Other Questions

Diabetes Strategy

Charlie McConalogue


47. Deputy Charlie McConalogue asked the Minister for Health his plans to create a centre of excellence in diabetes care in the north west in view of the fact that there is no centre of excellence in diabetes care north of the Dublin to Limerick line; his further plans to increase the level of staffing in the diabetes team in Letterkenny University Hospital; and if he will make a statement on the matter. [27785/17]

It is welcome that the Minister is due to meet the Donegal Diabetes Association next week and has met its representatives previously. Commitments were made to try to ensure services would be improved. My question focuses on what the Minister and the Government are doing to support diabetes services in County Donegal. In particular, what is the position on the Minister's commitment to explore establishing a centre of excellence in paediatric diabetes care in County Donegal and improve diabetic services and supports for adult diabetic patients in the county?

I look forward to the meeting next week. The Deputy is welcome to come along and engage with Oireachtas Members, the group and me on the issues we discussed when I visited Letterkenny previously.

Letterkenny and Sligo university hospitals provide essential high quality hospital care for patients in the north west. I can assure the Deputy of the continued commitment to develop services in both hospitals, including those for patients with diabetes.

Adult diabetes services at Letterkenny are provided by a consultant endocrinologist, supported by a locum consultant general physician with a diabetic interest. In order to address waiting lists, additional clinics are provided on a monthly basis. Furthermore, the Saolta University Healthcare Group has advised that it is making applications for the approval of a second consultant post and an advanced nurse practitioner post in insulin pump therapy to serve both adult and paediatric patients. I can assure the Deputy that when the applications are made, they will be assessed with a degree of priority because of the importance of the matter.

With regard to the provision of paediatric diabetes services, an insulin pump therapy service commenced at Sligo University Hospital in 2015, with outreach clinics delivered at Letterkenny. However, in mid-April the consultant paediatrician with a special interest in paediatric diabetes post in Sligo became vacant and the Saolta University Healthcare Group has advised that it is actively engaged in recruiting a replacement. That process is ongoing. Pending completion of the recruitment process, consultant paediatricians at Sligo and Letterkenny hospitals have undertaken additional training and development to maintain the provision of the paediatric insulin pump therapy service at both hospitals. Further additional support for these services has been arranged with another consultant, currently practising within the Saolta hospitals.

Provision of a diabetes centre at Sligo hospital is included in the capital plan for this year. HSE Estates advises that planning permission for the centre has been granted; construction is scheduled to commence by the end of the year and be completed in quarter three of next year. Filling the permanent diabetes consultant post at Sligo will enable the group overall, including in County Donegal, to further advance its plan for the diabetes care centre.

I will meet the Donegal branch of Diabetes Ireland, the HSE and the Saolta University Healthcare Group this month to discuss the current challenges and future development of diabetes services in the north west.

For children with diabetes, there is no centre of excellence in paediatric diabetes care north of the Limerick to Dublin line. Services are quite limited and in no way sufficient to meet the number of children in the county or the north west who need them. It is often considered at official level that if a service is provided in Galway, patients in County Donegal are covered. I know that the Minister has been to Letterkenny a few times and will know that it is closer to Dublin than to Galway. We need services in the north west.

On the provision of a centre of excellence in paediatric diabetes care which would include a consultant endocrinologist and support staff such as a dietician and a psychologist, will the Minister give a firm commitment that such a centre will be developed in the north west to serve children from Donegal and neighbouring counties? On the adult diabetes service, there is a need for an additional consultant in Letterkenny and a team to support him or her to deal with the number of patients in the county with diabetes. A total of 7,000 people in County Donegal have been diagnosed as having diabetes, of whom 700 have type 1 diabetes. The waiting time for a follow-up appointment is more than 20 months for patients with type 1 diabetes at a time when the recommended period is four months. It is simply not acceptable. The necessary resources and staff need to be provided to serve patients with diabetes in County Donegal.

The Deputy makes a very fair point. The health service cannot presume that Letterkenny is just up the road from Galway. It is a significant journey to travel. We have talked previously about certain specialties, inlcuding cancer care, and the need at times for patients to travel to Galway, but, in general, as many clinics as possible should be held in Letterkenny to help patients in the north west. As I said to the Deputy, active recruitment is under way to try to fill the vacant consultant paediatrician post. Filling it would make a significant difference. I have asked the HSE to come back to me with further information in advance of our meeting with the Donegal branch of Diabetes Ireland. Obtaining a replacement to fill the post would be of significant assistance. In the meantime it is worth saying, as I mentioned, that paediatricians in Sligo and Letterkenny hospitals have undertaken additional training in order that they can keep the paediatric insulin pump therapy service running at both hospitals. There will be the development of a diabetes centre in the north west. Funding is provided in the capital plan for this year. I want to see paediatric services provided in the north west. I will be happy to discuss the matter further with the Deputy and the group when we meet next week.

I thank the Minister and look forward to discussing the matter further with him with the Donegal Diabetes Association next Wednesday. I highlight the impact on children with diabetes in County Donegal of not having a paediatric consultant endocrinologist in Sligo. It means that insulin pump therapy is not available to newly presenting children under the age of five years with type 2 diabetes. The service is struggling to provide a support service for the children who are receiving this therapy. It is crucial that the post be filled soon to ensure a service will be available to all children with diabetes. It is also crucial that Letterkenny University Hospital see an increase in staff numbers. An additional consultant should be provided, with the necessary support staff, to serve adults with diabetes. Teenagers who enter the adult diabetes service on reaching the age of 18 years are moving from having repeat appointments every three to four months to having to wait over 20 months for them. That is simply not acceptable and is very distressing for them. The problem can be solved only by having an additional consultant in Letterkenny University Hospital to ensure the service can be provided. Having regard to the fact that there are 7,000 people in the county with either type 1 or type 2 diabetes, it is crucial a service be available. As we know, prevention is better than cure. Therefore, the provision of support is critical for patients with diabetes.

I will make four brief points. I can confirm to the Deputy that the process in regard to the consultant paediatrician post which is vacant will be expedited through what is known as the CAAC, the consultant applications advisory committee, and the Public Appointments Service. Saolta has confirmed that to me. Saolta has also advised that a plan is being put in place to ensure that all existing paediatric patients on pump therapy will continue to be managed locally in Sligo and Letterkenny with existing paediatric consultant staff and continuation of existing clinics. The locum paediatrician in place in Sligo and the existing consultant paediatrician in Letterkenny have undertaken additional training in order to continue provision of that service. Further development of clinical staff will be scheduled in coming months in order to continue the delivery of this therapy. All options, both internal and external to the group, are being explored to make sure that patients under the age of five years will have access to pump therapy. The Saolta group advises that it is currently engaging with a consultant in another hospital in the group with a view to putting governance arrangements in place for the oversight and review of patients and the management of new patients. This consultant has experience in the delivery of paediatric diabetic pump services. Sligo is further developing its centre for diabetes care. It is included in the capital plan for this year and this will ensure the facilitation of paediatric insulin pump services for people in the north west.

Mental Health Services Provision

Thomas Byrne


48. Deputy Thomas Byrne asked the Minister for Health if his attention has been drawn to the case of a person (details supplied) who was suffering from a mental health crisis and who did not receive appropriate and adequate care from a hospital; and if he will make a statement on the matter. [27651/17]

My question relates to an individual, whose details I have kept private, who received totally inadequate hospital care when he presented at Our Lady of Lourdes Hospital with what I will describe as a severe mental health crisis some time ago. The Minister has the details which were supplied with the question. The question has been tabled to initiate a discussion on that specific case but also on the general point of what happens when someone presents for medical help to their doctor or hospital. What services are there for a person in a mental health crisis?

As a general rule, information on individual cases cannot be given due to patient confidentiality. For that reason, this parliamentary question is being answered in unspecific terms in relation to the individual regarding mental health services in Our Lady of Lourdes Hospital, Drogheda.

The person was referred by a GP on 10 April 2017 and was assessed in the emergency department in Our Lady of Lourdes Hospital and subsequently seen by the psychiatric non-consultant hospital doctor in the department of psychiatry on the same day. Following assessment the person was not admitted to the acute psychiatry department but was referred to the local community mental health team for further involvement in his care. The person was offered a new patient outpatient appointment on 23 May 2017 in his local area which he had confirmed by phone but unfortunately did not attend. He was offered an additional appointment on 13 June 2017, which he attended, and he has a further review appointment pending which was offered by his local community mental health team.

A new multi-million acute psychiatric inpatient unit opened last September in Our Lady of Lourdes Hospital, Drogheda. This is a significant new capital development for people with severe, enduring and disabling mental health issues. Mental health remains a priority care programme for this Government. We are committed to increasing the mental health budget annually, as shown by the substantial additional funding of some €140 million since 2012.

With regard to specific complaints in relation to experiences of individuals in our hospitals, there is a formal complaints policy, entitled Your Service Your Say, details of which are on the HSE website. In accordance with this procedure, a complaint must be made in the first instance to the hospital in which the incident causing the complaint occurred. If an individual is not satisfied with the response from the hospital, a review can be sought from the HSE director of advocacy and the Ombudsman.

As I understand, the only reason my constituent raised this issue publicly was not merely to complain and create a fuss but to try to make the service better for others who might find themselves in the same position but who did not have the support of friends, community and family. Where would they be? The referral for specialist help was six weeks after the initial appointment. Luckily, this particular individual had considerable help from his community, family and friends such that he was able to deal with this issue but he has made it a public issue locally and, I suspect, nationally, mainly to get assistance for people and to clarify what help is available when someone presents at our hospitals or GP services with a mental health crisis which could be a matter of life and death. What treatment is available?

While the centre in Drogheda is welcome, the day centre in Navan, which was to replace the old centre in the town, has not been opened. TheJournal.ie has reported today that it is still closed, but that is known across the community. The services are really inadequate. Nobody seems to know what is available for someone at a point of crisis in mental health.

It is a distressing case. I was shown some of the background to it by officials in the Department. It is obviously a very sensitive case and I do not want to dwell on it, nor does Deputy Thomas Byrne, but the gentleman in question has done the State some service by highlighting the difficulties he experienced in his case. The Deputy asked what happens when somebody presents to a hospital. The HSE mental health division has a clinical care programme which comes into effect when people present to the emergency department with suicidal ideation or self-harm. All level-four hospitals have a liaison psychiatry service available on the site of the acute hospital. This service provides prompt assessments in the emergency department. In this case, the individual presented to the emergency department. I take on board the Deputy's concerns. I am new to the role and I am anxious to see for myself what is available on the ground. I thank the Deputy for highlighting its importance.

I am sure the Minister, Deputy Harris, has heard from my colleague, Deputy Browne. The Minister of State, Deputy McEntee, and the Taoiseach will have heard from Deputy Browne and my party leader, Deputy Martin, one of the key priorities for our party is the whole issue of mental health and implementing A Vision for Change and the money required to pay for the resources needed, which is the key part of it and what was missing in this case. The money was not there and the resource was not available to give the help when it was required. I have no doubt that my colleagues will continue to press this issue with the Minister and with the Taoiseach, Deputy Varadkar, as a key priority for us and the country. We are all very good at talking, at getting photographs taken and at promoting all sorts of fantastic initiatives but the role of politicians and of the Government is to provide the resources needed to help people when they present in crisis, as happened in this case.

The Deputy makes a very good point. It is a matter of deep concern to him and his party. In the continuance of the confidence and supply agreement he wants to see that this issue is dealt with. He is aware of the many different steps being taken with the mental health task force. I will meet it next Tuesday. We are having a consultation with numerous bodies, which we hope to publish very shortly. There is also A Vision for Change to which the Deputy referred. The Deputy mentioned resources and, of course, we want to see more resources. However, I am sure the Deputy would agree that it is not merely about resources but how we employ them. It is about awareness, education and cross-sectoral involvement. There are many issues to get right but I would welcome the Deputy continuing to keep the pressure on in regard to this issue during my time in this job.

Hospital Accommodation Provision

Mattie McGrath


49. Deputy Mattie McGrath asked the Minister for Health the status of the procurement of modular patient facilities at South Tipperary General Hospital; and if he will make a statement on the matter. [27646/17]

Mattie McGrath


102. Deputy Mattie McGrath asked the Minister for Health if he will address concerns that South Tipperary General Hospital has been operating on the full capacity protocol for over 17 months; and if he will make a statement on the matter. [27647/17]

Jackie Cahill


107. Deputy Jackie Cahill asked the Minister for Health the position regarding the provision of modular units at South Tipperary General Hospital which were promised to help ease the crisis in the shortage of beds at the hospital; and if he will make a statement on the matter. [27846/17]

Alan Kelly


120. Deputy Alan Kelly asked the Minister for Health his plans to alleviate overcrowding in South Tipperary General Hospital [27539/17]

When will we see relief in terms of the provision of patient facilities? We were promised a mini-hotel by one of my colleagues. We were promised additional bed accommodation to try to alleviate the savage crisis that pertains in South Tipperary General Hospital, formerly and affectionately known as St. Joseph's in Clonmel. Will the Minister make a statement on the matter?

I propose to take Questions Nos. 49, 102, 107 and 120 together.

Work is ongoing to address the capacity challenges at South Tipperary General Hospital. While the HSE is exploring what additional supports could be by provided by Our Lady's Hospital, Cashel, it has identified that the most immediate and effective means to alleviate pressure on the emergency department is the fit out of additional space for 11 trolley bays on the first floor of the hospital. Local Deputies may have been briefed on this by hospital management in the last week. This was prioritised for funding which was provided, and completed recently. A recruitment process is under way to provide staff for this new area and it is hoped to have staff in place, recruited in advance of this winter. It is anticipated that this additional capacity will open in September 2017.

Another option under consideration is to provide additional surge capacity through a temporary inpatient solution, in line with the National Framework for Alternative Accommodation at Hospital Sites. I understand that the HSE plans to address this issue in the context of the Estimates 2018 submission.

I should also mention that in recognition of the significant increase in bed utilisation in recent times, a capacity review of the South Tipperary General Hospital by the South-South West Hospital Group is nearing completion. This review will inform the precise level and nature of any additional capacity required to meet current and future needs. The Department's national capacity review will also help identify service requirements and inform resourcing priorities.

I note that a brief for the procurement of a master plan to provide for the orderly development of the South Tipperary General Hospital campus is currently being finalised.

This review will inform the precise level and nature of any additional capacity required to meet the needs of the people of Tipperary. The Department's national capacity review will also help to identify service requirements.

Finally, I wish to inform the Deputy that a brief for the procurement of a master plan for South Tipperary General Hospital to provide for the development of the hospital campus is being finalised. This will enable us to consider further developments in respect of the capital plan. I think it is fair to say this hospital over many years was overlooked for significant capital investment. The completion of this master plan, which has proceeded to procurement, along with the 11 bays, will enable us to try to include measures in the forthcoming Government's capital plan.

I am very disappointed because we have had promises about this. The extra capacity was expected to be available from early May and could be used to accommodate a space for up to 11 trolley bays. It should be remembered that these would only be on corridors. It is almost certain the modular patient hotel for South Tipperary General Hospital will not be delivered for at least another year. The Minister talked about many tendering processes and everything else. If we get the modular hotel, as promised in a blaze of glory to my colleague Deputy Lowry a year ago this month, it is estimated that the 40-bed unit will cost €60,000 per week to operate. I note that the Minister in his reply tells me that the corridor issue is nearly solved, there is space there for 11 trolleys - not beds - and he now has recruitment ongoing for staff. Why can he not do the two in tandem? I understand from my colleague who visited last week that the place is ready now, and now the Minister is looking for the staff and hopes to have the unit ready for September. Why can nothing be done in tandem? The hospital has been operating at emergency status for the past 17 months. It is under enormous pressure. Why can the recruitment not go on in tandem with the construction work and mini tender? Everything is just a matter of fobbing off and going back and forward. We will have another review and another capacity review by the South/South West hospital group and another one at a national level. It is just not good enough; it is not happening. The Minister visited Cashel with me and saw the spaces and the capacity there.

That is not fair. I do not want to get involved in Tipperary politics. The Deputy's colleague, Deputy Lowry, and indeed all Tipperary Deputies are regularly in contact with me-----

The Minister said he informed-----

-----as is Deputy McGrath, on the very important issues regarding both South Tipperary General Hospital and Our Lady's Hospital in Cashel. We are seeing progress on South Tipperary General Hospital. The 11 bays will open. They will provide badly needed additional surge capacity for the winter. We need to have a master plan for the development. Successive Governments have failed to invest in the hospital and, as a result, it does not have enough capacity. The master plan will enable the hospital group to say what it wants to do in Clonmel and ask the Government to include that in its capital plan. That is the way the process works, it is the appropriate way and I hope the hospital group does that because I would like to see this included in the capital plan.

The Deputy brought me to Our Lady's Hospital in Cashel, I was there with him and I think there is a possibility of alleviating pressure there. I am about to run out of time, but I have already asked the HSE to develop a proposal in this regard and it has developed a proposal which is particularly focused on the development of the Cashel health campus to deliver integrated care, particularly for older people. I think it could do an awful lot for older people in this regard. This will involve additional resource requirements, including specialist staffing, and I therefore expect this to be considered in the context of the budget.

The Minister replied quite recently to a question I tabled to tell me a decision will only be taken based on the outcome of the mini tender. Is the mini tender finished or has it become a major tender? How could any mini tender take so long? The HSE uses a particular vocabulary. The Taoiseach has talked about his new scriptwriter or historian or whatever. The Department of Health could get rid of half the speechwriters and scriptwriters it has for using multisyllabic words in the HSE to confuse people. The Minister saw Cashel. The HSE has no intention of placing patients in Cashel. It is a patient-free area, full stop. It is only being used for staff, as I said to the Minister before. It is an emporial fiefdom for the people in there. They do not want any patients in there. The Minister was there and I know he was shocked to see the condition and the splendour of the unit, the chronic pressure on South Tipperary General Hospital down the road in Clonmel, which he visited afterwards, and the palatial rooms, offices and suites of furniture in Cashel, and to hell with the patient. It is sickening, it is a disgrace, and he is not doing anything about it. I am glad he is back in his job. I will be holding him to account. He can tell Deputy Lowry whatever dúirt bean liom go ndúirt bean léi stories he likes but he will not tell them to me. I will not take them at face value and go announcing a patient hotel that was supposed to be in place last October. We have not even got the bed linen, not to mind the hotel. We have not got the pillowcases and there are no staff to dress the beds anyway.

I do not think I could confuse Deputy McGrath if I tried because he is very clear in his thinking on this and never afraid to articulate that. He is right that when I visited Cashel, I was taken aback by the underutilisation of what is a fine resource within the ownership of the HSE. However, before I became Minister for Health, there was diddly-squat planned to do anything with it.

As a result of my visit to Cashel with the Deputy and his Oireachtas colleagues representing Tipperary across the political spectrum, I directed the HSE to put in place a plan to utilise Cashel so that it can help alleviate pressure in Clonmel - in addition to the 11 bays in Clonmel, the consideration of the modular accommodation and the master plan - so we can have a real capital development. As a result, the proposal that the HSE has come up with for Cashel now predominantly focuses on older people and on the idea of developing the Cashel health campus to provide services for the local population. These services can be developed in the existing accommodation at the former Our Lady's Hospital. However, this will involve additional resource requirements including specialist staff. Therefore, I am telling the Deputy today that this will be considered in the context of the budget for 2018 and I will keep in touch with him and other Oireachtas Members from Tipperary about that.

Health Care Policy

Michael Moynihan


50. Deputy Michael Moynihan asked the Minister for Health if he or his Department has received and read the all-party Oireachtas committee report on health that was published recently; and the way in which this will be implemented. [27561/17]

Has the Minister for Health's Department received, read and studied the all-party Oireachtas Sláintecare report on the future of the health service, and what are his views on its implementation?

There was a similar question about this earlier and we will have a substantive debate, I hope, in the House tomorrow evening on the matter, but I welcome the question.

I have already spoken on this question today in response to a question from Deputy Harty, but it is important to use this opportunity again to thank and commend the committee on its work over the past year and acknowledge the thorough, open and positive approach the committee engaged in throughout this process in order to allow it to achieve this consensus report.

Regarding the Deputy's direct question, I absolutely assure him that I have read the report. Indeed, I have read it many times at this stage. I also assure the Deputy that I remain of the view that this process has provided us with a once-in-a-generation opportunity to transform our health services. People doubted that all the political parties in this House, and indeed Independent groupings, could come together and come up with a plan. With the exception of Deputy Barry, whose decision in this regard I respect, that is exactly what happened. This Government is committed to delivering real improvements in the area of health and our new Taoiseach made that very clear in one of his opening speeches last week. The report of the committee now provides us with a solid framework for delivering these improvements over the next decade.

The Deputy has rightly highlighted the issue of implementation. How we go about delivering on the report must now come to the forefront. This is acknowledged by the committee in its report when it states that "mechanisms for implementation are as important as the report's recommendations".

As the Deputy will appreciate, the report's remit is wide-ranging and its recommendations far-reaching. It is important, now that it has been published, that I give it careful and proper consideration in the context of how best we realise the vision and spirit of the report. Success will very much depend on the formulation of an effective implementation pathway. I assure Deputy Michael Moynihan that I will move quickly on this process of consideration and following the Dáil debate that will take place in this House tomorrow I will bring proposals to Government on this very shortly.

There are a number of aspects to the question. My experience of the health service over the past 12 months is that there is crisis in many aspects of it, but one that always evades me is home care packages and what the Government is doing about them. There is also a discrepancy in how the packages are distributed. The figures show that there are 1,200 in parts of Dublin north-west alone and only somewhere in the region of 200 in north Cork. There is a huge discrepancy in how they are distributed. The one question I have for the Minister in the limited amount of time I have is whether his Department has assessed the home care packages and if he can comment on the value for money in keeping people out of residential nursing homes and in their own homes. From the layman's point of view, it would be good value for money from the Department's point of view and the State's point of view. Has the Minister looked at these figures in real terms? Can he confirm to the House that it makes sound economic sense from the State's point of view to have many more home care packages available than there has been heretofore?

Yes, I can, and my new departmental colleague, the Minister of State, Deputy Jim Daly, will have responsibility for the area of home care in so far as it relates to older people. As Deputy Moynihan will remember, we had a debate in this House recently during which his colleague, Deputy O'Dea, raised this very issue by way of a Bill. We agreed at that stage that we would go forward with trying to develop a statutory home care scheme. We all say we would like people to be able to grow old at home but the only statutory scheme available for someone who grows old and needs more support is the fair deal scheme, that is, the nursing home support scheme.

We intend to launch a public consultation process shortly to hear the views of older people on how that statutory home care scheme, an alternative to the fair deal scheme, for people in need of home help could work.

While there are many elements of the report on which we will all agree, we may not all agree on how to fund its implementation. For example, it proposes the removal of private work from public hospitals. I believe in that proposal instinctively, but it would create a €650 million hole in the health budget. Reference is made to the cost of implementing the report, but it does not outline how we would fund its implementation. The Deputy's party and mine might have a view, but the parties and groupings on the left might have a different one. We will need to tease out these issues in the coming weeks and months.

I congratulate Deputy Jim Daly on his promotion and wish him well in the Department.

On care of the elderly, everybody is telling us that the demographics are changing and that the State needs to be ahead of the curve. When people seek additional home help hours and support within their communities, they have to dovetail with their families to ensure they can stay at home for as long as possible. By and large, when they go into a nursing home, they are fully covered under the fair deal scheme, which costs the State approximately €1,000 a week. There is still a huge challenge for everybody working with elderly people to secure half an hour or an hour of home help provision. The figures were debated recently in the House when we were told there had been no cut in the number of home help hours. The same number of hours is being provided this year as in 2015 and 2016, but the number of people who require this support has increased substantially because of demographic changes. From a constituency point of view, we find that we are constantly trying to make representations to secure additional help in order that families can work with the HSE to keep elderly people at home for much longer.

There will be no disagreement on this side of the House with the Deputy's analysis. The population of the country is changing; it is not just increasing. There will be 20,000 more people over the age of 65 years this year compared to last year and there will be 3,500 more over the age of 80. That trend is likely to continue into the future and will place significant demands on the health service for which we need to plan. The Deputy is correct that the home care system has largely developed with geographical inconsistencies and in an ad hoc way. It is not underpinned by statute, unlike the nursing home support scheme which has a budget of almost €1 billion a year. We need to have a serious conversation about older people seeking assistance to enable them to grow old with dignity. Should we have a statutory scheme that provides people with nursing home care if that is what they require or want but which can also veer in a different way if they wish to remain in their home and have the comfort and safety of knowing that they can avail of a consistent and sustainable model of care? That is where we want to get to as a Government and where the Deputy's party also wants to get to based on what I have heard. We will shortly launch proposals for public consultation in that regard.

Home Help Service Provision

Jack Chambers


51. Deputy Jack Chambers asked the Minister for Health the reason behind the 19% reduction in the number of home help hours in the Dublin West constituency in the period January to April 2017 relative to the same period in 2016. [29085/17]

What is the reason behind the 19% reduction in the number of home help hours in Dublin West in the period between January and April 2017 relative to the same period in 2016? The Minister referred to trends, demographics and ad hoc planning. In the past 12 months the increase in the number last year has been reversed. There has been a significant decrease this year. That contradicts Government policy which is that the threshold should remain the same or increase. It deserves an explanation.

I thank the Deputy for raising this important matter. Home supports provision is a key mechanism in enabling older people to remain in their own homes and communities for as long as possible and facilitating their discharge from acute hospitals. The HSE's national service plan for 2016 originally provided for a target of 10.4 million home help hours and 15,450 home care packages. However, the numbers of patients who had completed their acute treatment but required home care in order to be discharged were very high in the early part of the year. Without additional funding, this rate of hospital discharges could not have been sustained and the allocations for the rest of the year would have had to be reduced. The Government responded to this challenge by providing an additional €40 million for home care services in 2016. Further resources were provided through the winter initiative, in particular, additional home care packages and an increase in the number of approvals for transitional care beds.

This year's national service plan provides for a target of 10.57 million home help hours, 16,750 home care packages and 190 intensive home care packages for clients with complex needs. While the January to April data for home help hours are lower than for the corresponding period in 2016, of more significance is that the HSE target for this year is to provide approximately 200,000 home help hours in Dublin West, an increase of 20% on the number of hours delivered in 2016. A total of 509 people were in receipt of home care packages in Dublin West in April 2017, an increase of 8% on the expected target of 470. This represents an increase of 19% on the number in receipt of a package at the end of 2016.

I wish the Minister of State well in his role. He has a challenging few months ahead, given the ageing demographic. It is fundamental that we move away from the national picture he has outlined. Despite the changing statistics in the Dublin West constituency to which he referred, we know from the raw figures that there has been a 20% reduction in provision year-on-year. That is despite the ageing demographic and all of the challenges mentioned by previous speakers. The core issue concerns HSE management. Area managers are incentivised to balance their budgets and not to increase the provision of home care packages. There is a rigid threshold which is not about service delivery but about meeting budgetary targets. From a health service perspective, we need to move the management incentive away from an inhumane, rigid ceiling for different aspects of community-based health care and deliver for the individual. That should be the reward for the manager. Various area managers in Dublin West have been promoted on the back of cuts in the numbers of home care packages and community services, which have resulted in people being put into hospitals and nursing homes, resulting in a greater cost to the State. They have been rewarded for this flaw in the Government's health policy.

I appreciate the Deputy's comments. There is no point in us arguing over and back about the statistics. As the Minister alluded to previously, the number of hours has increased year-on-year, but there is also increased demand, which has resulted in a reduction in the number of available hours. There are too many disparities geographically, with greater availability in some places. We have to get to grips with this. I would like the service to be put on a statutory footing similar to the fair deal scheme. We spend €373 million on home help provision, which is a large budget. We can continue to increase it, but we need to put the service on a statutory footing with a level playing field. I agree with the Deputy that we need to make sure everybody can access the service because it represents better value for money and, more importantly, a better quality of life for elderly people who wish to remain in their own homes.

I agree that it is important that we keep people in their own homes and maintain a community-based focus in health care, but we need to be careful about a statutory package. We saw what happened with the Tory policy in the United Kingdom on a dementia tax. It is fundamental that the Minister of State avoid imposing another tax obligation or levy on people's homes through a statutory scheme. That would scare the living daylights out of people who want to stay in their own homes. We will have to see what the Minister of State proposes in his scheme. Caring for people in their own homes and ensuring they took their prescriptions delivered through the primary care or hospital system would save the State money. The State should fund such a service and not impose a levy on the family home or the individual. It should be willing to care for them in their own homes because that will keep them out of the hospital system or nursing homes, which are costly alternatives. It is important that we incentivise the scheme by making it free for people and not examine it on a cost basis.

We are saying the same thing. There is no argument from us. The Deputy's party colleague, Deputy Willie O'Dea, proposed a similar statute to the one we are discussing.

We all want to get there. Obviously, there is a cost and we have to deal with the reality that if we go with a demand-led scheme, we cannot have a limitless budget because the budget has to be allocated year-on-year with a certain amount of money. It is a difficult challenge for us to get it right but I think we all want the same thing. I thank the Deputy for his interest.

National Maternity Hospital

Mick Barry


52. Deputy Mick Barry asked the Minister for Health his views on whether the allocation of space for private practice in the plans for the new national maternity hospital is compatible with the elimination of private care from public hospitals; and if he will make a statement on the matter. [27861/17]

Mick Barry


128. Deputy Mick Barry asked the Minister for Health his views on the fact the State will pay for the construction of the new national maternity hospital yet it will be owned by a private entity; his Department's general policy in this area; and if he will make a statement on the matter. [27860/17]

The Committee on the Future of Healthcare has proposed the phasing out of private practice from public hospitals yet it is clear the plans for the national maternity hospital make provision for a significant amount of private practice within it. I do not know how that can be squared but I look forward to hearing the Minister's comments on the matter.

I propose to take Questions Nos. 52 and 128 together.

Deputy Barry must remember that when reforming a health service, one has to continue to run it on a day-to-day basis while those reforms are under way.

Discussions are ongoing with the St. Vincent's Healthcare Group on the terms of the State's investment in the new hospital and, in particular, arrangements for the protection of this investment - I had a question on this earlier from Deputy Shortall. There are long-standing arrangements in place between the State and the 17 voluntary hospitals to allow for public investment in the development of health care facilities and for these facilities to be protected for publicly funded health care. The Mulvey agreement envisaged that further consideration was required in regard to the precise legal mechanisms necessary to protect the State's considerable investment in the development of this much-needed national maternity hospital. My Department is actively engaged in discussing suitable arrangements to ensure the facilities are legally secured on an ongoing basis for the delivery of publicly funded maternity, gynaecology and neonatal services. I hope to update the Government and the Oireachtas on this progress very shortly.

On the issue of the allocation of private space in the new hospital, I would like to clarify that there is no differentiation between public and private inpatient rooms in the hospital designs. All inpatient rooms are of a similar, high quality design given we want to build a state-of-the-art new hospital. In terms of outpatient consulting space, some limited private space will be provided, based upon existing policy and subject to any policy development, in so far as this is necessary to support the commitment in the current consultant contract. As the Deputy knows, the current consultant contract does envisage that consultants can carry out a degree of private work. If that changes in line with the Sláintecare report or any consultant contract discussions, which I think is the Deputy's question, that will be reflected in the changes to policy development.

In regard to the more general issue of private care in public hospitals, I look forward to the Dáil debate on the Sláintecare report tomorrow and I will give full consideration to the report's recommendations when I have had the opportunity to hear views from across the Dáil. Following the debate, it is my intention to bring detailed analysis and proposals to Government. I have no doubt the report will be an essential document for this and future Governments and all parties in the fundamental reform of our health services over the next decade. While I know the Deputy was not in a position to sign off on the report, I acknowledge he worked very hard with many colleagues on it.

The architect's plans for the national maternity hospital, if anyone puts them up on the wall and has a look at them, show a corridor marked "private clinics". There are five rooms on the plans marked "private consult". We have a two-tier health service and it is two-tier in maternity services as well. I reject the Minister's point that there is equality. If anyone goes private, there is continuity of care. If they go public, that is very unlikely. A private patient who arrives for prenatal appointments does not have to wait whereas a public patient has to wait. It is two-tier. I am asking the Minister to comment and to state whether he agrees there is a two-tier care system within the health service or within maternity services in the context of planning for the future and the development of the national maternity hospital.

We all want to arrive at a single-tier health service, and if we were already there we would not all be working so hard to arrive at that point. That is the purpose of the Sláintecare report, which has received broad political consensus. I do not know if the Deputy has walked the corridors of Holles Street hospital lately but I have been there many times. The point I am making, which the Deputy seems to reject, is that at the moment public patients are receiving excellent care from staff in deplorable conditions. Every patient, whether public or private, in this new state-of-the-art national maternity hospital will have the same high quality inpatient room. That is very important and is a significant development.

Yes, there will be rooms for consultants to see outpatients; in fact, there will be 32 consult examination rooms in total. Under the current consultant contract, roughly proportionately, some five of them would be used for private clinics. The point I am making in direct answer to the Deputy's question, which is how it is compatible with the Sláintecare report, is that if policy changes in this area, so too will the allocation of those rooms. I have to comply with the law today in terms of contracts but we are going to deliver the same rooms to the exact same specification as outpatient consult examination rooms and to the exact same specification as inpatient rooms as well. That is very significant progress for women in this country in terms of their own treatment.

It is nothing to boast about that both public and private patients will have their own rooms. This is something that has existed for a long time in the National Health Service in the UK.

Not here though.

It is a real sign of the backwardness of the health service in this country that we have not had this up to now. It is not something to be boasting about.

Ireland is one of the few countries in Europe that does not have universal foetal anomaly screening and many pregnant women were not able to avail of that last year. If a woman has concerns about genetic defects, she has to pay for the tests. The nuchal translucency scan costs €250 while non-invasive prenatal testing costs €450. This is really backward.

I too look forward to the Sláintecare debate tomorrow. The sooner we get this for-profit, two-tier operation out of our health service and maternity services, the better.

My party has signed up to the implementation of the Sláintecare report whereas I do not believe the Deputy has. I look forward to that debate as well. It is not a matter of boasting; it is a matter of actually acknowledging when we make progress. I am determined and proud that this Government will deliver a state-of-the-art world class national maternity hospital for women and infants in this country, something that has not been done and was not done even in the boom years.

I want to have a universal single-tier system. I ask the Deputy to take up my invitation to go across to the National Maternity Hospital, Holles Street, and ask to meet with the master of the hospital, walk the facility and see the conditions in which women have to give birth in this country. It is not acceptable.

It is outrageous.

It was forgotten about, even in times of economic boom. We are going to do it and we are going to get it right. We have seen developments in regard to this project, with the Sisters of Charity withdrawing in recent weeks. I have made it clear that my Department, the Chief State Solicitor's office and St. Vincent's Healthcare Group are now in discussions in regard to the ownership model. We will get this right and we will build this. I share the Deputy's view that we are coming from behind when compared to where many other countries are in terms of capital infrastructure and single inpatient rooms. However, this is an example of good practice, which means we are going to deliver a high quality inpatient room to every woman, regardless of whether she is a public or private patient.

Hospital Services

Aindrias Moynihan


53. Deputy Aindrias Moynihan asked the Minister for Health the number of persons waiting for ophthalmology services in County Cork; his plans for reducing waiting times for persons; and the options he has considered to deal with these waiting lists [27868/17]

Over the last year we have seen the number of people waiting for ophthalmic procedures, in particular cataract operations, in Cork continue to increase. While that list is increasing, those people's quality of life continues to deteriorate. People are afraid of moving around their own homes in case they trip and fall and break a hip, and they have reduced mobility and are not able to get out to get their driver's licence renewed, for example. We need to establish what action will be taken to reduce the extraordinarily long waiting lists for those waiting for cataract operations in the south west.

I thank the Deputy for the question. As he will be aware, NTPF data for May 2017, the last month for which figures are available, indicate that 6,607 patients are on ophthalmology outpatient waiting lists for hospitals in Cork and a total of 1,118 are on inpatient or daycase lists. I acknowledge that waiting times are often unacceptably long and I am conscious of the burden this places on patients and their families. There is no doubt that our public hospital system is challenged in meeting the growing demand for care. In order to take action on this and do something about it, we have developed waiting list action plans for this year in the areas of inpatient-daycase and outpatient services. These plans focus on reducing the number of patients waiting 15 months or more by the end of October. Under these plans, approximately 14,200 patients have already come off the inpatient-daycase list and almost 49,000 off the outpatient lists.

Last December I granted approval to the NTPF for funding in the region of €5 million for those waiting longest for daycase treatment to ensure that in excess of 2,000 patients waiting more than 18 months for a daycase procedure will receive an offer of an appointment by the end this month.

The NTPF has advised that to date 2,500 patient files have been transferred to private hospitals under this initiative, 631 patients have accepted an offer of treatment and 178 patients have received their procedure.

The inpatient and daycase waiting list action plan will be delivered through a combination of normal hospital activity from the HSE budget, funded under the national service plan, as well as insourcing initiatives through the NTPF in public hospitals and outsourcing initiatives in private hospitals using the €15 million of budget 2017. I assure the Deputy that ophthalmology waiting lists, including for people in Cork, will be progressed using insourcing initiatives while we will provide additional funding to public hospitals to provide more ophthalmology procedures using funding through the NTPF. I expect this will show significant progress in the coming weeks and months.

I understand the €5 million aimed at daycase waiting lists was originally intended to reduce the number of people waiting by the end of June this year. At this stage, more than 87 people are waiting for inpatient procedures in Cork. Are we still on target for this? Is it realistic these people will get their procedures by then? Has the Minister looked at, for example, the Sligo model in which far more community services are used? This means instead of the consultant dealing with after-care this is done in the community and the consultant is free to deal with people who have cataracts and who are waiting for procedures. It is a major concern to so many older people in my community who, for example, are afraid of losing their driver licences because of their eyesight. This is not just about driving, it is about social isolation, a threat to the wider family and people being able to meet their grandchildren. Will the Minister prioritise this?

I thank the Deputy. In fairness, he has highlighted the seriousness of this issue to a person's quality of life, safety and well-being. As I stated, the €5 million was to treat in excess of 2,000 patients. The NTPF has transferred 2,500 patient files, because not every patient will be in a position to accept treatment for a variety of personal reasons. Today, 631 of these patients have accepted an offer of treatment and 178 of them have received their procedure. I expect this number to continue to grow apace because it is fully funded and fully authorised.

The point made by Deputy Aindrias Moynihan about doing more in primary care hits the nail entirely on the head. There is more we can do with regard to primary care by services in the community. As the Deputy may know, the HSE is about to finalise a report on a review of primary care eye services, the aim of which is to look at how much more can be done in primary care, with an increased emphasis on maximising the delivery of a comprehensive service in primary care, which thereby, as the Deputy correctly said, creates capacity in hospitals to provide more complex ophthalmology services. The programme for Government commits to developing a national eye care plan, including the evaluation of the Sligo model for cataract services. The Sligo model is largely one where more services are carried out in the community. I expect to have more information for the Deputy on this in the coming weeks and I will revert to him.

Are the NTPF figures quoted by the Minister national figures or are they specific to Cork and Kerry? CUH has the largest number of people waiting more than 18 months, with 1,350 people. Well over 7,000 people are waiting for inpatient and outpatient procedures. Has the Minister looked at the option of hiring additional ophthalmic physicians? Is there space in the Estimates? If so, how many people will the Minister consider taking on, specifically in the Cork and Kerry region?

They were national figures. Obviously, included in this is meeting the longest waiters regardless of where they live in the country. The figures that relate to the Deputy's region will be focused on in this regard. The South Infirmary Victoria University Hospital is actively working with the NTPF in terms of ophthalmology to ensure a number of patients will have their procedures performed by private providers locally. I have data specifically on Cork, which I am happy to share with the Deputy, but I would probably run out of time if I tried to get through it.

The Deputy's point on hiring additional staff is correct. The Deputy's party wished to see the re-establishment of the NTPF. It is very important in re-establishing the NTPF that we send out a message it is here to stay for a number of years and that hospitals, be they private or public, can hire additional staff. I have already asked the NTPF to start planning for 2018. The Government has already committed €55 million, which is a significant increase in the budget of this year, and Deputy Kelleher is wagging his finger to make sure we get on with it. That commitment should send an important message and I have conveyed this to the HSE to ensure we have in place and actively recruit additional staff so they can hit the ground running with regard to spending the money.

Mental Health Services Provision

Mick Wallace


54. Deputy Mick Wallace asked the Minister for Health the position regarding the pilot mental health peer support worker initiative, which was to be rolled out in counties Carlow, Kilkenny and Tipperary in early 2017; the timeframe for the evaluation of this scheme; when he expects to roll it out in County Wexford; and if he will make a statement on the matter. [27870/17]

We have one minute left and Deputy Wallace has waited all afternoon. He can put his question and the Minister can reply. It will be on the record and that is that

Or else no question.

My question is on the pilot mental health peer support workers initiative. I have asked about it a number of times. I asked the head of mental health services in the Wexford and Waterford region about it and she failed to answer my question. A month later she said funding for the trial of the initiative simply went to Carlow, Kilkenny and south Tipperary and that it will eventually be rolled out in Wexford. Of all the areas in the country, Wexford probably needs it more than most. We have no emergency mental health services outside 9 a.m. to 5 p.m. Monday to Friday. The programme is about empowering people to make decisions about how their care proceeds. Surely autonomy is a human rights issue and the bedrock of self-respect, and it is something that is not available to people who are challenged in this area in Wexford at present, where we probably have the worst mental health services in Ireland.

The Deputy has included his supplementary question.

That is not true.

The Minister can respond to both.

I thank Deputy Wallace for raising this important issue. The Minister of State, Deputy Jim Daly, who has responsibility for mental health policies since yesterday has had to go to the Seanad to take a Private Members' motion so he is already working hard. I am taking this on his behalf. I thank the Deputy for raising what is a serious issue in Wexford. I have received correspondence from the Mayor of Wexford town, among others, highlighting this important issue and the Deputy has been in touch with us regularly on it.

The 2016 national mental health division's operational plan outlined an objective to introduce peer support workers in mental health services. Peer support workers are people who have lived experience of mental distress and recovery. The peer support workers will use their expertise gained through lived experience to promote recovery and share information to promote choice, self-determination and opportunities for connection with local communities. In addition to working with other mental health multidisciplinary professionals, it is envisaged that the peer support worker will work alongside an agreed number of service users on a one to one group basis.

Following a national competitive process for all HSE mental health service areas, an initial funding allocation to develop the national peer support initiative was allocated to a small number of multidisciplinary teams in the Carlow, Kilkenny and south Tipperary area. The pilot initiative began in February this year. A review of the initiative is planned in September. Following this, it is anticipated the peer support worker model will be developed, subject to additional resources, across an extended catchment area.

Additionally, a commitment to peer support is outlined in the 2017 HSE national service plan. Peer support workers are now working as part of 13 teams within mental health services. The extension of this initiative and recruitment of more peer support workers will commence later this year, once the review in September is published. I will ask the Minister of State, Deputy Jim Daly, to keep in touch with Deputy Wallace on this.

The Deputy can have one supplementary question.

For the record, the executive clinical director for CHO 5 explained to one of my staff in November that there was no point in talking to the mentally ill, as the HSE like to called people with mental health issues, and that it is not possible to trust what the mentally ill are saying. That people hold this position is pretty much at odds with the approach at the heart of the peer support initiative. I wonder how the programme could take off when the executive clinical director for the area has zero regard for the integrity of those facing mental challenges. I plead with the Minister and the Minister of State to look at this area. We are not being well served by the personnel in the HSE in this region and that is a fact.

Obviously I do not want to comment on individual staff matters or comments that may or may not have been said because I am not familiar with the details, but let me be very clear about my commitment and the commitment of the Government on developing further the peer support programme. It seems extraordinarily logical that we would benefit from the experience of people who have been through mental distress and have gone on to recovery.

It is an invaluable tool. Anecdotally, I hear there are good benefits from the pilot project in place. The project was selected through a competitive process in which every HSE mental health services area had an opportunity to apply. We will have the results of the review in September, which will be in advance of both the budget and the HSE's service plan, and I am sure my colleague, the Minister of State, Deputy Jim Daly, will be eager to roll it out to an expanded area. I will take on board the Deputy's view about Wexford being considered in that context.

Written Answers are published on the Oireachtas website.