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Dáil Éireann debate -
Thursday, 19 Apr 2018

Vol. 967 No. 6

Other Questions

Hospital Services

Declan Breathnach

Question:

6. Deputy Declan Breathnach asked the Minister for Health his plans to reconfigure cardiovascular services in County Louth and the north-east region; and if he will make a statement on the matter. [17085/18]

The question raises the proposed reconfiguration of cardiovascular services in County Louth and the north-east region but could equally be applied to the 33 units providing cardiovascular services across the country. It is my understanding the advisory group was convened to devise a new clinical model of care for the provision of cardiovascular rehabilitation settings in Ireland, and that its proposal is to introduce a community-based and single-outpatient programme which can be provided anywhere. Will the Minister reassure both patients and staff that there will be no reduction in the service received by high-risk and low-risk patients or in patient outcomes?

I thank the Deputy for the important question. I can assure him the HSE has advised there are no current plans to reconfigure the cardiology services in County Louth and the north-east region which are currently provided in Our Lady of Lourdes Hospital, Drogheda, with consultants with cross-site commitment in the Mater Hospital. In addition, vascular surgeons from Beaumont Hospital provide an outpatient and varicose vein surgery service in Louth County Hospital, which I have had the pleasure of visiting.

The national cardiovascular policy 2010-19 made recommendations across a range of areas, including prevention, primary care, acute services and rehabilitation. These continue to be implemented by the HSE and its clinical programmes on heart failure, acute coronary syndrome and stroke. Since the publication of the policy, there have been a number of service developments, including structured care for heart failure, the expansion of stroke services and the provision of thrombolysis. Given the ongoing implementation of the policy, there are no changes proposed beyond the scope of the policy at this time. It should be noted, however, that a national review of specialist cardiac services started work on 31 January 2018 and has been welcomed by Deputies on a cross-party basis. Given the breadth of the review, it is possible that some of its recommendations may have an impact on cardiovascular services. However, the review is still in its early stages and a final report is not expected until 2019. There will also be an opportunity through public consultation for all citizens and stakeholders to give their view in regard to how we can further improve cardiac services.

I reiterate to the Deputy, so I do not create any confusion or ambiguity, that the HSE has advised there are no current plans to reconfigure the services referred to in the Deputy's question. I will be happy to arrange a more comprehensive briefing for the Deputy with the HSE to provide him with assurances in that regard.

It is almost 20 years since the Building Healthier Hearts cardiovascular strategy was adopted by the Department of Health to deliver a standard of care to patients of cardiovascular disease in terms of both prevention and treatment. The strategy clearly states that every hospital treating heart disease should provide cardiac rehabilitation, which was one of the six strands of care identified to manage the significant burden of heart disease in Ireland. It is vital that we follow evidence-based models of care and the standard of cardiac rehabilitation currently delivered is a gold standard. However, in light of the new model being considered by the advisory group, I suggest there is a real need for cardiovascular services to be delivered not just in a community setting but through people who have strong knowledge of the situation. Patient safety is always our top priority and cardiac patients who complete hospital-based cardiac rehabilitation after a cardiac event live longer, feel better and have greatly reduced need for acute care.

I will take the Minister at his word but I believe it is very important he meets the professionals who are delivering the service because they are not satisfied that moving into the community will not affect the outcomes.

I will be more than happy to take the Deputy up on his invitation to meet those professionals and I will be in touch with him to arrange that. I understand he has had a particular interest for a long number of years in cardiac rehabilitation services and concerns around the potential shift of after-care services from a hospital to a community setting, as he has outlined.

The policy context for the development in cardiac rehabilitation is the current cardiovascular strategy, Changing Cardiovascular Health: National Cardiovascular Health Policy 2010-2019. Most recently, the HIQA health technology assessment and the national self-management support framework identified cardiac rehabilitation as one of the most cost-effective methods of supporting patients to self-manage and, most importantly, to improve clinical and health service usage outcomes. The provision of cardiac rehabilitation capacity to meet the population needs is a top priority under the self-management support framework.

This framework is being prepared by the health and well-being division within the integrated care programme for chronic disease, and the actions concerning cardiac rehabilitation will be to combine the relevant recommendations of the 2010 to 2019 policy and include the recommendation for the development of a community model of cardiac rehabilitation to make services more accessible. I will be happy to meet the healthcare professionals.

Will the Minister categorically state to the House that any proposed changes that may be in the pipeline will not impact on the stated outcomes of any previous strategy? We committed to a reduction in mortality of up to 30%, a reduction in cardiac events, to cut cardiac readmissions by almost one third and, of course, most importantly, to improve the health and quality of life of our citizens, and this has been cost-effective. There is a worry that carrying out an experimental model in the community may impact on and reduce the quality and safety of care for patients. I ask the Minister to ensure investment in our current system, with a full multidisciplinary team, continues and will be enhanced.

I am delighted to give Deputy Breathnach that assurance. Everything all of us want to do in healthcare is to improve patient outcomes. That has to be at the absolute centre of what we do. As Deputy Breathnach knows very well, cardiovascular disease remains the commonest cause of death in Ireland. One of the ways we must address it is through prevention, with population-based approaches that target the entire population as well as those high-risk groups. We need to focus on issues such as obesity, particularly central waist obesity, and cardiovascular diseases such as heart failure, heart attack and angina. I fully agree everything has to be about improving patient outcomes.

I would point out to the Deputy who has a particular interest in this, to his constituents and to the healthcare professionals he referenced that the national review of specialist cardiac services, which I have asked Professor Philip Nolan, the President of NUI Maynooth, to chair and which includes two representatives of the Irish Heart Foundation, making sure the patient's voice is heard, and a number of other professionals, is an opportunity for us as a country, much like we have done in the area of cancer, to map out a roadmap of where we want to be to ensure the best possible outcomes for cardiac patients over a five and ten-year period, so we can make the same progress in cardiovascular disease that we have made, thankfully, in other areas including cancer. I will be delighted to work with the Deputy on it.

Home Help Service Provision

Shane Cassells

Question:

7. Deputy Shane Cassells asked the Minister for Health the reason Meath local health office experienced a reduction of 36,253 home help hours in 2017; and if he will make a statement on the matter. [17042/18]

Why did the Meath local health office experience a reduction of 36,200 home help hours in 2017? The fact the drop in home help hours in Meath is many times the national average is shown in the daily calls and visits to my constituency office from people whose loved ones receive half an hour or 40 minutes of care in the morning but do not see anyone else for the rest of the day. I would appreciate a statement on the matter.

I thank the Deputy for the question. Home help has been a priority for me since taking on this position in the middle of last year, and this is evidenced by the consultation process the Minister and I launched shortly after my appointment to review how we do home help. I have accepted in various fora that the current system is not delivering as it should be. I am a believer that if we always do what we always did, we will always get what we always got, and it is not good enough. The consultation has been completed and we are reviewing it. I hope in the next week or two to publish its results.

The overall macro picture with regard to home help is that this year we increased the budget for home help by €18.25 million and home help hours now have a budget of €408 million per annum. This is a significant budget by any standards but clearly it is not enough. I appreciate this does not, as somebody said before, butter any parsnips for those waiting to get home help hours or waiting to get a service delivered to their house.

The Deputy mentioned Meath and the reduction of 36,000 hours. There are two issues at play. One is that recruitment is a challenge in a number of areas, which is leading to a reduction. We cannot get the staff. It is not a financial issue. It is that we cannot get enough staff to deliver for the demand that is there. We are also seeing a fairly significant increase in the number of intensive home care packages. Last year in Meath we delivered 440 home care packages and this year we have delivered 496 packages, which is an increase of 56 intensive home care packages. The Deputy is aware these packages provide thousands of home help hours when they are added up and this makes up for the shortfall. The issue is the HSE's reporting structure, and it is now working to combine home care packages and home help hours to make it more transparent and create a more straightforward and easier to follow system for counting the hours.

I thank the Minister of State and I appreciate his reply and the information on the details on the review. In the three years since I have been elected, the biggest issue in my constituency office, after housing, is health, in particular the issue of home help hours. In a county with a population of 200,000 people, it is natural that the elderly population is increasing and the care required for the elderly should be paramount. Last year in particular, we were inundated with cases and pleas for help with securing home help hours, which had been reduced from 500,000 to 464,000, which was a drop of 7%. This was far in excess of the nationwide drop of 1.5%. I appreciate what the Minister of State has touched on in terms of the difficulties with staffing. It is something we are seeing as having an impact in the northern part of the county. Across the border in adjoining counties such as Cavan and Westmeath, staff are available but because of the county boundaries they cannot work in Meath. I ask the Minister of State to look at this as part of the review because the staffing issue is key. The system is under a lot of pressure and I appreciate the Trojan work done by the home support co-ordinators, but as part of the review I ask the Minister of State to look at this aspect also because the drop is significant. It is 7.2% as opposed to the national drop of 1.5%.

The issue is the increase in intensive home care packages of 13% in County Meath, which more than balances out the drop in individual hours being delivered to which the Deputy referred. They are being delivered through packages for people as opposed to individually. Notwithstanding this, I accept what the Deputy has said and I accept his acknowledgement of the challenge in recruitment. It is something we also experience in my constituency of Cork South-West. It is particularly challenging to get staff. This will be one of the key areas of focus for me when I review the scheme, to try to deliver a home help scheme along the lines of the fair deal scheme, whereby people will be able to get the care they need by statute and that it will be there on demand and delivered to them, as opposed to what some might describe as a postcode lottery in the current system, whereby how lucky a person is depends on where he or she lives. I accept the spirit in which the Deputy has put the question and I hope I have clarified it as best I can.

I thank the Minister of State. The drop is symbolic of resourcing issues in County Meath, which has one of the largest populations in the country but ranks the lowest when it comes to funding across a range of Departments, whether it is with regard to health, policing or housing. I have just come from a meeting of the Committee of Public Accounts where a departmental Secretary General has told us we have the lowest spend per capita in local government with just €522 per person as opposed to €1,400 per person in the city of Dublin.

The Minister of State and the Minister are aware of the campaign to save Navan hospital, and the promise made in 2011 of a regional hospital in Meath, which has disappeared off the books. Cabinet members have now admitted it is a dead duck. Last week, my local newspaper, the Meath Chronicle, had an article stating GP practices in my home town of Navan are turning away people because they have no space. In a town of 36,000 people, GP practices are turning people away from their doors. There is a real issue when it comes to centres such as Meath and commuter counties which have big populations but are not keeping track with the type of services that people in larger counties require. This particular reduction in home help hours is symbolic of a wider problem in a county such as Meath.

At the risk of repeating myself, if we add up the increase of 56 intensive home care packages and the number of home help hours included in them, there is no decrease. Nationally, the number of home help hours has increased from 16.36 million last year to 17.1 million this year. This is a significant increase in the delivery of home help hours but I appreciate it is not enough. If we are trying to move away from acute services and towards supporting more people in their homes, we need to invest further in home care delivery, home care packages and home help hours, but we can only do this incrementally, as the Deputy will appreciate, because of the demands on the acute side. It is a gradual move and shift away, in line with what is set out in the Sláintecare report, which is to deliver services at the nearest point possible to the person.

The Deputy mentioned the local authority, GP practices and Navan hospital. Unfortunately, many of these issues are above my pay grade to comment on.

To use a phrase used recently.

Emergency Departments

Dara Calleary

Question:

8. Deputy Dara Calleary asked the Minister for Health the status of the extension of the emergency department in Mayo University Hospital; and if he will make a statement on the matter. [17028/18]

Mayo University Hospital's emergency department was designed for 20,000 patients. In 2016 it catered for 40,000 patients. This is placing the fantastic staff and patients under intolerable stress.

The Saolta University Health Care Group has made a number of funding applications with regard to transforming the emergency department, but those applications are delayed at either HSE or Department level. There must be action on this and there must be progress on building a modular unit before next winter. Can the Minister give an update on this matter?

I thank Deputy Calleary for raising this issue. I had an opportunity to visit Mayo University Hospital a number of months ago and to meet the management and staff there. I am aware of the issues with the physical size of the emergency department. Despite the best efforts of the management and staff, which the Deputy rightly acknowledged, the emergency department is not large enough for the number of people who come through its doors. We are aware that the demographics in terms of the population and particularly the ageing population in many counties have resulted in increased attendances, and Mayo is experiencing that as well. I am pleased that through the national development plan I have a significant capital budget to expand the size of our health service to deliver 2,600 additional hospital beds and 4,500 community beds. I expect that Mayo and Saolta University Health Care Group will get their fair share of them. I will shortly ask the hospital groups to submit their proposals on how to increase bed capacity in their groups and Mayo will be examined in that context.

However, the Deputy's particular question is about how we can physically extend the size of the emergency department, an issue that was also raised with me by of members of staff and management when I visited the hospital. I was apprised of the requirement for a new emergency department and also of the fact that the hospital and the group have come up with an interim solution in terms of a modular unit alongside the existing emergency department, which they believe would significantly benefit patient flow through the hospital. I am advised that the hospital and the group have advanced work on that proposal since my visit. Indeed, only last week officials from the HSE national estates were on site at the hospital to review and discuss the proposal and, following this meeting, further work will be undertaken on the scope of the design so the proposal can advance to the next stage.

I am actively considering a number of locations where we could provide modular units and modular builds, and Mayo is one such site. We are awaiting a number of proposals from the HSE in that regard. I do not wish to say to the people of the country that we have plenty of capital to increase the size of their hospitals but that it will take a number of years to build the extensions and wings. Bricks and mortar take time so I am looking favourably at modular units in that context, and Mayo is certainly under consideration. I look forward to the next iteration of its proposal following the visit by the officials from the HSE national estates.

I thank the Minister for his update. I, too, was in the emergency department over the Christmas period and spent time watching the staff and the patients trying to work and be treated under intolerable conditions. It is a tribute to the staff that they are managing to deal with in excess of 40,000 patients. We need progress on this. It has been delayed, with site visits and site inspections taking place for years. We need to see some type of ground works proceeding and action happening before next winter. A modular extension is a temporary solution, but the longer it is delayed the less temporary it will become. Mayo University Hospital has also had to cope with a larger influx of patients as a consequence of the closure of the emergency department in Roscommon and due to the pressure on University Hospital Galway. People in the north of Galway find it quicker to go to Castlebar than to go their city hospital. The management, medical staff in the emergency department and the Saolta University Health Care Group are doing everything they can and treating the issue with the urgency that is required. We need similar urgency from the HSE and the Department.

The Deputy's analysis of the situation is correct. The current emergency department was designed to meet a capacity flow of approximately 25,000 patients per annum but the figure for attendances last year reached over 37,000, according to the figures available. As is the case in much of our health service, the infrastructure was built for a much smaller population. That is why I unapologetically believe that we must embark on a construction and capacity building programme in the acute hospital setting. It frustrates me when I hear people in the national media say it can all be done in primary care. Much more could be done in primary care and we need to have more done in that area and to shift more services to the community, but despite all that we will still need more physical capacity and Mayo University Hospital is an example.

There is a long-term proposal to provide a new emergency department in the hospital and we can look at how to progress that, but we need an interim solution and to see how we can extend the existing emergency department. The only interim solution I see is modular build. The HSE estates office is working with Mayo University Hospital to review and discuss the proposal. There is some follow-up work required on the scope of the design and the hospital management is familiar with that. However, I accept the point that we need to see if we can do something quite quickly on it. I will examine it in that context and I will keep in touch with the Deputy.

I welcome the Minister's commitment to review it. It is incredibly urgent. There was trolley pressure in the hospital this year. There are many pressures on the hospital and on bed management in the hospital because of delays in the emergency department, so there must be action in the coming weeks. It would be fantastic if there was some type of movement on this over the summer ahead of the winter season.

With regard to modular build in general, the Department and I will have to make a number of decisions quite shortly on two things. The first is assessing what sites are appropriate for modular builds, that is, can physically contain modular builds, and where they can work from an engineering and layout point of view, which lay people such as myself are not familiar with. A body of work is ongoing there. The second is which sites could be delivered quickly and in advance of the pressures that tend to peak in December and January, although there are year round pressures in hospitals such as Mayo University Hospital. We will be examining those two issues quite shortly and Mayo will be considered in that context.

Medicinal Products Regulation

Bobby Aylward

Question:

9. Deputy Bobby Aylward asked the Minister for Health the steps he and the Health Service Executive have taken regarding the issue of children affected by foetal anticonvulsant syndrome, FACS, in circumstances in which children were exposed to sodium valproate medicines in the womb; his plans to conduct a review of the families and children affected by this issue; his further plans to set up a compensation scheme for the families affected in view of the compensation scheme set up in France; and if he will make a statement on the matter. [17017/18]

I thank the Deputy for raising this important question. I had an excellent meeting with FACS Forum Ireland two or three weeks ago in Leinster House. A number of Deputies had requested the meeting. I met FACS Forum Ireland with representatives of my Department and the HSE.

Sodium valproate is a medicine licensed for use in Ireland to treat epilepsy and bipolar disorder, and is marketed in Ireland under the brand name Epilim. It is now well established that children exposed to valproate in the womb have an increased risk of congenital malformations and developmental disorders, often described as foetal anticonvulsant syndrome, FACS. In 2014, the European Medicines Agency, EMA, conducted a review of valproate and issued advice placing additional restrictions on the use of valproate for women and girls.

In March 2017, the EMA's risk assessment committee initiated a new review of the use of valproate in the treatment of women and girls who are pregnant or of childbearing age. This review has now been concluded and the committee’s new recommendations on sodium valproate were published by the EMA in February.

Some of the key measures recommended by the EMA are that valproate must not be used in pregnancy for the treatment of migraine or bipolar disorder; valproate must not be used in pregnancy for the treatment of epilepsy unless there is no other treatment option available - some women may have to continue treatment with appropriate specialist care in pregnancy; valproate must not be used in female patients from the time they become able to have children, unless the conditions of a new pregnancy prevention programme are met; the outer packaging of all valproate medicines must include a visual warning about the risks in pregnancy; and a patient reminder card will also be attached to the outer package for pharmacists to discuss with the patient each time the medicine is dispensed.

The HSE is working with my Department and other stakeholders, such as the Health Products Regulatory Authority, HPRA, and the Pharmaceutical Society of Ireland, to communicate and implement the recommendations of the EMA review. Yesterday, the HPRA issued a drug safety newsletter on sodium valproate to all relevant healthcare professionals, together with updated safety information from the drug's manufacturer. Both of these communications reflect the new EMA recommendations and restrictions.

Additional information not given on the floor of the House

I recently met with members of the FACS Forum Ireland to discuss the new EMA recommendations and other issues relating to the use of sodium valproate and children affected by foetal anticonvulsant syndrome. I have asked Department officials and the HSE to follow up on the issues raised at that meeting and I know that there will be further engagement with FACS Forum Ireland over the coming months.

At present, health-related therapy supports and interventions for children can be accessed through both the HSE's primary care services and its disability services, depending on the level of need. It is estimated that 95% of people’s health and social services needs can be met in a primary care setting. The specialist disability services look after children with more complex needs.

It is important to note that patients currently taking medicines containing valproate are advised not to stop taking these medicines and, if they have any concerns about their specific drug treatment and management of their condition, to discuss these with a healthcare professional.

In a reply to a parliamentary question from my colleague, Deputy Lisa Chambers, in November last year the Minister acknowledged that children exposed to valproate in the womb had an increased risk of congenital malformations and neural development disorders, including autism. He also stated that a warning label for the outer packaging of the Epilim product was introduced in Ireland in early 2017 and that products carrying the new external warning label were being supplied to retail pharmacies. I have different information. I met two mothers from Kilkenny who got a packet of the product in a local chemist in Kilkenny in November and there were no warning signs on it. It is not being implemented. Are the Department and the HSE enforcing this directive well enough?

Is the Minister monitoring the implementation of this warning label on these products, which he previously acknowledged pose an increased risk to pregnant women? I ask this because I met two women who have been affected by this and both of them were still receiving the drug Epilim in a plastic bag with no warning label. They were understandably and genuinely upset, not only because of their own personal situation but because they were all too familiar with the increased risk and danger being posed to other women by the lack of such warning labels. Are the Department and the HSE doing enough in raising awareness and warning vulnerable women of the risks posed by medicines that contain sodium valproate?

I had an excellent meeting with FACS Forum Ireland and I heard directly from parents whose children have been impacted by foetal anticonvulsant syndrome. I believe parents have been let down. As the Deputy said, it is not just an issue in Ireland and this is why the European Medicines Agency, EMA, has looked at the matter.

There are three issues, which I discussed with the FACS Forum Ireland. The first issue is what we do going forward to address the concerns, as raised by Deputy Aylward, such as labelling, safety and awareness of the appropriateness of prescribing this drug or not prescribing it. As recently as yesterday the Health Products Regulatory Authority, HPRA, issued new guidelines to all stakeholders on the use of the drug. I am confident and satisfied that HPRA is implementing the recommendations of the European Medicines Agency. This is the body of work we need to keep a close eye on; that it is progressing well; and how to make sure that from this point on the correct information, correct labelling, correct warning and appropriate prescribing is dealt with.

The second issue is what to do for the children who have been born with malformations and disabilities as a result of this situation. When I met with FACS Forum Ireland I was concerned that these are children who must deal with lots of different doctors and various different conditions. No two affected children have the same set of conditions. I am a little concerned that they have been run around from Billy to Jack. I want them to have one single point of contact within the HSE that can give them all of the information. I wrote to the director general of the HSE on 17 April instructing him that all the clinical leads in the HSE and the Children's Hospital Group need to meet with the FACS Forum Ireland to discuss how we deal with these children's needs, just as we have done in other areas.

The third issue is around how we look at the past and how we check that in the past Ireland did everything it could to make sure that parents were aware and that appropriate guidance was followed. My colleagues in the UK and France have initiated some reviews in this regard and I have promised to consider that and revert to the FACS Forum Ireland within the next month.

With regard to directives, implementation is the important thing. Who will monitor this? This is the problem. Young children in the State are suffering due to exposure to medicine that contains valproate. Children as young as six years of age have had to endure more hospital appointments and hospital surgeries than most adults do in a lifetime, as the Minister admits also. Will the Minister commit to looking at a specific support and service system for affected children and their parents? When asked about this previously the Minister pointed to the national disability strategy. This is a very complex and difficult issue, which requires a targeted and specific support service system. I do not believe it is fair or proper simply to cite a commitment in the programme for Government and consider this problem solved. These children and their families need recognition and support from the State.

With regard to compensation for these families, the Minister has previously responded to a written parliamentary question that he was aware of a State-funded compensation scheme in France that was considering claims from individuals affected by valproate. Will the State set up a compensation scheme or system, and if so what timescale are we looking at?

This is not an issue just of today or yesterday. Unlike how it has been dealt with in the past by the Department of Health I have taken a very personal interest in the matter. I have met with FACS Forum Ireland and I heard what they have had to say. I have made three very clear commitments to them, the first of which is how we make sure this does not happen, going forward; appropriate labelling; and implementing the EMA recommendations. The second commitment is how to deal with the children now who, the Deputy rightly said, are living with very difficult and complex conditions, and their parents who are not being adequately supported. This is the purpose of the Children's Hospital Group and the clinical leads sitting down with FACS Forum Ireland and having an understanding of what these kids need and how supports for them can be streamlined. The third commitment, which is the kernel of Deputy Aylward's question, is around what are we going to do about what happened in the past with regard to investigating what happened and seeing if the State did everything appropriate. The Deputy is correct that my counterparts in the UK and France have recently announced processes to do this. I have informed FACS Forum Ireland that I am considering that, in consultation with officials, and I will come back to FACS Forum Ireland within one month with my proposed course of action.

I thank the Minister and the Deputy.

We might be able to include three further questions but the timeframe is tight. If all Members co-operate then we might get the three questions in.

Hospital Services

Brian Stanley

Question:

10. Deputy Brian Stanley asked the Minister for Health when the consultation process on the Midland Regional Hospital Portlaoise involving local clinicians and the community will begin; and the expected timeframe for completion [16238/18]

When will the consultation process for Portlaoise hospital begin? At our meeting in December the Minister told the other two Laois Deputies and me that he would begin this process early in the new year and that he would discuss the matter with clinicians and representatives from the local community.

I thank Deputy Stanley for asking this very important question. I will commence a consultation process, but I am going to get it right unlike the so-called consultation processes of the past that the people of the midlands and Portlaoise clearly felt, with some justifiable reason, have been inadequate in not listening or engaging with all of the appropriate stakeholders, including concerns I heard directly from clinicians. I was very grateful to have the opportunity to meet with Deputies Stanley and Fleming, and the Minister, Deputy Flanagan, as the three Laois Oireachtas representatives. I would be happy to do that again in the coming weeks.

I am committed to securing and further developing the role of the Midland Regional Hospital Portlaoise as a constituent hospital within the Dublin Midlands Hospital Group. Since 2014, the focus has been on supporting the hospital to develop and enhance management capability, implementing the changes required to address clinical service deficiencies and incorporating the hospital into the governance structures within the Dublin Midlands Hospital Group.

Significant work has been undertaken at the hospital. The Deputy is aware that we have increased funding by 35% since 2012 and staffing levels have risen by 29% from the 2014 base. Governance and management arrangements in Portlaoise hospital have been strengthened, additional clinical staff has been appointed and staff training, hospital culture and communications have improved.

HSE consultations took place with the clinical staff and management in Portlaoise hospital, general practitioners, the Irish Prison Service, Tallaght Hospital paediatric surgery and emergency department services and the Master of the Coombe Women and Infants' University Hospital. As agreed at a meeting with Laois Oireachtas Members, I am currently giving consideration to a process for wider consultation. I am not satisfied that the consultation in the past was comprehensive or inclusive. I have heard very clearly in this regard from GPs, from clinicians in the hospital and from the Laois Oireachtas Members on a cross-party basis. I assure the Deputy that no decision has been made by me or the Government around the draft plan for Portlaoise hospital. Before any such decision is made there needs to be a new consultation process that is inclusive, exhaustive, engaging and meaningful. I am trying to work out the absolutely best way of making that work for the people of Portlaoise. I will keep Deputy Stanley updated.

I thank the Minister for his reply. I welcome the fact the pause button has been pressed and that we have moved away from the Dr. Susan O'Reilly plan. Consultations, however, can go on and on. I agree with the Minister that the consultation process needs to be extensive and meaningful, but it was announced five months ago. In answer to a parliamentary question that I asked in January the Minister said the process would begin early this year. The can has been kicked down the road a lot and it has been kicked from one election to the next. It is important to move on with it. In reply to a Dáil question on 27 March the Minister said "I have asked my Department to conduct a consultation process in this regard involving local clinicians and the community and this is currently under consideration." We now need to move on with the consideration part and progress on to the action part. This is important. When the Taoiseach was in Mountmellick last week he said he did not envisage any closure, downgrade or significant reduction in services at the hospital because it just would not work as Tullamore and Tallaght hospitals would not be in a position to deal with the extra patients from Portlaoise hospital. This is what the Taoiseach said last Friday in Mountmellick.

The Taoiseach is correct. If I believed that the draft plan and the consultation had been appropriate then we surely would not be in this place. I do not believe the consultation was adequate and I do not believe there was appropriate engagement. The reason I do not believe it is because the people of Portlaoise are telling me this very clearly. Deputy Stanley, Deputy Sean Fleming and the Minister, Deputy Flanagan, are also telling me this. The Laois Oireachtas Members, on a cross-party basis, have told me this very clearly.

I understand Deputy Stanley's desire, and that of the people in the midlands, for a decision to be made on the consultation as quickly as possible. I want to deliver it as quickly as possible, but not at the expense of getting it wrong. I want to make sure. One can have consultation and one can have real, meaningful consultation and engagement. I am trying to work out a mechanism whereby the people of the midlands, the people of Portlaoise, the clinicians, the stakeholders and the public can have their say and their views heard and can tease out and stress-test all the important issues. The issue of capacity, as referred to by the Taoiseach, is also very important. We are aware that the other hospitals, as mentioned by Deputy Stanley, do not have adequate capacity currently.

I am hearing the right vibes from the Minister but now we want to see the action to back it up. On his previous visits to Portlaoise hospital the Minister heard loud and clear from the clinicians and GPs that we need a plan for the future. I acknowledge that the Minister came down to meet these people. Certainty is needed for recruitment. Will the Minister confirm the announcement made by the Minister, Deputy Flanagan, to the local Fine Gael councillors on 25 March? Councillors said they had been informed by the Minister, Deputy Flanagan, that five new consultant posts would be filled. Perhaps the Minister will confirm that this is going to happen. This was announced to the councillors on the morning of 25 March. They said they had confirmation from the Minister, Deputy Flanagan, that the five consultant posts would be advertised and that there is a lot of interest in those posts.

I welcome that if it happening, but I would like the Minister to confirm it for me. I am hearing the right message from the Minister but we want to see action. We want to see a timeline for that consultation to begin and be completed. We also want a timeline for a plan for the future to further build the services in Portlaoise.

I am sure the Deputy would never doubt the bona fides of my Cabinet colleague and the Deputy's constituency colleague, Deputy Flanagan, when he tells the people of Laois something.

I want to hear the Minister confirm it. He holds the purse strings.

I am quite sure.

I am not going to allow any argy-bargy to waste time.

It is very important.

I know. The Deputy asked about the Taoiseach's comments and now he is asking about the comments of the Minister, Deputy Flanagan. I assure him that if the Minister gave that commitment it is obviously true. I will follow up with the HSE and provide the Deputy with the information he requires.

The Minister is confirming it.

I hear the Deputy and I assure him that trying to get this right is taking up a considerable amount of my time. It is appropriate that it should, it is an important, sensitive issue. We will get it right and put a comprehensive consultation process in place and I will be happy to meet the three Laois Deputies on this shortly.

Mental Health Policy

Catherine Connolly

Question:

11. Deputy Catherine Connolly asked the Minister for Health the persons undertaking the review of A Vision for Change; the terms of reference including confirmation that the terms include the re-establishment of an independent implementation body; when it commenced; the finish date envisioned; and if he will make a statement on the matter. [17116/18]

My question relates to the review of the Vision for Change, when it started and when it will be complete. Who is the team and what is its terms of reference and will an independent implementation body be included?

A Vision for Change came to the end of its ten year term in 2016.  Preparations for a review and an updating of policy have been underway since early last year. An external evidence and expert review was completed in February 2017 providing a review of international best practice and the experience of implementing A Vision for Change.

An oversight group has been established to oversee the development of a refreshed policy for mental health based on the recommendations arising out of the expert review. The policy review process will also involve consultation with key stakeholders.

An independent Chairperson, Hugh Kane, was appointed last summer and the remaining membership of the group was fully finalised in October last year. The oversight group members are as follows: Hugh Kane, Chair; Liam Hennessy, HSE head of mental health engagement; Dr. Philip Dodd, national clinical adviser and clinical programme group lead for mental health; Dr Amanda Burke, executive clinical director on Galway-Roscommon mental health services; Dr. Fiona Keogh, senior research fellow, National University of Ireland, Galway; Martha Griffin, expert by experience; Dr. Shari McDaid, director of mental health reform; Yvonne O’Neill, HSE head of planning, performance and programme management; Dr. Brian Osborne, GP, Irish College of General Practitioners; Leo Kinsella, head of service mental health, CHO1; and Gregory Canning, principal officer from the mental health unit in the Department of Health.

The terms of reference of the oversight group entail the review and updating of A Vision for Change. As they are detailed, I am arranging for a copy of the group's detailed terms of reference to be supplied to the Deputy.

The terms of reference require the group to produce "an updated draft policy framework which sets out current and future service priorities within a time-bound implementation plan". However, there is a not an explicit reference to an independent implementation body and this matter will be given consideration once the nature of the group's recommendations are clearer.

I welcome the Minister of State's response and that he will provide me with the terms of reference and the list of names. However, it is not clear when the review started. What date did it start and when will it be completed? The reason I am asking this is that I know A Vision for Change, I have read it and used it. It ran out in January 2016. We are now in April 2018. Since then, we have had a wide-angled international review of evidence and development, which simply looked at the literature. I have to welcome it. It was done very quickly in 12 weeks. The delay occurred in publishing it. The date on the review was February 2017 and it was not published until July, which was an unnecessary delay. I have not read it. What is required on this is a very light touch review. Will the Minister of State please give a timeframe?

The first meeting with provisional membership took place on 5 October 2017. The membership was fully finalised on 25 October 2017. The group is scheduled to complete its work by December 2018.

I very much welcome that clarification. Can I take it that we will have A Vision for Change No. 2 by the end of this year, in December 2018?

The second point relates to the independent implementation body. It is useless having more policies. What worked for A Vision for Change was that the independent implementation body sat for two three-year periods and then they were abolished because they were doing a very good job. I ask the Minister of State to re-examine that and make sure there is an independent implementation body if we are seriously interested in mental health.

I can assure the Deputy that I will take her comments on board. I know she has a particularly keen interest in this area and has followed it carefully. I accept what she says about an independent implementation body and I assure her I will give it further consideration.

Question No. 12 replied to with Written Answers.

Hospital Waiting Lists

Aindrias Moynihan

Question:

13. Deputy Aindrias Moynihan asked the Minister for Health his plans to reduce waiting lists for orthopaedic treatment; and if he will make a statement on the matter. [17007/18]

People regularly come to my constituency office and to clinics in great pain. Many are completely immobilised and in great distress as they wait for hip operations, often up to two years. What action is being taken to tackle waiting lists for hip operations in Cork where people regularly wait 18 months to two years?

Improving waiting times for hospital treatment is a key commitment in the programme for Government. In 2018, €50 million was allocated to the national treatment purchase fund, NTPF, to provide treatment for patients. In recent weeks, I published the inpatient/day case action plan which outlines the combined impact of HSE and NTPF activity in 2018. It projects a reduction in the number of patients waiting for treatment to below 70,000 by year end, from a peak of 86,100 in July 2017. To achieve this the NTPF will arrange treatment for 20,000 patients, while the HSE will deliver 1.14 million inpatient or day case procedures.

Orthopaedic procedures are a key focus and the action plan places a particular emphasis on hip and knee replacements, with €10 million of the €55 million budget allocated by the NTPF for such procedures. This means that all patients waiting over nine months for a hip or knee replacement in 2018, if clinically suitable for treatment in alternative private or public hospitals, will be offered treatment this year. The NTPF will also offer treatment to a range of other patients awaiting orthopaedic treatments in 2018.

 While the improvements set out in the plan are significant, I am committed to building on this progress in 2019 and to further reduce waiting time for Irish patients.

Any patient waiting in Cork or anywhere else for a hip or knee operation for nine months or longer will get an offer of surgery this year once it is clinically appropriate.

I thank the Minister for this information which is positive and helpful. I acknowledge there has been some movement on the matter. A great deal of the resources have been put into the NTPF which is a good move. My party pressed to have it included in the last budget. However, I am concerned that the NTPF is dealing with waiting lists, which is short term. Is a long term solution being put in place to prevent the lists growing further? The number of people waiting in Cork has doubled in the last two years, from over 250 to almost 500. Even if there is any small reduction in the figure, one is still only treading water. We need to know that a long term solution is in place for people going on those waiting lists. It seriously impacts people's quality of life. Take Dan Joe who came into my office who has had to stop driving because he is unable to move his foot and Chris has been waiting for over a year and a half. Many of these people are being told that they will have to wait 18 months to two years. I acknowledge the Minister's commitment but these are people who have received recent responses from the HSE. Is the HSE aware of the Minister's target?

Deputy Moynihan's comments are fair. The NTPF is used to drive down waiting times, which is an appropriate way to use it. We will get offers of treatment to anyone waiting over nine months this year which is a significant improvement on which we need to build further. The Deputy is correct. What we need to do in the longer term is elective only hospitals, one for Cork, one for Dublin and one for Galway. They are funded in the capital plan, so the funding is there and we need to get on and deliver them. Looking at other jurisdictions, in Scotland they established an elective-only hospital where they bought what had been a private hospital and converted it to a hospital to drive down waiting lists. They made huge progress and I want to do that in Ireland. I have the funding to do it and there will be hospitals in Cork, Dublin and Galway.

If Deputy Moynihan is happy with that answer I will move to his colleague Deputy Cahill.

Mental Health Services Provision

Jackie Cahill

Question:

14. Deputy Jackie Cahill asked the Minister for Health his plans to improve the services and facilities for adolescent psychiatric patients in County Tipperary; and if he will make a statement on the matter. [17081/18]

I raise the issue of adolescent psychiatric care in County Tipperary. In recent months we have had three adolescents who have spent eight to nine weeks in a paediatric unit in Clonmel waiting for acute psychiatric care to become available in Cork.

It is intolerable that a teenager, whose parents had her admitted to the hospital system, has to wait such a length of time for specialised psychiatric care. Will the Minister give us an assurance that if a person is admitted to hospital, acute psychiatric care will be provided within a reasonable length of time?

I am aware of the issue the Deputy is talking about. Yesterday I spoke to a parent from Tipperary who was in that situation. I guess it is the same case. There are about 300 admissions a year to adolescent inpatient CAMHS units. Thankfully, the number is reducing. Last year there were about 380. I am aware of the pressures in the provision of beds. There are new beds. We have about 70 beds in the system. There will be new beds in Portrane and the new national children's hospital. I am working with management in the HSE on the issue at Eist Linn and the issue in Tipperary which the Deputy has raised. If he wants to speak to me afterwards, I am happy to do so.

The mother of one of the girls had to spend seven to eight weeks sleeping in the ward at night. The girl was on suicide watch 24/7. To have to wait eight to nine weeks to be admitted to a specialised psychiatric care unit is not acceptable.

I am uncomfortable speaking about the case, as I am familiar with it and have spoken to the family. I am aware of the issues involved. The Deputy may chat to me afterwards about it. I would prefer not to discuss it with him across the floor of the House.

Written Answers are published on the Oireachtas website.
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