give the Minister some figures, 4,193 women are waiting for an outpatient gynaecological appointment in Cork. This is the longest waiting list of all gynaecological units nationwide. The waiting list is twice as long as the gynaecological waiting list in the Rotunda Hospital in Dublin. One in three women will wait more than an year for an outpatient appointment with many having to wait two to three years. That is what women are facing in Cork on a consistent basis.

Rather than just visiting the hospital, there needs to be a co-ordinated response to address what is an alarming continual delay in accessing vital services.

I replied to both questions as a group and, therefore, the points I made in response to Deputy Moynihan regarding what I wish to do to tackle waiting lists and the longest waiters stand in the context of this question about Cork. I intend to take the steps I have outlined and that the South-South West Hospital Group will outline as well. Although the Deputy is not suggesting that I am visiting the hospital for the sake of it, I am visiting because I want to meet the clinicians who I have read have a number of views on measures that should be undertaken. I want to hear directly from them and I will make arrangements to do that as quickly as possible.

I welcome the fact the Minister will visit the hospital and I do not suggest he is doing so just as a photo opportunity. I hope he will recognise the difficulties and challenges facing staff. However, there are a few problems we know about in advance of his visit. The CUMH has only one gynaecology theatre in operation. There is a huge opportunity because the infrastructure is in place for some services but the clinicians and support staff are not in place. A gynaecology one-stop-shop, which was envisaged and costed, should be built, as Deputy Moynihan said. A minimum of four additional consultant gynaecologists should be employed as well as nursing and support staff. If all this was put in place, it might improve services. We must avoid a scenario where women are potentially not being diagnosed with life-limiting illnesses and potential threats to their lives because they cannot access services or because of inordinate delays. I urge the Minister to do something quickly and proactively prior to his visit to Cork.

I take seriously the points raised by Deputy Kelleher and, indeed, a number of Cork-based Deputies have brought these to my attention. I will act on them. I have asked the HSE to provide a report on gynaecological service waiting times and what it proposes to do to reduce them. I expect to have that in hand before I meet directly with clinicians in Cork, who also have a range of options. We need action on this and I am determined to deliver it.

Question No. 13 replied to with Written Answers.

Maternity Services

Clare Daly


14. Deputy Clare Daly asked the Minister for Health his views on the implications for patient safety of the shortfall in midwifery posts in maternity hospitals, particularly in Dublin; and his further views on whether this shortfall may lead to an increase on the sums paid out annually by the State Claims Agency in maternity cases, which amounted to €379 million in damages and legal costs in the years 2007 to 2015. [37783/16]

The former master of the Coombe Hospital has said unequivocally that Ireland has long been skating on dangerously thin ice when it comes to maternity services. His view seems to be supported by the phenomenal sums the State Claims Agency has paid out in maternity cases. A total of €379 million was paid in damages and legal costs between 2007 and 2015. Is the Minister concerned about the impact of the crisis in midwifery on patient safety?

I thank the Deputy for raising this important matter. I visited the Coombe Hospital only yesterday, I visited Holles Street Hospital only last Friday and I visited the Rotunda Hospital the week before. In years past, our maternity services did not receive the priority they needed in respect of investment and I am determined to fix that. This is not a political point; it is one levelled at all our doorsteps. This is not just about words. Earlier this year, I launched Ireland's first ever national maternity strategy. It is shocking in some ways that it is the first ever but it has been recognised as a good document with great input from experts but also from women who are the experts in this regard. Our first set of bereavement standards were also published for women who are bereaved through pregnancy or neonatal death, again with direct input from women, their partners and midwives. That will lead to a number of changes in maternity services.

There are plans to relocate the National Maternity Hospital to St. Vincent's Hospital because while there is excellent work going on there, the building is simply not fit for purpose and women deserve a state-of-the-art, world class facility. I also recently approved the HIQA standards for maternity services, which will be launched this month.

I am aware of, and am concerned about, increasing claims to the State Claims Agency arising from maternity cases. However, I assure the Deputy that the safety and quality of maternity services is a priority for the Government and a personal priority. The publication of the national maternity strategy earlier this year, I hope, demonstrates a new and enhanced focus on maternity care at both policy and service delivery level, and provides a road map for how we can improve services in the years ahead. This month, HIQA will publish national standards for safer and better maternity services, the first standards in the area. They will provide a framework for maternity service providers to ensure that they are meeting the needs of women, their babies and their partners, and that a consistent service is delivered across the country. I am confident that the strategy, coupled with the new standards, will provide the building blocks for a safer and better service.

With regard to midwifery numbers, in 2014, the HSE commissioned a midwifery workforce planning project. The project will inform the allocation of new midwifery resources on a phased basis over the coming years. In May 2016, the HSE granted approval to the hospital groups to appoint an additional 100 staff midwives. The majority of these posts were allocated to the three Dublin maternity hospitals.

In line with the national maternity strategy, a national women and infants health programme is being established within the HSE to lead the management, organisation and delivery of maternity, gynaecological and neonatal services. The programme will drive the delivery of the strategy.

It is a good strategy but it is a long way from being implemented. It was followed by a report on midwifery numbers which suggested that to implement the measures in the strategy, a midwife to birth ratio of 1:29.5. would have to be achieved, which would require the recruitment of an additional 450 midwives and not just the 100 who have been recruited. While I welcome their recruitment at a cost of €3 million, there has been a twelvefold increase in litigation taken by women who have been damaged by our maternity services in precisely the same period that the budgets for maternity hospitals were cut. Maternity cases represent more than half the claims dealt with by the State Claims Agency, which is absolutely scandalous. The link between the two cannot be denied. Why are all these women and families suffering? A fraction of the amount spent by the State on legal costs and damages on maternity services would transform them.

I agree with the Deputy. Maternity services were neglected compared to other parts of the health service, even in years when money was aplenty. It cannot, therefore, just be put down to a recessionary challenge. It was an issue going back through the generations and we have to work collectively to rectify it. I acknowledge the Deputy said the national maternity strategy is a good document but it has not been fully implemented in any way, shape or form. However, it was published last January and it is a living, breathing document. We have to get on to implement it. We are using the same model to implement it as was successfully used by previous Governments to implement the national cancer strategy. Rather than it just being a strategy, there will be a national women and infants health programme within the HSE to drive it and, by any objective standard, that attaches a priority to its delivery and implementation.

According to the October census, there were 1,402 whole-time equivalent midwife posts within the health service and when midwives, midwife managers and other midwifery specialists are included, there were 1,934 whole-time equivalents.

The Minister said the strategy only came in in January but, 11 months on, 13 maternity hospitals do not have access to ultrasound scans and they have been unable to recruit programme directors and so on. An inherent weakness in the strategy is the lack of targets and timeframes. The need to deliver way beyond the number of midwives that has been sanctioned, which would have a valuable impact, has not been taken on board enough. The number needs to be doubled or trebled. I welcome the recruitment of 100 additional midwives but the HSE spent €6 million last year fighting claims in maternity cases. That money would have enabled the recruitment of 200 midwives. The Minister is going in the wrong direction and the strategy has not been implemented quickly enough. I have received horrific correspondence from midwives at the coalface of this crisis.

Midwives, who are members of the Irish Nurses and Midwives Organisation, in Mayo University Hospital are being balloted on industrial action, a decision they have not taken lightly. They are doing so because of staff shortages. An additional 100 midwives is not enough; a total of 450 is required. The Minister's recruitment plans for the health service are not achieving their targets. Even those who are coming to Ireland to take up posts are leaving to go abroad again. We are not competing with private hospitals and hospitals abroad.

Women deserve better treatment than they are getting. They have been badly served by the maternity services and that is no fault of the midwives who are providing that service. The midwives in Mayo are sending the Minister a very clear message that more staff are needed.

This is the Minister's final response.

I will do my best. The issue in Mayo has been referred to the Workplace Relations Commission and I hope everyone involved will use all available mechanisms to resolve the dispute. People do not take these decisions lightly but it is in everybody's interests, including those of women, that this issue be resolved as quickly as possible.

I accept the thrust of what Deputy Clare Daly is saying. There is so much more we need to do in maternity services. I ask the Deputy to believe that this is a project on which I will work with everyone and anyone in this House in order to ensure that we deliver. There have been generations of neglect in the context of investment in our maternity services. It is not that we have done nothing since the maternity strategy was published in January. We have seen the extra 100 midwives, which the Deputy has welcomed. We have seen the publication of the bereavement standards and HIQA is about to publish the national standards. We should not underestimate the importance of having national standards published by HIQA, which is an independent regulatory body. We have €150 million of capital funding to build a state of the art, world class, national maternity hospital for women in this country on the campus of St. Vincent's. We also have plans to move the Rotunda to Connolly Hospital and the Coombe to St. James's. These are issues we need to try to fund in the context of the review of capital.

The point on midwifery numbers is that there is a challenge in recruitment and retention and one could apply the same argument to nursing numbers. It is a challenge that goes beyond funding. I hope the public sector pay commission will look at these as well in exploring the sectoral challenges. I expect the HSE to look at its Bring them Home campaign which has been disappointing in terms of the results it has delivered to date.

Written Answers are published on the Oireachtas website.