Ceisteanna Eile - Other Questions

Hospital Accommodation Provision

Louise O'Reilly


43. Deputy Louise O'Reilly asked the Minister for Health if he has had dealings or meetings in relation to a proposed private hospital in Swords, County Dublin. [48892/19]

The front pages of my local papers advise me that the local by-election candidate from the Minister's party is going to deliver a private hospital. My understanding from what has been said publicly on this is that there have been meetings at the highest level, up to and including An Taoiseach, so I should have probably included him in my question and that this is a project that Fine Gael has in fact been campaigning for for two and a half years. In light of the conversation that the Minister has just been having, this project goes a little bit against that to be committing public money to purchase beds in the private sector so that those beds will be available. These are the things I wish to tease out with the Minister. My understanding is that public money will be used to purchase beds in this private hospital and it will be available for everybody in some nirvana. Perhaps the Minister might comment on that.

I wish all the candidates in all four by-elections the very best and I do not want to involve myself in that campaign.

That is great generosity of spirit.

I note reports of plans by a private company to build a private hospital in Swords. I have not met anyone involved with the development of this proposal.

This is a time of unprecedented capital investment to develop our public health services under Project Ireland 2040. Our public health service was starved during the recessionary and somewhat during the Celtic tiger years of significant health investment from a capital perspective. Current budgets rose, capital budgets did not. We now have 165% more to spend on capital over the next ten years than in the last ten years. That is about €11 billion compared to just €4 billion. Our national development plan outlines the projects that we intend to deliver during that time.

It is of course the reality today, which the Deputy knows well, whether she or I agree with it, that the public health service and the State utilise capacity that is available in private health facilities. It does that through the National Treatment Purchase Fund, NTPF which is now investing a third of its budget in public and not just private hospitals. The reality today as we move towards creating a universal healthcare system is both public and private models are used. It is also a reality, whether or not the Deputy agrees with it, that through the NTPF and others, private hospitals sometimes have service level agreements, SLAs, and the like to provide services. I have no role in that regard.

Is the Minister saying that he has not met anybody, be they a colleague of his from his own party or somebody from the organisation who is building the hospital, and that he has not had any meetings on this hospital? The impression is being given that the public purse will be used to purchase beds for this hospital.

Since the Minister is talking about a 165% increase in capital spend, is there any consideration being given to constructing a public hospital since his party has obviously identified the need for a hospital in the constituency? As I point out to the Minister every single day and at every single opportunity, this is the fastest growing constituency in the State, with among the youngest population.

It has been given to understand that the Minister himself has been met and that this has been discussed with him, with An Taoiseach and with the Minister for Finance. Is it the case that this is a project? Has an SLA been agreed with this private company? Has the NTPF agreed to purchase any places? While the adverts are in the papers saying that access will be available for public and private patients, one could not say exactly that at this stage in the proceedings because the SLA has not been concluded, or am I wrong in that?

I said very clearly that I have not met anybody involved with the development of the proposal. Senator Reilly has indeed mentioned this proposal to me.

I am well aware of it because it is very visible, with a number of people promoting it. I have not had any meetings with anyone involved in the development of the proposal. Senator Reilly has mentioned it to me. It is not for me to speak for him in this House, although I believe his view is that the extra capacity could indeed help people on the public waiting lists in the interim as we build our universal healthcare system.

The question of which private facilities are used for which procedures is not a political decision for me to make. It is a decision which is made by the NTPF or, on occasion, by the HSE. I am open to correction since I am not overly familiar with this but my understanding is that planning permission is being sought for the hospital in Swords, or it is at least certainly not built yet, so no service level agreement or the like will be agreed until such a time as it is. Those matters are for the NTPF to address. We will unapologetically continue to use all capacity, both public and private, to try to drive down waiting lists in the interim as we build our Sláintecare health service.

Home Help Service Provision

Michael Moynihan


44. Deputy Michael Moynihan asked the Minister for Health the number of the additional 1 million home help hours promised in budget 2020 that will be allocated to the north Cork area; and if he will make a statement on the matter. [48876/19]

I ask the Minister, in light of the additional home help hours promised in budget 2020, what amount will be allocated to the north Cork area, which is starved of resources for home help hours at present. How many extra hours can we expect in the north Cork region in 2020?

Home supports enable older people, as the Deputy is aware, to remain in their own homes and communities, as well as facilitating timely discharge from hospital. The latest preliminary information available to me indicates that at the end of October, 1,424 people were in receipt of home support and Cork Kerry community healthcare had provided 352,902 home help hours in the north Cork area in the year to date. In addition, 5,014 hours have been provided through intensive home care packages. At a national level, additional supports are being put in place as part of this year's winter plan, which will assist timely discharge from hospital, as well as improved access to home support in the community.

In line with programme for Government commitments, we have made improved access to home support services a priority. We have committed to an additional investment of €52 million in budget 2020 for home supports and next year, the HSE will deliver more than 19.2 million hours of home support. This represents a substantial increase of 1 million hours more than this year's target.

This investment is focused on enabling older people to remain at home, where they want to be, and reducing the current waiting lists for the service being experienced in almost all areas. As appropriate, provision of hours will also be targeted at times of peak demand in winter 2019 to 2020, at the beginning and end of the year, to ensure more timely egress from hospital for our older citizens. The HSE national service plan for 2020 has been submitted and is under consideration in my Department. The allocation of hours and targets to community healthcare organisations is currently under way and I have been advised that this will be finalised in the coming weeks.

I thank the Minister of State for the reply. He mentioned 2019 to 2020. I understand that the additional hours in the budget are for 2020. If he is true to his reply, no extra home help hours are becoming available. We are into the last five weeks of this year and there is a crisis as people wait for home help hours. Families are waiting for home help packages and are making decisions about loved ones coming home. As I have told the Minister for Health on a number of occasions in recent weeks, a constituent of mine is in Dún Laoghaire, awaiting discharge. The HSE has met all the relevant bodies over the past few days but the family is still waiting for sanction of home help hours. The difficulty, which has been clearly described to me in writing, is that it is a question of funding. If we are to be serious about it and about getting the best possible bang for our buck in the health budget, if we can take people out of long-stay, very specialised beds and into a home setting, it would be by far the best way to utilise resources. I cannot see why we cannot look at individual cases as a priority, even at this late stage in 2019.

I thank the Deputy again and acknowledge the Deputy's commitment and consistency on this issue, having raised it a number of times in this forum. The Minister, Deputy Harris, is aware of the specific case because Deputy Moynihan has brought it to his attention. The Minister has addressed it with the HSE and asked it to prioritise and look at the case. He has also been in contact with the HSE about the wider question of availability. The Deputy asked about the end of this year. There is €26 million for the winter plan, which is to assist with both home help hours and respite and transitional care, to improve movement through the hospital system. In answer to the question of whether there is anything towards the end of this year, additional money has gone into the system to support it. I have a number of these cases in my own constituency. These cases can be complicated, where one is trying to start a service and get the necessary personnel available. I am not speaking about the Deputy's specific case but not all cases are resource-dependent. Some are resource-dependent, and more important than the money is whether a person is there to deliver the service, which is a complication in my area and other areas.

I acknowledge what the Minister and Minister of State have said on the particular case. I will continue to raise this in any forum that I can to try to get a result for that particular person and the family. The wider issue is that it is almost as if we are working in silos. The home help budget and acute hospital care budget are there. If we were able to manage it better to try to make sure that people are discharged from hospital to their home settings faster, it would alleviate many difficulties. If any assessment is done, it will be seen that the home care package has delivered considerable results for the State, along with the carer's allowance. Keeping people in their own homes for a small amount of money each week has delivered very well. We should prioritise home care packages and try to have people in their own home settings as much as possible. Back that up with respite but have people in their homes as much as possible. Last Thursday, the Minister of State, Deputy Finian McGrath, responded in a Topical Issue debate. It was a case of three high-dependency beds being tied up. They would all be freed up by a home care package. Many State resources were being tied up by not applying home care packages properly. The Minister of State and the HSE should look at this and continue to keep an eye on the specific case that I raised.

The Deputy makes a very fair point about the difference between the budget for community care and acute care. That is why the Minister has overseen the change from that system to what we call the regional integrated care organisation, which takes both together. Those organisations which have been established, as the Deputy is aware, have a single budget to address the issue. We are aware of and have addressed the issue. Home care is being addressed with the introduction of a statutory home care scheme in 2021, which is committed to under Sláintecare. We have funding in the budget for next year to bring in some pilots to test the scheme. I will bring proposals for that scheme to Cabinet in the next weeks and we will unveil more detail of it in late January. That will assist as well because there is an issue there. The Government accepts the benefit of home care and that is why the budget has increased from €300 million or so to almost €500 million in the last number of years. We cannot keep up with the pace of its success and trying to meet the demand for it, but we are determined to do so under a statutory scheme.

Drug Treatment Programmes Policy

John Curran


45. Deputy John Curran asked the Minister for Health if the methadone treatment protocols will be reviewed, in particular the length of time persons are on methadone treatment here; and if he will make a statement on the matter. [48841/19]

The Minister will be aware that more than 10,000 people are currently on methadone treatment, many of them for extended periods. Will the Minister advise the House when methadone treatment protocols were last reviewed, especially for individuals who have been on methadone treatment for a long time? What are their care and progression plans? How frequently are individuals offered those care and progression plans in light of the fact that many of them have been in receipt of methadone treatment for a good number of years?

I am answering on behalf of my colleague, the Minister of State, Deputy Catherine Byrne. Methadone is one of the medications used in opioid substitution treatment along with suboxone. Methadone prescribing for opioid dependence is a key element of the harm reduction approach to opioid use set out in the national drugs strategy. As of 30 June, 10,396 people were in receipt of methadone maintenance treatment. A review of the methadone treatment protocol was published in December 2010. Arising from the review, the HSE implemented an opioid treatment protocol to provide appropriate and timely substance treatment and rehabilitation services tailored to individual needs. The focus in the strategy is on implementing the HSE national clinical guidelines on opioid substitution treatment published in 2016. These guidelines are the first that specifically relate to opioid substitution treatment in HSE clinics and primary care settings.

Opioid substitution treatment supports patients to recover from drug dependence. HSE addiction services work within the national drugs rehabilitation framework to support progression pathways.

The framework ensures that individuals affected by drug misuse are offered a range of integrated options tailored to meet their needs and to create rehabilitation pathways.

There is international research evidence that increased length of time in opioid substitution treatment is associated with improved treatment outcomes and short-term methadone maintenance treatment is associated with poorer outcomes. I believe that methadone treatment reflects the public health approach to drug and alcohol misuse set out in the national drugs strategy. It is an important tool to reduce harm and to aid people on their journey to recovery from drug use. I am committed to improving the availability of this treatment and to supporting service users to access progression pathways.

The Minister of State indicated there were 10,300 people in receipt of methadone treatment, approximately 6,000 of whom have been on treatment for more than five years, 4,000 for more than ten years and 1,400 for more than 20 years, so some people have been on treatment for an extended period. The pathways to progression are not always very clear. I have met many people who have been on methadone treatment and they indicated it is harder to detox from methadone than from heroin. People are concerned that when they get on methadone treatment, it is not the answer but only part of it. I fully accept and acknowledge the role methadone treatment has in terms of removing somebody from heroin and illicit drugs, removing the criminality element and bringing them into treatment services. However, I have a concern that a significant number of people have been left in treatment for a long time.

The Minister of State made reference to international studies and long-term studies on the positive effects of being on methadone for a prolonged time. Those studies are 20 years old. If we are considering new and alternative treatments, are those studies as valid today as they once were? For individuals who are on methadone treatment, particularly for an extended period, how frequently are their care plans and pathways reviewed with a view to progression?

As I understand it, there are no current plans to carry out a review. A mid-term review of the national drugs strategy is planned for 2020 and I would imagine that would be an appropriate time to consider a review. I accept the Deputy's point that it is a long time since a review was carried out on the length of time, the treatments and the model of care associated with this. Perhaps the review of the national drugs strategy in 2020 is an appropriate time to accede to the Deputy's very reasonable request.

I acknowledge that a review is necessary, particularly in terms of the changing environment. I indicated my concerns for the individuals but I also have a general concern with the amount of methadone. I want to put the following point very clearly on the record because we sometimes do not recognise it. The last full year for which we have figures from the drug-related deaths index is 2016. In that year, there were 72 poisoning deaths in which heroin was implicated but there were 103 poisoning deaths in which methadone was implicated, so the figure is significantly higher for methadone than for heroin. Of those who died, 66 were on methadone treatment. The figures show there is a risk in terms of the population in general because, obviously, some of the methadone that is being dispensed to individuals is not being taken by those individuals and is being used elsewhere. However, even for those who are on methadone programmes, there is a significant risk. In 2016, there were some 9,500 people on methadone treatment and 66 of those died a death where methadone was implicated.

I reiterate my acknowledgment of the Deputy's concerns, which are genuine and valid. I accept there is no plan for a review but I also accept the date and the timeline the Deputy has put forward. Again, I am hopeful that, as part of the overall review of the national drugs strategy, this will be reviewed, starting in 2020.

Cross-Border Health Initiatives

Brendan Smith


46. Deputy Brendan Smith asked the Minister for Health if additional resources will be provided for the processing of claims under the cross-border directive [48868/19]

The cross-border directive scheme has become more and more popular, there is a greater awareness of it and we all know of people who have availed of it. At present, in my reckoning from dealing with constituency cases, there is a three and half month delay in having reimbursement applications processed and approved, and payment made. We know many of the people who avail of the scheme are elderly and they have to borrow in many instances, be it from family or financial institutions, and they worry about the delay in getting reimbursement. There is an obvious need to devote more resources to this scheme to eliminate these delays, which are not acceptable.

I thank the Deputy for raising this question and I know of his particular interest as this is a matter he has raised in this House on a number of occasions. I very much appreciate the importance of the cross-border directive and we have worked very hard, in the context of Brexit, to make sure cross-border healthcare, and healthcare North and South on this island, and east and west, can continue. I am very pleased with the progress that has been made in this regard.

The cross-border directive allows public patients to access necessary healthcare, which they would have been entitled to access in the public healthcare system in Ireland, in another EU or EEA country. The patient pays upfront for the treatment and is reimbursed upon return to Ireland.

The HSE is responsible for the operation of the cross-border directive and has a dedicated cross-border directive office for this purpose. Since being introduced in 2014, awareness of the provisions of the directive has grown steadily. In 2015, the first full year of operation of the scheme, 150 reimbursements were made at a cost of €585,863. In 2018, some 3,886 reimbursement claims were processed, at a value in excess of €12 million. Significant further growth is expected in 2019 as people become more aware of the scheme, and we are seeing this across the EU.

The growth in use of the scheme has placed additional demands on the cross-border directive office and given rise to a build-up of applications. It is important that this service operates in a responsive way, and that both treatment approvals and reimbursement applications are processed within a reasonable timeframe. I, therefore, requested the HSE to examine current resourcing of the cross-border directive office and to identify any necessary actions needed to mitigate waiting times arising from current demands for the scheme. I am pleased to inform the Deputy that I have now been advised by the HSE that additional resources are being allocated and specific initiatives implemented to urgently address the backlog and delays in reimbursement. My Department will continue to engage with the HSE to ensure that the measures being implemented facilitate the efficient ongoing operation of the scheme.

In the next couple of weeks, we will be publishing the HSE service plan for 2020. I expect and, indeed, am aware that the plan will show a very significant increase in the resources being provided to this office to do exactly what the Deputy is suggesting.

I welcome the additional resources being provided. From speaking to constituents throughout Cavan and Monaghan, and from the point of view of a public representative, I know the personnel in that cross-border directive office are exceptionally helpful and courteous to people, and they go beyond the call of duty to try to help people. It is very important, when the office is under pressure, to recognise the good work they are doing under difficult circumstances.

Most of the people availing of the cross-border directive are aged over 60 or even over 70. We are aware that most of the procedures undertaken are either on hips, knees or cataracts, and it is predominantly the older age groups that need to have those procedures. We are aware that most people who avail of the scheme are pensioners and are on limited incomes. In many instances, as I said, they borrow money, perhaps from family or from a credit union, and they are extremely worried about any delay in being able to pay back the person or the institution they borrowed from. To allay the fears of those people, it is particularly important that payments are made in good time.

My understanding was that, at some stage, the HSE proposed that it wanted a turnaround of 20 working days, which is roughly a month, and I believe that is what we should aspire to. Over the years, there were regulations and legislation stating that Departments and statutory agencies should have a minimum time to pay their debts. In this instance, it is a debt to the patient who has gone and paid their own way initially because of the lack of capacity here. It is a win-win for many patients, but we do not want to have the good taken out of those procedures by having that person worry about the payment.

I agree with Deputy Smith, who is correct. My understanding is that, roughly, there is now a waiting time for processing of applications of about two months and the office is processing applications for reimbursement received in September. I agree with the Deputy that the staff in the office, many of them I know and I hear this on a regular basis, are exceptionally helpful and go above and beyond the call of duty. The Deputy will agree, and the facts will show, it is not a financial resource issue but a need to resource the office financially in terms of staffing, and that is exactly what we are doing.

Recognising the issues, officials in my Department have met the HSE to discuss the issue of reimbursement delays. We requested that mitigating measures be identified and put in place. I am pleased to confirm that various steps are now being taken by the HSE to deal with delays in the processing of applications. As a first step to addressing the issue in the short term, the HSE has arranged for the provision of overtime for existing staff and deployed additional staff in the cross-border office.

As for longer-term measures, the HSE is now in the process of recruiting further additional staff and sourcing extra accommodation. I understand that the recruitment of additional staff is imminent and that alternative accommodation has been identified to house the expanded complement of staff for the cross-border directive office. The combined effect of these actions will help address much of the existing backlog and alleviate the ongoing pressure on resources. Officials in my Department will continue to liaise with the HSE in this regard, and I expect the service plan also to reflect this.

My understanding from my constituency work is that the applications made in August are the ones being processed at present, so the turnaround is in excess of three months. We want it back to 20 working days if at all possible. In the most recent exchange the Minister and I had on this issue on Question Time, I pointed to the farce whereby newspapers in Northern Ireland were carrying advertisements from the private hospitals in our State looking for patients to come to avail of the cross-border directive. Similarly, in our provincial and national newspapers here we have advertisements from the private hospital sector in Northern Ireland looking for patients to travel to Northern Ireland's clinics and hospitals to avail of the cross-border directive. There is a good case for more direct funding for the National Treatment Purchase Fund and use of the capacity within our own private hospital sector rather than having people trek from one end of our island to the other. We should maximise the capacity within our own hospital system as much as possible.

I agree with the Deputy. The only slight caveat I will offer - I know he will agree with me on this - is that there is additional capacity in some of our smaller public hospitals as well, including in the Deputy's own constituency. He has spoken to me about this. I refer to Cavan hospital and particularly Monaghan hospital. We should be and indeed we are asking the NTPF and the HSE to identify more that can be done there. I do not want to see any funding leave our State, nor ideally do I want to see any money leave the public health service and go into the private health service if that can be avoided.

My note tells me the HSE is processing applications for reimbursement received in September, but I am open to correction on that. As for ensuring fairness of approach, the cross-border office must process all applications received in chronological order. In short, I reassure the Deputy's constituents that we will fix this through additional staff and the additional office accommodation those staff will require. The recruitment of additional staff is imminent. The locating of additional accommodation, I understand, is well under way. There will be significant extra resourcing of this office in the HSE service plan for 2020 and we will continue to support the office in doing its good work.

Question No. 47 replied to with Written Answers.

Disabilities Assessments

Margaret Murphy O'Mahony


48. Deputy Margaret Murphy O'Mahony asked the Minister for Health the action being taken to reduce the number of overdue assessments of need under the Disability Act 2005; and if he will make a statement on the matter. [48760/19]

What measures are being taken to reduce the large numbers waiting for assessments of need under the Disability Act 2005?

I thank Deputy Murphy O'Mahony for raising this very important issue.

The Disability Act 2005 provides for assessments of need for people with disabilities. Any child thought to have a disability born on or after 1 June 2002 is eligible to apply for an assessment of need, which will detail his or her health needs arising from any disability. Since the Act's commencement in 2007, there have been significant year-on-year increases in the number of children applying for both assessments of need and disability services generally. Regrettably, these increases have led to the extended waiting periods experienced by children and their families.

In order to improve the assessment of need process and ensure that children receive interventions as soon as possible, the HSE has developed a new standard operating procedure for the assessment of need process. This measure will ensure that children with disabilities and their families access appropriate assessment and intervention as soon as possible while at the same time bringing consistency to the assessment of need process across all community healthcare organisations of the HSE. It is intended that the procedure will be implemented from quarter 1 of 2020.

In addition, the HSE disability services are currently engaged in a major reconfiguration of their existing therapy resources for children with disabilities into multidisciplinary geographically based teams. This is part of the HSE's national programme on progressing disability services for children and young people from birth to 18 years of age.

The key objective of this programme is to bring about equity of access to disability services and consistency of service delivery, with a clear pathway for children with disabilities and their families to services, regardless of where they live, what school they go to or the nature of the individual child's difficulties. Evidence to date from areas where this has been rolled out shows that implementation of this programme will also have a positive impact on waiting lists for both assessments of need and therapy provision.

An increase in the number of therapy posts has been identified as a priority requirement to meet current unmet need and projected future needs in children's disability services nationally. In this regard, last year's budget provided for the recruitment of an additional 100 therapy posts to help reduce the long waiting times for assessment and to support interventions for children who need them. The recruitment process for these posts is well under way. There were 63 in post by the end of the first week in November, and the remaining 37 are expected to be in post before the end of the year.

As the Minister of State knows, under the Act the assessment is supposed to start within three months of application and to be completed within another three months. This is not happening. Right across west Cork and indeed nationally I have heard of many cases in which the parents, who obviously know their children best, know what is wrong with their children but just need this official assessment done and an official diagnosis. Many people can afford to go private; many more cannot. Even for those who can, this diagnosis is often not accepted. It is therefore imperative that this list is cleared in order that parents get these official diagnoses. The diagnosis opens many doors, including those that will allow children access to special needs assessment, SNAs, so it is very important. The Minister of State will be aware that overdue assessments under the Act rose from 3,568 at the end of March to 3,768 at the end of June of this year. I recently received figures for the end of September showing 4,100 now overdue, so we have seen an increase of 15%. This is not acceptable, with respect.

I am conscious that timely access to assessments and therapies is imperative in a child's development. I fully understand that delays in accessing services are a source of great concern for children and their families. While not addressing all needs, it is important that the process has begun. I accept the Deputy's point that it is very important we get in early when it comes to these young children with disabilities. What are we doing? As I mentioned in my response, the recruitment process is under way. There were delays with trade union issues within the HSE. As I said earlier, however, 63 were in post by the end of the first week of November and we have been told that the remaining 37 are expected to be in post before the year end. This new resource will result in additional new therapy posts ranging from speech and language therapy to occupational therapy, physiotherapy, social workers and psychologists. I am confident that the initiatives I have outlined will have a significant positive impact on reducing waiting times for assessment of need over the course of the next year.

What the Minister of State is trying to do is obviously not working. If there has been an increase in the number of overdue assessments in the past six months, there is something wrong. I acknowledge that the numbers went down in 2018, but this year they are increasing, and that is just not good enough. The Minister of State spoke of the importance of early intervention, and it is hugely important, but without this diagnosis people cannot get early intervention. This is cruel and if there is no early intervention, it can have a detrimental effect on the child as he or she grows up. I ask the Minister of State to put something in place for these children and their parents. We must remember that behind every child affected are parents and siblings who are all going through this torture together. I therefore ask the Minister of State to do something to reduce the numbers on this list.

I take this issue very seriously and take on board the point the Deputy makes. It is essential we put these early intervention services in place. As I said, though, the key issue is that the staff numbers have increased dramatically. We are trying to deal with this. We have also set up the health service reform programme, which seeks to have health and social care networks in place. The HSE is also establishing a total of 96 children's disability networks across each of the nine CHO areas. These networks comprise special multidisciplinary teams to work with complex disability needs. Each network will have a children's disability network manager with specialised expertise in providing clinical disability services.

The appointment of these network managers can now proceed following the recent Labour Court ruling. I am optimistic that this will improve the services. I accept the point that we must act and hope to have these 37 new posts filled before Christmas.

Question No. 49 replied to with Written Answers.

It has been agreed that Deputy Murphy O'Mahony will ask Question No. 50 on behalf of Deputy Michael McGrath.

Emergency Departments Waiting Times

Michael McGrath


50. Deputy Michael McGrath asked the Minister for Health the reason to date in 2019 more than 1,500 persons over 75 years of age have endured emergency department waiting times of more than 24 hours at Cork University Hospital, CUH. [48768/19]

Why is it that to date in 2019 more than 1,500 people in the over 75 age group have endured emergency department waiting times of more than 24 hours at CUH?

I thank the Deputy for turning up to ask this question. So far today, three Opposition Members who tabled questions have not turned up to ask them, which is interesting. In fairness, I am not criticising the Deputy, who is ably deputising for her colleague but there were three other questions that the Opposition never bothered to turn up to ask me.

Deputy Michael McGrath has a genuine reason for being absent.

There must be something important happening to which I was not invited.

The number of patients attending emergency departments has increased this year with the result that the hospital system is currently operating at close to full capacity. HSE figures show that for the first ten months of 2019 the number of patients attending Cork University Hospital increased by 3.5% and the number of attendances of patients over the age of 75 increased by 6.9% compared to the same period in 2018. This reflects increasing demand for unscheduled care, especially by patients in the 75 years and over age group. A number of factors may affect the waiting times for older patients. In particular, people in the older age category presenting to emergency departments are more likely to have complex needs and to be admitted than the population generally.

In preparation for the anticipated increase in demand over the winter period the HSE's winter plan was launched on Thursday, 14 November. The Government provided an additional €26 million to fund the implementation of the plan. Nine winter action teams, each aligned to a CHO and associated acute hospitals and hospital groups, have prepared integrated winter plans. These plans focus on demand management and reduction, staffing availability, timely access to the most appropriate care pathway for patients and appropriate timely discharge from acute hospitals. Each action team has now set out a range of initiatives it will undertake within its area to implement the plan. I am confident that with the immediate measures being undertaken under the winter plan and the strategic approach being taken by the Government, we will make progress in addressing the difficulties in emergency departments.

I share the Deputy's view that far too many people over the age of 75 are waiting far too long on hospital trolleys. I have conveyed clearly to the HSE that it must prioritise the care of older people in our emergency departments. The action teams must put in place the necessary care pathways for frail, elderly patients. We have allocated €26 million in this regard.

I reiterate that my opening comments were not related to this question, which is being covered ably by the Deputy, but to three other questions for which there was no Member in the Chamber.

I am glad that the Minister clarified that because Deputy Michael McGrath has a genuine reason for being absent. He left this question in my capable hands, I hope. Between January and the end of October this year, a total of 1,508 people aged over 75 endured emergency department waits of longer than 24 hours in CUH. These are some of our most vulnerable patients. The Mercy Hospital in Cork was not as bad as CUH but still another 450 patients aged over 75 had to suffer waits of more than 24 hours. This is not acceptable. What exactly is being done to address this? I seek more details from the Minister. He has explained a number of issues but I ask him to go into more detail. Does he believe it is acceptable to treat vulnerable older people in this manner? Is it not a form of elder abuse? Does he believe it is acceptable that this is happening? What communication has he had with the HSE on this matter? I seek specific details of his contact with the HSE.

I am in daily contact, often several times a day, with the most senior members of the HSE, including the CEO and the chief operating officer, as well as with the CEOs of the hospital groups on occasion, the director of the acute hospitals and many others, along with senior members of my own management team. We engage several times a day on the situation in the acute hospitals, as one would expect at this time of year. That will continue and intensify through the Christmas and new year period. The Deputy asked a fair question as to what is happening now. We have provided €26 million to the Minister of State, Deputy Daly, for the nursing home support scheme to ensure a quick turnaround time of four weeks. We have also put in place more home care packages and more funding for transitional care. Regarding structural change, from January next under the new GP arrangement, there will be a structured chronic disease management programme for patients over the age of 70 for the first time. This means that older people who are currently being treated in hospital for a number of chronic conditions, including asthma and heart conditions, will be treated in the community instead.

I accept that the Minister is trying hard but something is very wrong when the most vulnerable in our society have to wait so long in emergency departments. Many older people do not want to go into hospital because of the long waiting times. That is not good enough. Is he aware that the numbers are twice as bad as for the same period last year? This is not acceptable, particularly as there is no major flu epidemic at the moment. What will it be like if there is a major outbreak or crisis? With respect, what is being done is not working. There are too many people aged over 75 and too many people in general waiting on trolleys in Cork hospitals. I often raise the issue of Bantry Hospital with the Minister because I believe that providing more funding for that hospital would help to alleviate the long waiting times and the overcrowding in the city hospitals.

I agree with the Deputy regarding Bantry Hospital. The Minister of State, Deputy Daly, is due to meet management of the hospital on 2 December. The Deputy is correct that we need to continue to make that hospital busier and to invest more in it, which is our intention. She is also correct that there is a need for more capacity in Cork generally. That is why we are funding a new elective hospital for Cork. I have received correspondence from the hospital group on a proposed site for that hospital and I hope to be in a position to make an announcement on it early in the new year so we can get on with delivering this new hospital.

I do not find this situation acceptable. Nobody finds it acceptable that mothers, fathers, grannies and grandads or any other loved ones, but particularly frail older people, have to wait around in emergency departments on trolleys. We need to do everything we can to create alternatives to our emergency departments. That is why we are investing more in general practice. In the interim, while we are trying to implement Sláintecare, the ten-year strategic plan agreed by all parties in this House, we will invest more in social care supports to get people out of hospital quicker and back into their communities, something about which the Deputy is passionate. We will continue to focus on that.

Question No. 51 replied to with Written Answers.

Cancer Screening Programmes

Bríd Smith


52. Deputy Bríd Smith asked the Minister for Health his plans to investigate further the significant statistical difference between laboratories in terms of the number of slides reviewed as a percentage of their overall intake, as per the report on the 221 patient group laboratory audit results profile; the reason the 38 slides that showed no difference in grading were not removed from the total of 343 slides in the analysis; and if he will make a statement on the matter. [48816/19]

My apologies but I do not have a copy of the question. I ask the Minister to proceed.

In fairness to the Deputy, we have now reached a position where four Opposition Members have failed to turn up to ask their questions. I do not know where they could be or what is more important than asking the questions they have tabled in the Dáil.

The Deputy's question relates to the statistical difference between laboratories vis-à-vis the number of slides reviewed as a percentage of the overall intake. She referred specifically to the 221 patient group laboratory audit results profile report. This report provides information as to which laboratories carried out cervical screening tests for the women in the 221 patient group. The HSE has been clear that the data presented in the report, which relate to 343 slides in total, represent a minute subset of the overall screening data for CervicalCheck, which has completed in excess of 3 million screening tests since 2008. We are talking about 343 slides out of more than 3 million. As such, while these data are accurate as to which laboratories were used for women within the 221 group, I am advised that they would not be statistically sound for the assessment of the performance of any of the laboratories.

It should be noted that the HSE engaged intensively with the patient representatives on the report and agreed its contents with them in advance of publication. I thank them for their work in that regard. The purpose of the report was to provide a summary laboratory profile report on the 221 women for whom the CervicalCheck audit found that a different interpretation could have been provided for their previous slides. The 38 slides to which the Deputy referred are part of the screening history of this cohort of women and the HSE has advised that there is no reason to remove these slides from the analysis. It should also be noted that in the report of his scoping inquiry, Dr. Scally has said he found no evidence of deficiencies in screening quality in any laboratory.

I have asked similar questions to this one many times seeking more precise information on what happened with this group of slides, how they were examined and delved into.

It strikes me that we should know what happened, what the rate of error is and what those errors are. I imagine the Minister would want to know that too. The Minister may not have the report in front of him - I am not saying he should - but table 4 is quite clear that the rate of error in some of the US labs is significantly higher than that of the Coombe laboratory, which is a native lab. I have long contended that we should be looking at why, how and if this happened. Errors in labs which conducted these tests, based in the US or elsewhere, have been clearly admitted and acknowledged. They have made serious financial settlements, not out of the goodness of their hearts but because women and their representatives were able to prove that there was a significant error in the testing. Perhaps we could have a further discussion on that table, which is on page 8 of the report.

I do not have the report in front of me but I may have some of the material from it. This information was requested by women and their families, and by a number of Deputies, including, principally, the Deputy herself. The report was finalised in September following engagement between the HSE and the 221+ patient support group. The report was prepared by a group of four specialists with expertise in cytology, pathology and laboratory quality assurance. I am sure the Deputy has their names. The objective for the results profile was set out by the HSE CervicalCheck screening group and aimed to provide a summary laboratory profile, including overview of laboratory quality assurance, factors affecting the laboratory performance profile, and the laboratory profile specific to the 221 women audited by CervicalCheck. This report was not intended to be a clinical review. Additionally, it did not look at individual women's information and therefore did not report on the degree of change noted in the slides under consideration. It is noted in the report that a cytopathology review would be required to confirm that degree of change, which was not within the report's scope. The information in the report represents a very small subset of the overall data for CervicalCheck, which has completed in excess of 3 million screening tests. We are talking about just over 300 slides out of 3 million. I will have more to say about the Coombe and repatriation in a moment.

The Minister might look at the table to which I have referred later, but I am sure he and his Department have studied it.

The table shows that the rates of error in the Quest laboratories in Illinois and Teterboro, and the Clinical Pathology Laboratories, CPL, in Texas, were five, three and seven times that of the Coombe, respectively. I would not be alarmed if the difference was only 0.5% or so, and neither should the Minister be. However, he should be alarmed at this rate, compared to the rate in the Coombe. If we had included the 38 slides that showed no change in this analysis, would that have changed the statistical information? All or a significant number of those slides could have come from the Coombe. We knew from the get-go that the labs in America were substandard, that they were not ISO accredited at the time, and that each laboratory technician examined 100 slides a day as opposed to the 60 slides a day examined in the Coombe. We did not know whether the standard of education was the same as in Irish laboratories. When we outsourced this service, everything was at a lower standard in the American labs than in the Irish labs. We knew that because there were huge protestations from clinical laboratory technicians, professional organisations and politicians in this House. This report gives us a glimpse into why that might have happened.

I cannot agree with the Deputy's use of words such as "substandard", because I have to base my assessment on the reports and analyses that have been conducted. Dr. Scally found significant failures in Quest Diagnostics and MedLab not informing the scoping inquiry of all the locations used at the earliest opportunities. There were also issues relating to appropriate accreditation, which I accept. Those are clear findings. Crucially, Dr. Scally's report also stated that, on the basis of the information available to him, the use of additional laboratories did not result in a reduction in the quality of the screening provided to Irish women, and that there is no evidence to suggest deficiencies in screening quality in any laboratory. That is what I am taking from the report.

On the broader point, about which I know Deputy Bríd Smith is concerned, of whether we can do more in Ireland or repatriate our service, it is our intention to significantly expand those services and create a national screening laboratory in the Coombe. The move to HPV testing, as well as reducing the number of false negatives and positives, will provide an opportunity to do more here in Ireland.

Questions Nos. 53 to 55, inclusive, replied to with Written Answers.

Home Care Packages Provision

Bernard Durkan


56. Deputy Bernard J. Durkan asked the Minister for Health the extent to which adequate provision has been made in respect of home care packages, with particular reference to the need to concentrate on home care, thereby alleviating the pressure on hospital bed spaces; if comparisons have been made to achieve best or most effective and efficient practice or both nationwide; and if he will make a statement on the matter. [48820/19]

My question relates to a well-known subject. What provision has been made for home care packages to alleviate the burden on hospital beds and accident and emergency departments?

This year’s HSE winter plan was launched on 14 November 2019. Its aim is to ensure that service providers are prepared for the additional external pressures associated with the winter period. The plan is supported by an additional €26 million in winter funding, which is being used to relieve demand for emergency department services, and to support discharge and other initiatives to help hospitals deal with the challenges associated with winter. Specifically, the winter funding will support access to the nursing homes support scheme, home support, transitional care, aids and appliances and other local actions to both facilitate timely hospital discharges and reduce congestion in emergency departments over the winter period.

The Government is investing an additional €52 million in budget 2020 for home support services and next year, the HSE aims to provide over 19.2 million hours, which is 1 million hours more than this year’s target. The investment is focused on enabling older people to remain at home and, as appropriate, provision of hours will also be targeted at times of peak demand at the beginning and end of the year to ensure more timely egress from hospital for older people.

The Programme for a Partnership Government commits to a timely review of the management, operation and funding of national home help services. In fulfilment of this commitment and to enhance the evidence base for the development of the statutory home support scheme, the Department has recently commissioned a review of the management, operation and funding of existing home support service provision. Focusing on the home support services currently funded and provided by the HSE, the findings of this review will ensure that the statutory scheme builds on emerging good practice. Additional funding has been provided in budget 2020 for the testing of the new statutory home support scheme. This investment is a vital step towards the development of the scheme in line with Sláintecare.

I thank the Minister of State for his reply. Have comparisons been made between hospitals and community care areas throughout the regions as to the most effective and efficient method of delivering the services required by the public?

A national committee is looking into the issue of delayed discharges, which would include this particular topic. Information will feed into that committee from each of the nine community healthcare organisations, CHOs. Best practice will always be identified and replicated across the system.

Written Answers are published on the Oireachtas website.