Jack Chambers
Question:7. Deputy Jack Chambers asked the Minister for Health the reason the HSE has ceased counting the number of private beds in public hospitals; and if he will make a statement on the matter. [20457/17]
Other Questions
Hospital Beds Data
What is the reason the HSE has ceased counting the number of private beds in public hospitals and will the Minister make a statement on the matter? We know that since the Health (Amendment) Act 2013 the Government has brought forward a policy of quasi-private hospitals within our public hospital system, which is regressive and has contributed to the significant waiting times. Why has the HSE, as a matter of governance, stopped counting the number of beds? We deserve a full explanation on the matter.
I thank Deputy Chambers for the question and I will endeavour to give him as full an explanation as possible. The reason the HSE has ceased reporting the number of private beds in public hospitals is that since 2014, as referenced by the Deputy, all private patients are charged in a similar manner, and the charges set for private patients are no longer set with reference to being in private or semi-private hospital beds.
The Health (Amendment) Act 2013, as Deputy Chambers mentioned, established the basis for this policy, enabling all private patients in a public hospital to be subject to charges. The Act addressed a situation previously identified by the Comptroller and Auditor General whereby when private inpatients were accommodated in public or non-designated beds no private inpatient charges applied, despite the patients having a private treatment relationship with their consultants. This was a matter highlighted by the Comptroller and Auditor General to which the legislation endeavoured to respond. The absence of a maintenance charge in such instances represented a significant loss of income to the public hospital system and to taxpayers at large.
Since 1 January 2014 revised charges are levied on all private patients. The charging regime now distinguishes between the accommodation of private patients in single rooms and multi-occupancy rooms, with the former charged at a higher rate. Analysis I commissioned at the request of Deputy Kelleher is being finalised by my Department. It indicates that changes to the charging structure have not resulted in a significant increase in the proportion of patients treated on a private basis in public acute hospitals. I hope to be in a position to share this with both Deputies in the coming days.
The use of beds in public hospitals is now more closely aligned with the clinical needs of the patients. This change allows for more efficient use of beds, with priority being given to issues such as end of life care, where a person can be given a single room, and infection control, regardless of the public or private status of the patient. The concern the Deputy has about these changes and the impact they have had on an extra number of private patients in public hospitals and the impact on the public health service is something on which I expect to have analysis in the coming days. The initial analysis I have received suggests this has not seen such an increase and, therefore, this is the rationale behind not counting private beds.
Public hospitals should be for public patients and only public work should go on in public hospitals. They should not be quasi-private institutions. Patients receive private care in the public health system and this is not a progressive way to run a public health system. What we have seen with the policy is that hundreds of thousands of people, who have already paid their taxes and who happen to hold health insurance, are being effectively charged twice. This is what the policy stance has changed. Instead of utilising the full capacity of public and private the Government has decided to charge people twice. The fact the Minister does not know and cannot state in the Dáil the number of beds used on a private basis is a serious concern with regard to management control. We know from the health insurers' figures that hundreds of millions of euro of insurance is going to public hospitals to bail them out because of the inefficiency in the current system. It is important the Minister addresses it. There is a recommendation from the health policy reform committee to remove private work from public hospitals. This is an example of how the previous policy was regressive and has impacted on increased waiting times for public only patients.
I thank Deputy Chambers. I revert back to my original point, which is this first became a public policy issue in an effort by the Oireachtas to respond to the Comptroller and Auditor General highlighting an important issue. I hope the analysis I will provide to the Oireachtas shortly on the impact this has had on the private-public mix in public hospitals can enable us to decide if we need to review the policy. I have already said I intend, on foot of receiving this analysis, to review the policy to check whether it is having any unintended consequence. This is the prudent and appropriate thing to do.
When Deputy Chambers says our public hospitals should be purely for public patients, and I mean this respectfully, it is quite a profound statement because while it is likely to be the direction the Oireachtas Committee on the Future of Healthcare proposes and it is likely to be the direction I and the Government would favour, we do need to be cognisant of the fact the provisional figure in terms of private patient income in 2016 to our public hospitals was €626 million. This is a big hole that I or any Minister would have to fill. It is a lot of money to take out of the public hospital system and take out of our public health service. How we deal with this is something that needs to be dealt with on a multiannual basis.
The Minister needs to deal with it. It is an example of how ineffective Fine Gael has been in setting its health policy. It has introduced effective quasi-private hospitals in our public hospital system and this is regressive. The hole will only get bigger because the incentive for managers is to have increased private output in the context of our public health system, and the people who cannot afford health insurance are being left behind. They are the people who must wait longer, and we see this in the waiting times in our public hospital system.
Public patients are all citizens and if people happen to want private health insurance, they should go to a private hospital. The State should not get those citizens who pay their taxes throughout their lives and charge them twice. It is having an impact on their health insurance premiums. Effectively, they are paying twice. They have paid their taxes and they are also paying health insurance. They have a right to health care in the context of our public health system. The Minister should not be levying middle Ireland with an additional tax and levy, which is what the Health (Amendment) Act does. Of course, it would leave a hole, but the Minister has a duty to fix that and manage the budget of the system properly. It is one of the biggest health budgets in the EU with some of the worst outputs. It is for the Minister to match the gap and provide a vision for the Dáil and stop talking about solutions in months and years to come when he is not in the Department.
My God, I certainly hope I will be. I will not take a lecture from the Fianna Fáil Party on how to run a health service when I still find myself having to try to unpick some of the structural difficulties with which it left me through the creation of the HSE, which has become an awful bureaucratic scenario that we must pare back.
One of the first decisions taken by this House on a cross-party basis was to set up a cross-party committee. It is accepted that it is going to involve us all in pulling together and that it will take a ten-year period to get this absolutely right. While I have many responsibilities which I endeavour to discharge with enthusiasm and my very best effort, anybody coming into the House to suggest we should abolish one charge has a responsibility to tell us how we would replace it. I am sure that in due course when the election is held - God willing, it is quite a long time away - Fianna Fáil's manifesto will detail how the €642 million that would be removed from the health service budget with the swipe of a pen would be replaced or the services we would not be able to provide.
Let me be clear that I think the Deputy has a fair point that there could be unintended consequences with regard to the current legislation. That is why I am doing two things. At the request of Deputy Billy Kelleher at the Oireachtas Joint Committee on Health, I am carrying out an analysis which will be presented very shortly. I will then review the legislation in that context and revert back to the Deputy.
The Minister should not ensnare me in his policies.
Mental Health Services Provision
Mick Wallace
Question:8. Deputy Mick Wallace asked the Minister for Health the steps he will take to address chronic underfunding of child and adolescent mental health services; the further steps he will take to tackle CAMHS staff shortages which are affecting the delivery of the service across the country; his views on the fact that County Wexford, with 14 other counties, does not have an on-call mental health service for children; and if he will make a statement on the matter. [20738/17]
I can see Deputy Jack Chambers replacing Deputy Billy Kelleher soon as health spokesperson for Fianna Fáil.
Child and adolescent mental health services outside the hours of nine-to-five Monday to Friday are non-existent in many parts of the country. If one has a referral accepted, nobody can lift a finger to help the child, unless the consultant psychologist assesses him or her. There is usually one in each child and adolescent mental health service, CAMHS, team. If a child is assessed and qualifies for child psychology services, he or she will go on an endless waiting list. The HSE informed my office last week that it was recruiting to fill 120 assistant psychologist posts. The persons concerned will work within the primary care service under the supervision of clinical psychologists. Does the Minister of State know when the posts will be filled? Will any of them be filled in Wexford? Are there plans to extend the hours of availability of CAMHS services in Wexford and other parts of the country that are being failed by the HSE?
I thank the Deputy for raising this issue which he has raised before. I stress again that I remain committed to developing all aspects of the mental health service, including CAMHS, which is a particular priority not just for me but also the HSE.
Additional funding in the budget for this year has resulted in an overall provision of €853 million for HSE mental health services. It takes into account significant additional resources for mental health services generally since 2012. However, funding is not the core issue in CAMHS, to which the Deputy has referred in his question. CAMHS services face particular challenges in the recruitment and retention of staff. The turnover rate for CAMHS teams is particularly high. That is an issue we are trying to address. The HSE is addressing it on an ongoing basis. We have recruited 1,150 staff in the past four years, of whom 270 have been for CAMHS teams. The HSE has also given priority to reducing the CAMHS waiting list, especially for those waiting over 12 months. This is dependent on the availability of key clinicians within teams, particularly CAMHS consultant psychiatrists. I know that the issue the Deputy is raising is the fact that there is no child consultant psychologist on-call within emergency departments 24/7. That is an issue of which we are very aware. Additional resources have assisted in supporting 67 CAMHS teams, with three paediatric liaison teams. There are also 66 CAMHS inpatient beds in operation nationally, with additional beds to come on stream as staffing levels permit. The new standard operating procedure introduced in 2015 has provided greater clarity and consistency on how the service is provided.
As the Deputy knows, during normal working hours, nine-to-five cover is provided Monday to Friday within mental health services by a number of interlinked components, including community mental health teams and emergency departments. During the on-call period, between 5 p.m. and 9 a.m., Monday to Friday, and throughout the weekend period there is a consultant psychiatrist, together with a psychiatric registrar or senior house officer, on duty in acute hospitals. Since 2014, this has been supplemented by the development of the self-harm clinical programme under which specialist nurses are available. A preliminary review of weekend access by the HSE mental health division shows that weekend mental health services are provided in only eight of the 17 mental health areas. In a further eight areas there is partial cover, in which in certain geographical areas within the service a weekend service is provided. The HSE has prioritised the need to ensure access to a weekend service for current service users is provided in all areas. A service improvement project was commenced last November to carry out more detailed mapping of current provision at weekends and the uptake in the extended hours services, taking account of international best practice and the service user perspective. The position in Wexford will be addressed as part of the overall service improvement initiative.
I will answer the other questions asked when I speak again.
The truth of the matter is that the service is not good enough in Wexford. I recently asked the HSE what services were available for children and adolescents who presented with suicidal ideation but who were not deemed by CAMHS to have a psychiatric disorder. The reply from the head of mental health services, Ms Liz Kinsella, stated individuals could access a health service on a 24-hour basis, despite the fact that I was asking about mental health services. She went on to refer to a few of the services which were not available on a 24-hour but a nine-to-five, five days a week basis. She referred to a school counsellor who was available during school hours and the Ferns Diocesan Youth Service which was available in Wexford town. Again, it is a nine-to-five, Monday to Friday, service. We rang two of the organisations she mentioned - I think the Minister of State mentioned one also - the HSE community primary care and disability psychology service and the HSE self-harm intervention programme, on the day we received her reply after 5 p.m. but it rang out. She also referred to the CAMHS team in Wexford, but the question was what would happen when the CAMHS team put someone on a waiting list for psychology services? The HSE needs to provide talking therapies for children that are affordable, easily accessed and promoted as part of the HSE child and mental health services. The services available in Wexford are not what the Minister of State seems to think they are. They are abysmal. We are inundated with complaints from parents about the current situation.
I agree with the Deputy that there is a gap within the services, but there are others that are available or were not mentioned. The self-harm intervention programme was established in Wexford in 2004. It caters for young people, aged 16 years and over. Last year 155 persons aged under 18 years were referred to it. There is the Ferns Diocesen Youth Service that provides services in Enniscorthy, Gorey, New Ross and Wexford town. It is for young people aged 13 to 25 years. There are four day hospitals, Tara House, Carn House, Summerhill and Maryville; as well as the nurse specialist liaison service that is available seven days a week and the suicide crisis assessment nurse, SCAN. I agree that there is a gap in the services, which is why, similar to the exercise happening in identifying where the gaps are in the seven-day-a-week service, progress has been ongoing with the HSE, service providers and the mental health teams to identify where consultant psychologist posts are not being filled within emergency departments on a 24-7 basis. They are working with the HSE to identify how they can implement the initiative in the best way possible, obviously including in Wexford. The assistant psychologist posts have been approved and recruitment is starting. That will happen throughout the country. It is a much needed support, not just in Wexford but also elsewhere.
The self-harm intervention programme mentioned by the Minister of State is actually based in Waterford. It is one of the places we rang after 5 p.m. At 5.15 p.m. the telephone was not being answered. One of the parents who contacted me recently has a ten-year old boy who has been diagnosed with severe verbal and oral dyspraxia, a sensory process disorder and as suffering from high anxiety. It is suspected that he has other undiagnosed disorders. CAMHS has seen him, but it does not believe it can help him. It has closed his case but never notified his mother who wrote to us. I would like to quote a few of her words:
My son wants to be dead. He is ten years of age. I spend my days trying to convince him being alive and with his family is more fun. My son is majorly suffering but nobody seems to care. We are on the psychology waiting list for two years now. I spend my time trying to convince him being alive is so much better even if it doesn't feel like it. It is heartbreaking watching him suffer and listening to how he feels about himself and why he thinks being dead is the answer to his problems. He wants to know why he is different, why he has struggled so much, but I don't have the answers.
What I do not understand is why there has not been a greater emphasis on psychotherapy. There are psychotherapy services available in the county. I know that the HSE was hiring, but psychologists are not in place. There are two CAMHS services in the county and two leaders. It is not good enough. There has to be a rethink.
It is not acceptable that a ten-year old feels he does not want to live. That is part of a much wider conversation we need to have with young people in order that they will be able to express what it is they are feeling and identify the supports they need. We also need to ensure we have programmes in place that are suitable for individuals. We have always had a one-size-fits-all approach. If a young person had a problem, he or she was automatically sent to CAMHS, but we know that it is not the answer for everybody. That is why we are trying to look at the supports available within the community which would be best suited and best provide for young persons at the age of ten years.
It is also why we are developing the assistant psychology posts and why we are looking at providing supports that are tailored towards people's needs, specifically for our younger people.
We had another meeting of the task force yesterday. Work is ongoing. The recruitment of staff is key to this, and that is a problem we are facing not just in Wexford but throughout the country. We are trying to invest in our services. The Deputy mentioned that people are not keeping in touch and that if a person is referred on to another service he or she is not then coming back. There is no easy flow forwards or backwards. That is down to technology and a change in people's attitudes, and it is something on which we need to work with service providers to try and improve.
Ambulance Service Response Times
Éamon Ó Cuív
Question:9. Deputy Éamon Ó Cuív asked the Minister for Health the action being taken to assist University Hospital Galway improve ambulance turnaround performance, in view of the fact that just 7.7% of ambulance calls at the hospital were cleared in less than 20 minutes during February 2017 [20757/17]
Lisa Chambers
Question:13. Deputy Lisa Chambers asked the Minister for Health the action being taken to assist Mayo University Hospital improve ambulance turnaround performance, in view of the fact that just 9.5% of ambulance calls at the hospital were cleared in less than 20 minutes during February 2017 [20760/17]
Jackie Cahill
Question:29. Deputy Jackie Cahill asked the Minister for Health the action being taken to assist South Tipperary General Hospital improve ambulance turnaround performance in view of the fact that just 8.9% of ambulance calls at the hospital were cleared in less than 20 minutes during February 2017 [20776/17]
Mary Butler
Question:44. Deputy Mary Butler asked the Minister for Health the action being taken to assist Waterford University Hospital to improve ambulance turnaround performance in view of the fact that almost 15% of ambulance calls at the hospital were not cleared within an hour during February 2017 [20751/17]
Michael McGrath
Question:46. Deputy Michael McGrath asked the Minister for Health the action being taken to assist Cork University Hospital improve ambulance turnaround performance, in view of the fact that just 11.8% of ambulance calls at the hospital were cleared in less than 20 minutes during February 2017 [20762/17]
Anne Rabbitte
Question:76. Deputy Anne Rabbitte asked the Minister for Health the action being taken to assist Portiuncula Hospital improve ambulance turnaround performance, in view of the fact that just 11.5% of ambulance calls at the hospital were cleared in less than 20 minutes during February 2017 [20753/17]
The Minister is probably aware of the fact that 92% of turnaround times in University Hospital Galway exceeded 20 minutes. Only 7.7% were less than 20 minutes. This is to do with trolley back-up and so on and the crazy situation that has not been dealt with in the emergency department at University Hospital Galway. What is the Minister going to do, in a holistic fashion, to deal with this issue and reduce the logjams that are there so that we can get the ambulances back out on the road to actually do what they are supposed to do, which is bring the patients into the hospital?
I propose to take Questions Nos. 9, 13, 29, 44, 46 and 76 together.
Ambulance turnaround times measure the time interval from ambulance arrival at a hospital, to when the crew is ready to accept another call. When the emergency care system is under pressure, there is the potential for delay in the transfer of care of patients from ambulance to emergency department personnel. I accept that in a number of hospitals, including those highlighted in the individual questions, the emergency departments are particularly busy and this can contribute significantly to delays in ambulance turnaround.
A framework has been developed to create a standardised approach between the national ambulance service and acute hospital emergency departments which allows all parties to understand their role in the timely release of ambulance resources from acute hospitals.
In addition, the framework sets out the escalation process to alert management, both within the national ambulance service and acute hospitals, to significant increases in emergency demand and activity, and occurrences of delayed turnarounds. Hospital management is tasked to enable the release of all ambulance resources in a safe manner.
In regard to emergency department overcrowding, my Department and the HSE are developing a plan focused on working with hospitals to improve performance, and overall patient experience which should also assist in improving ambulance turnaround times. I have been assured that the HSE is committed to ensuring that patients are clinically handed over in a safe, professional and timely manner, with the safety and dignity of the patient being of paramount importance.
If we are serious about reducing the turnaround times it means that we need to reduce the length of time people are spending in our emergency departments. It is with that in mind that I very much welcome the INMO's figures this morning which show a 12% decrease in the number of people on hospital trolleys awaiting admission in April of this year compared to April of last year. We still have a long way to go in this regard, and I look forward to talking to the INMO about recruitment of more nurses. We have ambitious plans in place to hire 1,208 new nurses this year and have a number of incentives to try and assist in that regard, because it is very much interlinked with the ability of an ambulance to get in, safely hand over the patient, and get back to doing exactly what we want them to do.
The Minister recently met a delegation from Connemara to discuss the ambulance service. I was surprised to get a reply from him yesterday telling me that the solution to the rural areas ambulance problem is a do-it-yourself job of voluntary responders. The letter says that the capacity review indicated that the only practical way to improve first response times in rural areas is through voluntary community first responders. I find this rather shocking. I accept that there are challenges in rural Ireland and that we cannot expect to achieve the same turnaround times as urban areas, but they could be vastly improved. Can the Minister tell me if that is really his policy or is that just what was written in the answer for me? It seems to me to be a shocking response. I am not against volunteerism, but I do not see why rural people are always expected to do the DIY job when urban people rightly expect it to be done properly. What is the policy on ensuring that rural people get good and comprehensive ambulance services in a timely manner?
I assure Deputy Ó Cuív that the way we are going to make sure that people throughout this country, regardless of whether they live in rural or urban areas, get better access to ambulances in a more timely manner is by investing in the national ambulance service. That is what we are doing. The €7.2 million of extra funding in 2016 for the service will be supplemented by a further €3.6 million, including another €1 million for new developments. The first report I received when I came to office was the Lightfoot report. It was the first external international look at our ambulance service. The piece of my response which the Deputy has put on the record of the Dáil referencing the report says three things. It says that we need significantly more ambulances and paramedics, but it also says that even if we increase ambulances and paramedics - we are committed to doing that, hence the extra investment - in order to meet HIQA response times, because of the demographic layout of this country we are going to need to continue to see additional contributions from our community first responders. They are doing a superb job around this country, as the Deputy has acknowledged, but with the best will in the world, even as we continue to increase ambulances, as we are going to do, and continue to increase the number of paramedics, which we are doing, we still require community first responders to help support rural Ireland. It is not just rural Ireland but urban Ireland as well. There are three pieces to this - more ambulances, more paramedics and the community first responders working hand in hand. I had a very good meeting with the group from Connemara on this issue.
I want to raise directly with the Minister the issue pertaining to the constituency of Mayo. Back in 2014, one of the ambulance bases there was determined by HIQA to be an ambulance black spot. Since then we have had a crew appointed to that base in Mulranny, but unfortunately what we have seen happening is that that crew very often does not make it to the Mulranny base. It is pulled back into Castlebar, Ballina or Belmullet, and so the area is not getting the service that we think we are getting. This was back in 2014, three years ago. The situation has not improved.
The Minister has touched on the HIQA response times. We should have a first responder on the scene in just under eight minutes, and for a vehicle carrying a patient they should be there within 20 minutes, or just under 20 minutes. Geographically the Minister is correct. It is not physically possible, with Belmullet, Castlebar and Ballina, and including Mulranny, to reach parts of our county in those times even if one leaves within minutes.
On the turnaround time at the hospital, from speaking to staff locally at Mayo University Hospital the feedback I am getting is that when an ambulance arrives at the hospital they very often have nowhere to put the patient. There is no trolley or bed to transfer the patient to, so they cannot actually get the patient off the bed that has to go back into the ambulance, which is remarkable. These are ambulances that could be deployed to another area.
I have raised the issue of the massaging of figures relating to response times for many years. If something happens in Galway a Castlebar ambulance will often be called when a Galway ambulance is not available in the knowledge that that ambulance will never make it to Galway. It was, however, dispatched on time. The ambulance may get half way there and is then sent back when the Galway ambulance becomes available, thereby massaging the figures that the Minister is supposed to use to develop policy. These are very serious, ongoing issues. It is happening all over the country.
I thank Deputy Chambers. I will follow up on the figures and how authoritative they are and revert to the Deputy directly.
On a general point, before dealing with the Mayo-specific issue, the national ambulance service received 859 calls per day on average in March. That is 26,629 calls over the full month of March. Of all of those calls we saw 1,668 ambulances delayed for greater than an hour. It is not acceptable that ambulances are delayed for that long, but it gives a sense of the volume of calls that our ambulance service is dealing with, and shows that the overwhelming amount of them are very successful.
However, we do need to do more about this.
I thank the Deputy for acknowledging the difficulty of meeting HIQA response times in certain parts of the country. This is not due to a lack of willingness on the part of the national ambulance service but because of particular geographical challenges which we have to work in innovative ways to overcome.
Staff reports from Mayo University Hospital are accurate and it is true that when an emergency department is congested it results in additionality in terms of time. I thank the staff in the hospital because we have seen an improvement in trolley numbers and on one day this week there was a 46% decrease in patients on trolleys as compared with the same day last year. Ultimately, the issue is bed capacity and we need more beds in our health service. Class sizes have increased as the population has increased but bed capacity has not, and this has been the case over periods of successive Governments. We need to do this collectively and that is why the bed capacity review is under way. I need to have a clear figure for the number of extra beds we need for the health service in time for the mid-term capital review.
A total of 174 out of 823 calls took over an hour to clear in GUH. That is nearly three times as many as were cleared within 20 minutes. That is always a problem but it is a much bigger problem if the ambulance which is waiting outside has come from an area that only has one ambulance within 30 miles of its base. Are there proposals to ensure ambulances from stations with no back-up vehicle will be given priority and can disgorge patients so that it can get back out on the road? That is one simple thing that could be done. Is there a process to prevent an ambulance from Clifden or An Cheathrú Rua, where there is no other ambulance nearer than Westport, sitting in Galway for over an hour when somebody else needs an ambulance? Will the Minister give an instruction that areas where there is only one ambulance cannot be pulled into Galway as back-up, leaving a very extensive area without any ambulance cover within a reasonable distance? These issues can and must be dealt with immediately.
I had the honour of visiting Galway University Hospital recently to talk to staff, patients and management. The clear need is for a new emergency department, which has been much talked about for many years and which we will deliver. I have provided the funding for the design team which is being appointed and it is important that its work is completed as quickly as possible so that I can ensure the new emergency department for Galway University Hospital is included in the mid-term capital review. It is vital we get the emergency department under way because that will assist staff in the clinical handover of patients from ambulances to the emergency department and will provide them with more capacity, better working conditions and privacy for patients.
It is a clinical consideration for the national ambulance service to decide which ambulance to prioritise getting back out onto the road. The hospital must deal with the patient's needs and triage them when they arrive in the emergency department but I will raise the two matters the Deputy raises with the national ambulance service and come back with a response.
I welcome the fact the Minister will look into the issue of ambulances being called when they know they will not get there, which is happening all over the place. Crews from Castlebar and Ballina have been sent to Roscommon and to Galway and a crew that is meant to go to Mulranny on a daily basis often does not get there. They might be sent a small bit down the road but are then called back to man a base in Castlebar or Ballina because a crew from one of those places has been called out to a wild goose chase somewhere else. The staff do not have any choice but to do this.
The recruitment of nurses is a key issue to ease congestion in our emergency departments. The Minister will be well aware of the difficulties in attracting nurses back and we all know people working in other jurisdictions where they are treated far better and have a smaller workload. We need to do an awful lot more in terms of working conditions to attract highly skilled and qualified people back.
I welcome the reduction in trolley numbers at Mayo University Hospital this year as compared with last year. I have raised the movement of patients to other wards with the Minister in the past but I do not know if he has looked into it. They are often moved to the medical assessment and day service units in the hospital to remove them from the view of those who conduct the trolley watch. Staff tell me that there is pressure on hospital management to ensure patients are not counted on trolleys so that the numbers can be made public. They are human beings and it puts pressure on them and this incentivises some managers to do things which massage the figures, creating an inaccurate reflection of what is happening on the ground. The Minister needs to look behind the figures and talk to staff in the hospitals.
I always enjoy talking to staff in the health service and I have visited 48 of our hospitals in the past year. The Deputy makes an important point about trolley figures. The INMO produces its own trolley watch and its members have clear guidelines, as does the HSE, as to what constitutes a trolley as opposed to an additional bed. Its figures are published on a daily basis and the HSE publishes figures three times a day. The general secretary of the INMO is co-chair of the emergency department task force, where there is an exchange of information on this, so I believe the 12% decrease in April, according to the INMO's figures, is widely accepted among staff.
The Deputy is entirely correct to say we need to recruit more nurses and we need to do more to recruit nurses. The HSE has been at career fairs in London and, as part of our discussions with the INMO and SIPTU to avert industrial action, we agreed a number of measures including the doubling of the bring-them-home allowance from €1,500 to €3,000, and extending it beyond the UK. There is a number of pre-retirement allowances for people who want to work part-time rather than full-time, meaning we keep a part-time nurse in the system. I am looking forward to going to the INMO conference later this week, where I will have an opportunity to outline plans in this area.
Hospital Procedures
Eoin Ó Broin
Question:10. Deputy Eoin Ó Broin asked the Minister for Health the estimated cost of rolling out early supported discharge programmes nationally for stroke patients in circumstances in which this would improve patient outcomes and free up acute hospital beds; if he will roll out early supported discharge programmes nationally for stroke patients in view of the fact that this would improve patient outcomes and free up acute hospital beds; and if he will make a statement on the matter. [20214/17]
Question No. 10 is in the name of Deputy Eoin Ó Broin and Deputy Louise O'Reilly has been nominated.
When I was a union official we had a particularly difficult employer and we used to say that if something we suggested made sense he would not do it. My question, however, makes eminent sense. Supported discharge programmes have been proven to work so will they now be rolled out nationally? Will they be funded and prioritised?
I always listen to the Deputy's sensible suggestions. The national clinical programme for stroke has been in place since early 2010. The vision of the programme is to design standardised models of integrated care pathways for the delivery of clinical care. Early supported discharge is a rehabilitation programme that aims to accelerate discharge home from hospital and provide rehabilitation and support in the home setting in order to maximise independence as quickly as possible after stroke. Pilot early supported discharge programmes in three sites in Ireland have proved to be effective, with up to 35% of stroke patients being discharged successfully.
The HSE has advised my Department that its integrated care programme for patient flow has identified the need to strengthen the integrated patient-centred approach. Improving discharge processes is not only necessary to deliver safe and truly person-centred care but also to optimise bed utilisation.
Funding has been allocated by the clinical strategy and programmes division to the integrated care programme to support the national clinical programme for stroke to expand the early support discharge stroke programme in 2017. This involves increasing staffing in three existing early supported discharge stroke teams and developing two new teams at a full-year cost of €460,051.
Early supported discharge complements the range of measures to improve stroke care including 24-7 access to thrombolysis and increasing the number of stroke units to 22. These measures have reduced stroke mortality, reduced average length of stay in hospital and enabled more stroke patients to be discharged directly to home. This is in their rehabilitative interest as patients, as well as being in the interest of the health service by ensuring better bed utilisation. In advance of the Estimates for 2018, the HSE will prepare costings for the roll-out of this programme and the Department is currently engaged with the HSE on the business case, as part of the development of the HSE's national service plan in advance of budget 2018. I will share more information on this with the Deputy as it becomes available. It will be hard not to agree on something that is beneficial and we are expanding it this year with additional teams. There is scope to do more and I hope we will have a full business case in advance of the 2018 Estimates.
The Minister says it will be 2018. If it makes sense now, would it not make sense to prioritise it?
Even though pilot ESD programmes have been proven to be effective, only three early supported discharge teams are in existence covering four acute hospitals. If we have all decided we agree on it, it is farcical not to act on it. International studies show that 25% to 40% of all stroke patients can benefit from early supported discharge programmes. The long-established cost effectiveness helps in the production of any business case. It is estimated that we could save between €2 million and €7 million a year. It is not just saving money; it is good for the patient to have early supported discharge. When will we see this in place? Since it has been proven to work, I do not know what the problem is leading to its delay.
There is certainly no problem. We are not just saying it works and is that not great; we are actually saying it works and let us do more in 2017. That is why we are providing additional funding this year to increase the staffing in the three existing early supported discharge stroke teams and to develop two new teams. As I have outlined to the Deputy, the cost of that is €460,051 in a full year. As is normal, in advance of the Estimates process the HSE is working with my Department to prepare costings if we were to roll out this programme nationally. In advance of the Estimates process formally beginning I would be very supportive of this because it makes sense from a bed utilisation point of view. We have had the benefit of the pilots. We are now putting the staff into those two additional teams. I expect to be able to share with the Deputy more concrete details on the costs of rolling it out nationally well in advance of the budget 2018 process. This is something my Department, the HSE and I all support. A body of work is being done to see how it can be rolled out nationally.
Let me clarify this. We are agreed that the pilots worked, that there are savings for the Exchequer and that there are benefits for the patients. We are ticking all those boxes. Is the plan for the Estimates that it would be a full roll-out next year and not another pilot or a partial roll-out? I am not trying to put words in the Minister's mouth; I am asking a genuine question. It will not be another pilot, but a full roll-out giving full availability to those who need it for next year.
I accept it is a very genuine issue. The Deputy will also accept that I cannot deliver the budget for 2018 now at the start of May. However, my Department is working with the HSE to prepare the business and health case for the roll-out of early supported discharge services throughout the country. That is the work the Department of Health is undertaking with the HSE. I would like to see this rolled out nationally and the vehicle for achieving that is the budgetary process. The Deputy is correct; I am not talking about another pilot, but a national roll-out.
Brexit Issues
Stephen Donnelly
Question:11. Deputy Stephen S. Donnelly asked the Minister for Health the status of the health services’ preparations for Brexit. [20784/17]
Question No. 11 in the name of Deputy Donnelly will be taken by Deputy Kelleher.
What is the status of the health services' preparations for Brexit? We have discussed this issue in the committee, but I seek clarity on the Minister's thinking on the issue of Ireland's preparations for the impact it could have on our health services here given that Article 50 has been triggered. I instance the treatment abroad scheme and the cross-border health care directive given the number of people who go to Northern Ireland under that directive. The other issue relates to the number of people working in the UK health services who could be discommoded with the withdrawal of the free movement of people.
I have taken part in a number of Brexit-related meetings, including at the North-South Ministerial Council. I have also met the European Commissioner for Agriculture and Rural Development; the UK Parliamentary Under Secretary of State for Health; the European Commissioner for Health and Food Safety; the Northern Ireland Minister for Health; the UK Secretary of State for Health; the executive director of the European Medicines Agency; the CEO of the German-Irish Chamber of Industry & Commerce; the Scottish Cabinet Secretary for Health and Sport; the Belgian Minister of Social Affairs and Health; 23 EU permanent representatives as recently as last Friday; and a number of Irish officials as well as our ambassador. We have been very busy in the Department of Health working on Brexit, as all Departments are.
Ireland’s preparations for Brexit continue to be strongly co-ordinated from the centre of Government through the Brexit Cabinet committee chaired by the Taoiseach. My Department participates fully in the senior officials group on EU affairs, the interdepartmental group on EU-UK affairs, and as appropriate its working groups established to support the Cabinet committee on Brexit. Regular contact is being maintained with Departments on cross-cutting issues of relevance for the health sector.
As the Deputy is aware, a very extensive programme of engagement on Brexit by the Taoiseach and Ministers has been taking place with other EU Governments and the EU institutions reinforced by extensive engagement at diplomatic and official level. I have outlined the series of meetings I have had in the past year, including with the EU Commissioners and fellow health Ministers.
In the area of health, all work relating to the impact of Brexit is informed by the following key priorities: to ensure continuity in the provision of health services; and to avoid any changes to the current situation that would have a negative impact on human health.
The Department of Health and its agencies have been conducting detailed analysis on the impacts of Brexit in the area of health. Multidisciplinary workshops are continuing within the HSE and with key external stakeholders in this regard. Work on the implications of Brexit is also a priority for other health sector agencies. The ongoing preparations for Brexit include an in-depth analysis of relevant EU legislation and regulations.
In my Department, we have established a management board subcommittee, which serves as a co-ordinating body to pull the various strands of this work together. It is chaired by the deputy Secretary General and includes HSE representation at national director level.
The Government also believes that Dublin would be a very suitable location for the European Medicines Agency, particularly in the interests of ensuring continuity and sustainability in the conduct of its business. Such continuity is critical for European citizens and the industries which the EMA regulates. I visited Brussels last Friday to meet 25 EU ambassadors and diplomats and the Belgian Minister for Social Affairs and Health to provide detail of the Dublin campaign. I presented a brochure and website, www.emadublin.ie, setting out the compelling reasons for relocating the European Medicines Agency to Dublin. I will officially launch the brochure and website for the Dublin bid tomorrow. The relocation of the EMA is one of the potential benefits from Brexit. We have tough competition. The Deputy has alluded to other challenges to which I would be happy to respond.
I wish the Minister good luck in his campaign to relocate the EMA to Dublin, or to Ireland at the very least.
Dublin Bay North.
Obviously, decentralisation would be very much appreciated in other parts of the country. We wish him well with that. However, there are potential downsides to the whole issue. We cannot accept that the relocation of the EMA will resolve all our problems.
I know.
I am not saying he is. For example, I refer to vaccination programmes on an all-island basis; co-operation on rare diseases, particularly in paediatrics; and transplanting where we do not have the capacity on our own, but with the Republic, the North and Britain we would have critical mass. A considerable amount of work needs to be done on those areas.
The negotiations by the UK Prime Minister, Mrs. May, have been quite ham-fisted to date. Views such as no deal is better than a bad deal are being expressed. I can accept that people are squaring up to each other to a certain extent. However, real lives are at stake here given the impact it could have. I urge the Minister to keep an interested eye on these areas and not to be side-tracked by the bigger issue of the EMA coming to Dublin, which I accept is very important. However, in the longer term, the issues I have outlined are significant.
In accordance with Standing Orders, I call Deputy Louise O'Reilly for a short supplementary question.
When officials from the Department of Health Brexit committee appeared before the Oireachtas Joint Committee on Health, I was flabbergasted. When we asked how many people use the cross-border directive to avail of NHS services, they were able to give us an approximate figure, but were not able to tell us how many people go to England. However, what was worse was that when I asked why they did not have that information for the meeting, they advised me that they had only sought the information from the HSE when they got the invitation to our meeting.
I asked a follow-up question on the service level agreement between the HSE and Altnagelvin hospital. I asked them if it was Brexit-proofed. That SLA was signed after the referendum. However, they could not tell me. The Minister and the Department are sleepwalking us into the worst effects of Brexit. I do not think this issue is being taken seriously - perhaps by the Minister but not by his officials.
I take it very seriously, which is why I have had meetings with the Northern Ireland Minister for Health. If we had a Northern Ireland Minister for Health now, I would be able to have another meeting with the Northern Ireland Minister for Health on Brexit. It is being taken very seriously by me and by the Government. We saw the benefit of this being taken seriously by all of Government in the outcome of the European Council negotiating guidelines. That is why I met the Northern Ireland Minister for Health on a number of occasions on Brexit. We had good engagement on that. I have met the UK Secretary of State for Health, Mr. Jeremy Hunt. I have met the EU Commissioner for Health and Food Safety to discuss Brexit on a number of occasions.
Deputies Kelleher and O'Reilly are correct in pointing out very serious issues affecting health care, just as there are in many other services if we end up with the common travel area being in any way compromised.
That is why the common travel area has been identified as one of the Government's four Brexit priorities. This is of particular relevance to cross-Border health care. The fact that the common travel area has also been referenced as a priority by the European Commission, the Council of Europe and the British Government is a result of our collective work. I do not mean this in a partisan sense. It is a result of all of our work in making sure the common travel area remains. There is absolutely no sleepwalking. There is an absolute determination to get Brexit right. We are very determined with regard to that. There are other issues that I will come back to in a moment if I have the opportunity.
We have two minutes left for questions. I could take Question No. 12. I will allow Deputy Kelleher a quick supplementary question.
Reference has been made to the many discussions on these issues. A person can be busy but equally needs to have a strategic plan in place to address them. I urge the Minister not to be sidetracked by the big prize of the European Medicines Agency but to ensure that there is this monitoring across all areas of health to do with cross-Border activity. It could have profound impacts, even in the context of emergency services, for example, and in all of these key areas, particularly for people living in the Border areas who should have certainty. As referenced by Deputy O'Reilly, the cross-Border health care directive and the treatment abroad scheme are critically important because people do avail of them in the North and in the UK. They should be areas in which we try and see if we can come to some arrangement bilaterally to ensure that they can continue in some way or another. Otherwise, we will have other capacity problems.
I could not agree more. I assure the Deputy that that is the Government's perspective and that is exactly what we are working towards. When I meet the UK Secretary of State for Health, the Northern Ireland health Minister or the European Commission, this is what we are discussing. Like all Government Ministers, I am making people throughout the European Union aware of the importance of getting this right and the importance of making sure that Brexit does not result in a return to a hard Border and does not result in damaging or undermining the common travel area, which is so important to our people. It is important to nurses travelling either side of the Border, to emergency vehicles as the Deputy said, to the very sick children in this country who have operations carried out in London and to the very sick children in Northern Ireland who come down to Crumlin to have their cardiac operations. This is an issue that we have made sure Europe and the European Commission are very clear on. I believe that clarity is reflected in the negotiating stance taken by the European Commission. I can assure the Deputy that my Department and the whole of Government will be making sure that these issues are adequately addressed in the Brexit discussions to take place.
Hospital Waiting Lists
Michael Healy-Rae
Question:12. Deputy Michael Healy-Rae asked the Minister for Health the status of the waiting lists for cataract operations in the south-south west hospital group (details supplied); and if he will make a statement on the matter. [20446/17]
I thank Deputy Healy-Rae for asking this question, which he has raised with me and takes very seriously, about people waiting for cataract operations. I wish to acknowledge that ophthalmology waiting times in the south-south west hospital group are often unacceptably long. I am conscious, as the Deputy has made clear to me, of the adverse impact that can have on somebody's life.
Reducing waiting times for the longest-waiting patients is one of our key priorities. As a result of that, we allocated in the budget €20 million to the NTPF. We have also ring-fenced a further €55 million for 2018. This will mean more procedures for more patients.
In December 2016, I granted approval to the National Treatment Purchase Fund to dedicate €5 million to a day case waiting list initiative with the aim of ensuring that no patient will be waiting longer than 18 months for a day case procedure by 30 June 2017. This will mean that in excess of 2,000 day case procedures will be managed through this process and patients today are already receiving their appointments for such procedures. Based on his question, the Deputy will be glad to know that long-waiting ophthalmology patients are a core group that will receive treatment under this initiative.
In order to reduce the numbers of long-waiting patients, I asked the HSE to develop action plans for 2017 in the areas of inpatient day cases, scoliosis and outpatient services. These plans have now been finalised and I expect the HSE to get on with implementing them.
The HSE is currently finalising the report of the primary care eye services review, which aims to reorganise primary eye care services with an increased emphasis on maximising delivery of a comprehensive service in primary care. I meet a lot of people who say that more of this can be done in the community. This thereby creates capacity in hospitals to provide more complex ophthalmology services.
The HSE has advised that the south-south west hospital group is currently examining solutions for ophthalmology services across the group, including increasing the number of ophthalmic physicians in the group, which will obviously have a further positive impact. We intend to increase the number of physicians. We are seeing patients get cataract appointments now through the NTPF. We are about to receive the final report of primary care eye services review, which looks at what more we can do in the community. I know this is a very important issue in Kerry and a very important issue for the Deputy.
I want to be clear that this is of huge importance. People are going blind while waiting for their operations. I and a manager from a hospital presented the Minister with a plan specifically for County Kerry. We were talking about carrying out operations in County Kerry. When is that hospital going to something it did in the past, which is carry out cataract operations on people in County Kerry to specifically target that waiting list and to take people off it who have been waiting two, three or four years to have cataracts removed from their eyes? It is one of the most basic operations that can be carried out. If they were paying for it, it would cost about €2,700. It is a shame and a disgrace in this day and age. If it was happening in Africa, we would be outraged and asking how it could be allowed to happen in any part of the world. However, it is happening under our noses and in County Kerry. I have been highlighting it for a long time. I ask the Minister to answer the specific question about Tralee in County Kerry. When are we going to see operations being done in that town?
In fairness, the Deputy has been highlighting this for some time. I am grateful for the meeting the Deputy arranged for me to have. I see there is a willingness and a desire in Kerry to try to come up with a local solution to this. The Deputy will understand that through the NTPF we have provided funding for non-public hospitals in the private sector to apply for. The procurement and tendering rules are a matter for the fund. I am happy to follow up with the Deputy on where the proposal put forward by the hospital for a Kerry-based solution is at. I will revert to the Deputy directly on that.
Written Answers are published on the Oireachtas website.