Written Answers Nos 1-34
8. Deputy Micheál Martin asked the Minister for Health if he is satisfied that our health services are putting in place sufficient measures to deal with hospital acquired patient infections; and if he will make a statement on the matter. [48952/12]
View answerI would like to thank Deputy Martin for raising this issue.
Hospital-acquired patient infections continue to be an issue in hospitals worldwide. Many of these infections are difficult to treat as they involve antimicrobial resistance (AMR), where the infectious agent is resistant to a treatment to which it was previously sensitive. Current evidence shows that while antimicrobial resistance in MRSA has continued to decline. Over the last five years MRSA infection among people with the infected agent has declined from 40% to 23.5%. However, resistance in other organisms, such as E Coli, is rising. In relation to the incidence of infection, there has been a decrease in central IV line infection and a decrease in C. difficile infection. There has been a minimal increase in peripheral line infection.
A national clinical programme, under the Royal College of Physicians in Ireland (RCPI) and the HSE, is in place to address this issue. This will be run through a multidisciplinary clinical advisory group under RCPI governance, with joint working groups on prevention of surgical site infection and critical care and hospital-acquired infection. An HSE implementation group will be chaired by the National Director for Patient Safety, Dr Philip Crowley, and the programme operated under the Regional Directors of Operations. The issue is also being addressed outside the acute system, through initiatives in primary and long term care. The programme aims to ensure that healthcare workers focus on three areas every time they care for patients. These are:
- Hand hygiene compliance
- Appropriate use of antimicrobials
- Prevention of medical infections associated with medical devices such as intravenous lines and urinary catheters.
Because treatment of these infections is complicated by antibiotic resistance, emphasis is being placed on better antimicrobial use and on hygiene-related measures in hospitals, with compliance in this area audited on a regular basis. The most recent data shows that compliance with certain measures are at appropriate levels, and that increased effort is needed in other areas. For instance, hand hygiene compliance has improved, with the most recent hand hygiene compliance audit (June/July 2012) indicating an increase to 81.6% (below the 2012 target of 85%). Nursing/midwives scored the highest (86%) with medical staff the lowest (69%). I recognise that there is a need for further improvement in this area and in particular in relation to aseptic tasks, such as inserting an intravenous (IV) line, where compliance is at a sub-optimal rate of 80%.
I am very much aware of this issue, and will continue, as will my department, to monitor measures being taken by the HSE and the compliance audits of these measures. While this issue requires ongoing clinical vigilance, I am satisfied that current measures are having a positive effect, as is evident from a decrease in incidence of infection and decline in AMR in relation to MRSA.
9. Deputy Joan Collins asked the Minister for Health if he will provide an update on the planning application of the Simon Community, Usher's Quay, Dublin, in relation to a transfer of services from the Rowan ward in Cherry Orchard, Dublin; if he is satisfied with the way the transfer of services has gone to this point; and if he will make a statement on the matter. [48745/12]
View answerA review of the Rowan Ward HIV respite service found that when the Rowan Ward was set up in 1990 its purpose was to provide end stage palliative care to AIDS patients. In more recent times, the ward had come to provide respite and stabilisation for a limited number of HIV patients who were also clients of the HSE addiction services. Given these changes in the Rowan Ward service model the review outlined alternative care pathways for the Rowan Ward client base within the homeless/addiction sector.
Following the review, the HSE proposed to close the Rowan Ward and to locate the service in an existing service in the homeless/addiction sector. This was accomplished by the creation of eight dedicated beds for the Rowan Ward patient group within an addiction/homeless service currently provided by Dublin Simon in Ushers Island. The transfer of Rowan Ward clients to the Ushers Island facility commenced on 1st September 2012, overseen by a steering group consisting of statutory and voluntary service providers. The new service provides a more amenable care pathway for the Rowan Ward HIV patients and the staff in the Ushers Island complex will be better positioned to manage clients with addiction associated issues. This approach will see Dublin Simon taking responsibility for the service, thereby delivering improved clinical governance as part of a Service Level Agreement.
The Rowan Ward clients have been temporarily located within the existing Ushers Island campus. However, a new unit is nearing completion in a separate building which is currently being refurbished, and this will serve as a permanent home for the Rowan Ward clients. No planning application was required for this refurbishment work as it only involves internal structural development.
10. Deputy John McGuinness asked the Minister for Health the action he will take on foot of the recent NESC report Quality and Standards in Human Services in Ireland; Disability Services; and if he will make a statement on the matter. [48946/12]
View answerThe recent NESC report: 'Quality and Standards in Human Services in Ireland: Disability Services' was very timely in that it followed the recent publication of the Value for Money and Policy Review (VFMPR) of Disability Services by my Department and was in advance of the current consultation being carried out by the Health Information and Quality Authority ( HIQA) on the revised draft standards, for residential services for both adults and children's disability services, which will allow for a robust registration and inspection system to be put in place by way of regulation by mid 2013.
One of the main challenges facing the disability sector identified by the report is that there has been little formal regulation in the sector, with no inspections or compulsory standards. As I have indicated previously, it is a priority for this Government to put the draft HIQA standards for the disability sector on a statutory footing and ensure that the services are registered and inspected by HIQA. These draft standards outline what is expected of a provider of services and what a person with a disability, his or her family, and the public can expect to receive from residential care services.
The draft standards document is currently the subject of a 5 week consultation process prior to being finalised and brought before the Board of HIQA. The final agreed standards will then be forwarded to my Department for approval with a likely publication date in January 2013. It is expected that the new regulatory system should be up and running by mid 2013. Work is also ongoing in my Department on both the 'Registration and Inspection' regulations and the 'Care and Welfare' regulations required to bring the standards into law. These are being developed taking into account the lessons learned from similar regulations for nursing homes.
In broader terms, the report echoes many of the findings of the VFMPR report and my Department in conjunction with the HSE, is currently developing an implementation framework for the recommendations in the VFMPR report which will be informed by the NESC report as appropriate. It is the intention that adherence to quality standards and a focus on personal outcomes, as underpinned by personal needs assessments, will be built into service provision as the recommendations in the review are implemented, so as to align disability service provision with Government policy, over time and within available resources.
11. Deputy Seamus Kirk asked the Minister for Health the total number of patients that have been staying in acute hospitals for more than three months; and if he will make a statement on the matter. [48928/12]
View answerThe SDU has worked with the Clinical Care Programme on the Elderly and the HSE on proposals for a joint Acute Hospital/Community Service transitional care initiative. This will speed up access and egress from acute care (reducing ED times, length of stay, and delayed discharges). In 2012, this initiative will see 190 transitional care beds being put in place along with 150 rehabilitation beds, with the initial focus being on the Dublin North East and Dublin Mid-Leinster regions. There will also be investment in home supports and funding provided for rehabilitation packages (rehabilitation at home) and home adaptations. €12m has been made available to year end.
This initiative is about improving the patient experience and outcomes for our frail older people. The initiative will also underpin significant savings in bed days through moving from acute beds to transitional and rehabilitation beds and through reduction in the average length of stay for patients in acute beds.
In relation to the specific information sought by the Deputy I have asked the HSE to respond directly to the Deputy in relation to this matter.
12. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if the review he initiated in his Department on how best to compensate those women victims of the former consultant Michael Neary and who were excluded from the terms of the redress scheme on the grounds of age, has reported to him; the way he intends to proceed; how quickly he will act, in view of the fact that the number of women involved continues to reduce; and if he will make a statement on the matter. [48959/12]
View answerThis Government has given a commitment in the Programme for Government to seek a mechanism to compensate those women who were excluded on age grounds alone from the Lourdes Hospital Redress Scheme. I understand that approximately 35 women who suffered an unnecessary bilateral oophorectomy were excluded from the Redress Scheme on the basis of age alone. The Scheme of Redress approved by Government in 2007 was a non-statutory, ex-gratia scheme. Awards were determined by an independent Redress Board in 2007 and 2008.
My Department has been engaged in a review to identify the most appropriate mechanism to compensate these women. This review has included taking instructions and legal advice, including advice from the Office of the Attorney General, with a view to bringing proposals to Government for a decision. This process is ongoing, and it is my intention that it will be brought to a satisfactory, legally sound conclusion as quickly as possible.
13. Deputy Sean Fleming asked the Minister for Health the total number of bed closures in acute hospitals in 2012; and if he will make a statement on the matter. [48927/12]
View answerI believe we must concentrate on getting the best possible services for patients from the budgets available to us. This means we need to focus on how beds are used, on the throughput of patients, on reducing length of stay to international norms and on having as many procedures as possible carried out as day cases rather than inpatient work.
The work of the Special Delivery Unit, together with implementation of the Clinical Care Programmes in the HSE, will help to improve the efficiency of our hospitals, allowing us to treat as many patients as possible within budget. I believe that pursuing efficiencies through these means will be a far more productive approach than debating the number of beds open or closed at any one time.
In the current economic climate the acute sector must reduce its costs in order to deliver the agreed level of activity within the resources available to it. The emphasis in 2012 will continue to be to make the most effective use of acute bed capacity through shorter lengths of stay, increased rates of day-of-surgery admission and more day surgery. For example, the implementation of the HSE’s Acute Medicine Clinical Care Programme has saved 121,000 bed days to date this year. In this way the acute hospital system can ensure that, within the level of resources available, it provides safe, effective and efficient care to the maximum number of patients.
Throughout 2012 hospitals will open and close beds on various wards in order to deliver the planned level of activity. These beds may be closed for a number of reasons, including cost containment, infection control and refurbishment. It is not possible at this time to determine what beds in which wards will be closed and what length of time they will be closed for. The decision to open and close beds is made at hospital management level and approved by the Regional Director of Operations.
Please find in the table the latest data in relation to bed closures for the week ending 28th October 2012. There are 759 inpatient beds closed and an additional 11 day case beds. Contained in the table are the inpatients closures broken down under the various headings.
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Overall numbers In-patient Total 759 Day bed Total 11 Total Bed Closures 770 |
Profile of Inpatient bed closures Reason Summary Infection Control 23 Cost Containment 585 Refurbishment/Maintenance 55 Seasonal Closures 6 Other 90 |
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Bed Type Summary Surgical 253 Medical 339 Critical Care 15 Oncology 2 Not designated to a particular specialty 101 Psychiatry 49 |
Network Group Summary Dublin Mid Leinster Region 196 Dublin North East Region 178 South Region 204 West Region 103 Galway Hospital Region 52 Mid West Hospital Region 26 |
14. Deputy Seán Crowe asked the Minister for Health if his attention has been drawn to the fact that cuts to funding for disability services are beginning to threaten the progressive policy of accommodating persons with disabilities in community settings rather than in institutions; and if he will make a statement on the matter. [48970/12]
View answerThe HSE’s Report ‘Time to Move on from Congregated Settings’ was published in July 2011 and sets out a framework to guide the transfer of identified individuals from congregated settings to live in the community. It is currently estimated that 3,600 people still reside in these settings. The Report defined a congregated setting as a residential setting of ten or more people. The Report found that, not withstanding the commitment and initiative of dedicated staff and management, there were a significant number of people still experiencing institutional living conditions where they lacked basic privacy and dignity, living their lives apart from the community and families.
The HSE has established a National Implementation Group on Congregated Settings under its National Consultative Forum on Disabilities comprised of representatives from the HSE, disability umbrella groups and service user representative organisations. The Group is currently developing the high level implementation plan to be rolled out at regional and local level, in full consultation with the appropriate stakeholders. Implementation of the Report will pose significant challenges for many stakeholders, including clients, families, disability service providers, the HSE, various Government Departments and statutory bodies, and representative organisations. In the context of the Joint Housing Strategy for People with Disabilities; launched in October 2011, the Department of Health and the Department of the Environment, Community & Local Government have worked closely to identify sustainable funding resources to maintain progress on the transition programme. While the overall implementation of decongregation is expected to be cost neutral, and not withstanding the significant progress on funding overall, the Department of Health has agreed to transfer funding of €1 million to the Department of the Environment, Community & Local Government in 2013, to support the commencement of the programme. This funding will be ring fenced to meet the social housing needs of people leaving institutions in 2013, enabling housing authorities to provide up to 150 new homes in the community. These units will be additional to the overall social housing supports which are expected to be delivered through all supply mechanisms in 2013.
It must also be acknowledged that the Report recognises a seven year time-frame for the implementation of its recommendations. The HSE has advised that this time frame should be treated with caution as there are a number of complexities involved due to multi dimensional elements of implementation including, individual choice of accommodation, living arrangements and location, funding, and the future role of staff, training and skill mix.
15. Deputy Dessie Ellis asked the Minister for Health if and when the signalled package of supports for children who contracted narcolepsy associated with the Pandemrix vaccine will be made available; the other measures that will be undertaken in this regard;; and if he will make a statement on the matter. [48963/12]
View answerMy Department is working closely with the Health Service Executive (HSE) and the Department of Education and Skills to address the needs of those affected by narcolepsy following pandemic vaccination.
The HSE provides a range of services and supports to those affected including access to rapid diagnosis, clear treatment pathways, temporary medical cards and reimbursement of expenses incurred. Multi-disciplinary assessments which allow for the appropriate individualised health and educational supports to be put in place have commenced. The National Educational Psychological Service (NEPS) is also engaging with the HSE and with the individual schools and parents of children concerned to identify and provide educational supports for the children and adolescents affected.
My Department is considering all other possible supports which may need to be put in place for those affected. Any such supports require my approval and the consent of the Minister for Public Expenditure and Reform. officials are currently engaged in discussions with the Department of Public Expenditure and Reform on this issue.
I would like to assure the Deputy that this matter continues to be a priority for my Department.
16. Deputy Kevin Humphreys asked the Minister for Health if the relocation and redevelopment of Dublin's Maternity Hospital is being considered in the context of the decision pending on the National Children's Hospital; and if he will make a statement on the matter. [48741/12]
View answerOn Tuesday, I announced the Government’s decision to develop the new children’s hospital at the campus of St James’s Hospital in Dublin. In identifying the new site, the Government has carefully considered the report of the Dolphin Group along with detailed supplementary information on cost, time and planning which was subsequently sought from those members of the Group with the relevant technical expertise. The report was published on Tuesday on the website of my Department.
This decision has been made in the best interests of children, with clinical considerations being of paramount importance. It is essential that the new children’s hospital can deliver best clinical outcomes for our children. Co-location with an adult hospital has been deemed essential by the Dolphin report, and by all previous reports on this issue, while tri-location with a maternity hospital is optimal. Co-location, and ultimately tri-location with a maternity hospital, on the St James's campus will support the provision of excellence in clinical care that our children deserve.
I intend to move quickly now to put in place all the necessary structures and governance arrangements to enable the delivery of this project as quickly as possible and to the highest quality. This Government regards the building of the new children’s hospital as a key priority and no effort will be spared in expediting its completion.
The decision of the location of the new Children's hospital does not impact on the proposal to relocate the National Maternity Hospital to St Vincent's.
17. Deputy Éamon Ó Cuív asked the Minister for Health when the White Paper on Financing Universal Health Insurance will be published; and if he will make a statement on the matter. [48933/12]
View answer38. Deputy Pádraig Mac Lochlainn asked the Minister for Health in view of the numbers of persons dispensing with private health insurance, if he is reviewing hiss plans for funding universal healthcare through an insurance-based system, since such a system would be heavily dependent on private health insurance companies; and if he will make a statement on the matter. [48965/12]
View answer78. Deputy Pearse Doherty asked the Minister for Health in view of the fact that the Programme for Government promised the White Paper on Financing Universal Health Insurance early in his first term and that his Department's recent briefing for the Oireachtas Health and Children Committee stated that it will be published as early as possible within his term of office, if he will provide a report on progress on same an a more specific date for publication. [48976/12]
View answerI propose to take Questions Nos. 17, 38 and 78 together.
The Government is embarking on a major reform programme for the health system, the aim of which is to deliver a single-tier health service, supported by universal health insurance (UHI), where where access is based on need, not on income. Under UHI, every citizen will be insured and will have equal access to a comprehensive range of curative health services. A new Insurance Fund will subsidise or pay insurance premia for those who qualify for a subsidy. I want to assure the Deputy that this Government is committed to the introduction of a universal health insurance model and is of the view that this model of healthcare will deliver the necessary reform of our healthcare system.
In designing the precise model of care on which universal health insurance will be based, I want to ensure that it meets the needs of the Irish system and achieves the best outcomes for patients. This requires that we carefully plan and sequence the reform programme and that we give detailed consideration to the most appropriate structures for delivery of different services. We also need to look at the relationships between services, and at best practice in healthcare reform.
To help us in this work, I established an Implementation Group on Universal Health Insurance in February of this year. The Group is tasked with assisting the Department of Health in developing detailed and costed implementation proposals for universal health insurance and in driving the implementation of various elements of the reform programme. The Group consists of a mix of those with executive responsibilities within the health service and external expertise, including international experts.
The Implementation Group has already met on five occasions and has advised the Department in relation to its work on some of the core building blocks for UHI, including the introduction of a Money Follows the Patient funding system and the creation of Hospital Groups.
The Group will also assist my Department in preparing a White Paper on Universal Health Insurance. The White Paper will outline details of the UHI model in addition to the estimated costs and financing mechanisms associated with the introduction of universal health insurance.
Preparation of a White Paper is a complex and technical process. It will require significant research and financial modelling to support analysis and costing of different design options. This, in turn, demands a wide-range of specialised expertise. Officials in my Department, in consultation with the Implementation Group on UHI, are putting in place a process to ensure the provision of this expertise to feed into the Department’s preparation of the White Paper. This work is ongoing at present with a view to ensuring that the White Paper will be published as early as possible within the Government’s term of office.
To complement the work of the Implementation Group on UHI, I also established the Health Insurance Consultative Forum in February of this year. The Forum comprises representatives from the country's main health insurance companies, the Health Insurance Authority and the Department of Health.
This Forum has been established with a view to generating ideas which would help address health insurance costs. Its core focus is on identifying ways of addressing costs throughout the industry, whilst always respecting the requirements of competition law.
Bilateral meetings have taken place with each insurer where they have brought forward their own ideas for cost savings in the market. The Forum will also give a voice to the insurers in the development of the new Universal Health Insurance model.
18. Deputy Joan Collins asked the Minister for Health his plans to ensure that there are standard contracts with detailed terms and conditions for workers in the home help sector; and if he will make a statement on the matter. [41678/12]
View answer21. Deputy Michael McGrath asked the Minister for Health his plans regarding the continuing refusal of the Health Service Executive to provide contracts to persons employed as home helps; and if he will make a statement on the matter. [48945/12]
View answer23. Deputy John Halligan asked the Minister for Health his plans to ensure that there are standard contracts with detailed terms and conditions for workers in the home help sector; and if he will make a statement on the matter. [41676/12]
View answer55. Deputy John Halligan asked the Minister for Health if his attention has been drawn to concerns being raised by home helps with regards to their lack of contracts and conditions of employment; his plans to take action regarding same; and if he will make a statement on the matter. [41677/12]
View answerI propose to take Questions Nos. 18, 21, 23 and 55 together.
On 29 June 2012, the Labour Court recommended that the HSE and SIPTU should engage in relation to matters concerning home help contracts and that in the event that there are any outstanding issues, they may be referred back to the Court. The HSE engaged with SIPTU concerning the recommendation and advised that as part of the process it would be undertaking an information-gathering exercise to ascertain the up-to-date position regarding the nature of the contracts held by home helps and the hours worked under such contracts. This exercise is being undertaken at present.
Having met with the parties again on 15 October 2012, the Labour Court recommended that they should re-engage under the auspices of the Labour Relations Commission and that this engagement be completed by 30 November 2012. The parties are to meet at the LRC on 19 November 2012. It would not be appropriate for me, as Minister, to comment further on these matters while these processes are under way.
19. Deputy Éamon Ó Cuív asked the Minister for Health the date on which the positive ageing strategy will be published; and if he will make a statement on the matter. [48948/12]
View answerThe Programme for Government has committed to completing and implementing the National Positive Ageing Strategy so that older people are recognised, supported and enabled to live independent full lives.
The Strategy will set the strategic direction for future policies, programmes and services for older people in Ireland. It will set out a common framework for the development of operational plans by a number of Government Departments which will clearly set out each Department’s objectives relating to older people. Mechanisms designed to monitor the implementation of measures contained in operational plans will also be included in the Strategy. However, I do not envisage that the Strategy will propose new service developments. Rather it will set the strategic direction for future policies, programmes and services for older people in Ireland.
A considerable amount of preparatory work has already been completed. The drafting of the Strategy will proceed within the Department within the constraints of available staff and other priorities. At this stage I envisage that a draft of the Strategy will be brought to Government in Q4 2012.
20. Deputy Sandra McLellan asked the Minister for Health his plans for the future of St. Raphael's Centre in Youghal, County Cork, in the context of the implementation of the Time to Move On congregated setting report published in June 2011; the timeframe for the introduction of his plans; its impact on residents; its impact on staff and the future service provision for adults with an intellectual disability he intends providing at the St. Raphael's site in Youghal; and if he will make a statement on the matter. [48957/12]
View answerSt Raphael's Centre, Youghal is a HSE intellectual disability service providing day, residential and respite services for 180 clients in Youghal. The majority of the services are delivered on the main campus that includes an old institutional style residential centre, where over 80 clients reside in dormitories. There are also two large hostels, a new 30 bedded unit and 3 community houses.
The HSE adopted the policy “Time to Move On” Congregated Setting report in June 2011, which recommends the transition of all people with disabilities who currently reside in large institutions into community living.
The HSE has established a National Implementation Group on Congregated Settings under the National Consultative Forum, which is comprised of representatives from the HSE, disability umbrella groups and service user representative organisations. I understand that this group is currently developing a high level implementation plan, to be rolled out at a regional and local level in full consultation with the appropriate stakeholders. The development of future plans for the residents of St Raphael's Centre will be a feature of these plans in due course.
The HSE is fully committed to engaging as appropriate with the key stakeholders in terms of the developments within any one service, both in terms of Congregated settings and other reconfiguration programmes, such as the New Directions Policy on Day Service provision in the Disability Sector.
At the current time I understand that there is no definitive plan or timescale around the decongregation of St Raphael’s Centre. The HSE has informed me that its Disability Services Management team will engage fully with the staff and residents in the development of any future plans, to ensure that plans are person-centred for the individuals and take account of the valuable expertise and knowledge of the staff. The co-operation and collaboration of the staff from St. Raphael’s will be a significant factor in ensuring that the move to community for the residents will be successful and sustainable in the long term.
22. Deputy Mick Wallace asked the Minister for Health if his attention has been drawn to the periods of time children are waiting to receive orthodontic treatment; his views on whether it is unacceptable that applicants from May 2009 are only being processed now; and if he will make a statement on the matter. [48753/12]
View answerThe HSE provides orthodontic treatment to patients based on their level of clinical need. An individual's access to orthodontic treatment is determined against a set of clinical guidelines. Waiting times for orthodontic assessment and treatment vary across the country and within the HSE regions and priority is given to patients with greatest needs. The HSE has commissioned an independent review of orthodontic services. The outcome of this review will give guidance as to what changes will be desirable to provide the best possible model of care delivery, given the current resources available and future demand for services.
24. Deputy Pádraig Mac Lochlainn asked the Minister for Health in view of the fact that 1,201 public nursing home beds have been closed between January 2011 and August 2012, the current total number of nursing home beds in the State; the number public and the number private; and if he will make a statement on the matter. [48964/12]
View answerThe latest validated information from the Health Service Executive indicates that at the end of September 2012 there were 7,376 public residential beds for older people in Ireland. Of these, 5,468 are designated long stay beds and 1,908 are designated as short term beds. The Deputy will be aware that the Health Information and Quality Authority (HIQA) is the statutory body responsible for the registration of all designated centres for older people. Full details of all currently registered nursing homes, including the maximum number of residents who can be accommodated can be found on the HIQA website, www.hiqa.ie .
However, the Department of Health carries out a survey of long-stay units each year. Each long-stay unit (public, private and voluntary) is sent a questionnaire and the responses are collated by the Department. The aim of the survey is to provide statistics on the number of beds available for long-term care, how these beds are used and the types of residents who occupy these beds. The results of the surveys are used to prepare the Long-Stay Activity Statistics Reports which are published on the Department's website. The Long-Stay Activity Statistics for 2010, the most recent year available, and for previous years can be accessed at www.doh.ie . The completed survey for 2011 will be published shortly. Each report provides a breakdown of the number of private and public beds in each County on a unit by unit basis. The Deputy should be mindful that these are self reported survey results.
25. Deputy Dara Calleary asked the Minister for Health the extent of staff shortages in acute hospitals; if the bill for agency staff in acute hospitals has reduced; the other alternatives to agency staff that are being used; and if he will make a statement on the matter. [48924/12]
View answerAs this is a service matter it has been referred to the Health Service Executive for direct reply.
26. Deputy Clare Daly asked the Minister for Health if he will agree to animal welfare advice not to directly transpose a loophole in the ban on inflicting severe and prolonged pain on animals in experiments, article 55.3 of the animal experimentation directive, and instead require the passage of secondary legislation for the licensing of such high levels of harm [48751/12]
View answerThe matter the Deputy is referring to are the Safeguard Clauses set out at Article 55 of Directive 2010/63/EU on the protection of animals used for scientific purposes. These Safeguard Clauses cover exceptional circumstances in which Member States may, on scientifically justifiable grounds, provisionally authorise applications for derogations relating to a number of restrictions set out in the Directive including authorisation of procedures involving severe pain, suffering or distress that is likely to be long lasting and cannot be ameliorated.
Under Article 55(3), such exceptional provisional measures could, for example, be required to deal with an unexpected outbreak of a life threatening or debilitating clinical condition in humans or an outbreak of an highly infectious pathogenic disease. The Safeguard Clauses would also allow for emergency measures in the event of a natural disaster that resulted in, for example, the contamination of land and livestock.
It will only be possible to introduce any such provisional measure by way of Ministerial Order after consultation with the Irish Medicines Board (the Competent Authority for the purposes of the Directive) and any such measure will be subject to EU Member State and Commission scrutiny and approval. The European Commission, assisted by an Advisory Committee (composed of Member State representatives and chaired by the Commission) must, subsequently, authorise or disallow any such provisional authorisation.
It is clear from the Directive that the replacement, refinement and reduction of animal testing is at the core of this legislation and I strongly endorse this objective. Nevertheless, and even if difficult to foresee, it is my considered view that it is both reasonable and correct to make provision for exceptional emergency situations that might arise, if only to ensure that the necessary legislative tools are available to deal with such an eventuality. The Directive provides Member States with the legislative tools needed to respond in an effective way to such situations. Not to incorporate such tools in our transposition of the Directive might prove to be most regrettable if fate were to take a hand.
27. Deputy Aengus Ó Snodaigh asked the Minister for Health if he will set out his revised timetable for the promised roll-out of free general practitioners care, beginning with long-term illness patients; and if he will make a statement on the matter. [48974/12]
View answerThe Programme for Government commits to reforming the current public health system by introducing Universal Health Insurance with equal access to care for all. As part of this, the Government is committed to introducing, on a phased basis, GP care without fees within its first term of office. Primary legislation is required to give effect to Government commitment to introduce a universal GP service without fees.
Legislation to allow the Minister for Health to make regulations to extend access to GP services without fees to persons with prescribed illnesses is currently being drafted by this Department and the Office of the Attorney General and will be published shortly. Implementation dates and application details will be announced in due course.
28. Deputy Robert Troy asked the Minister for Health the action he has taken to develop mental health services for young persons; and if he will make a statement on the matter. [46715/12]
View answer319. Deputy Bernard J. Durkan asked the Minister for Health if he is satisfied regarding the adequacy of child psychiatric or psychological services; the extent to which such services can meet the demand; and if he will make a statement on the matter. [49148/12]
View answerI propose to take Questions Nos. 28 and 319 together.
The development of the Child and Adolescent Mental Health Service (CAMHS) has been prioritised by the HSE in recent years and considerable progress has been made to date. A special allocation of €35 million was provided in Budget 2012 for mental health, in line with commitments in the Programme for Government. Funding from this special allocation will be used primarily to strengthen Community Mental Health Teams in both Adult and Children’s mental health services by ensuring, at a minimum, that at least one of each mental health professional discipline is represented on every team. Of the 414 posts approved to implement the €35 million package, 150 will be allocated to Child and Adolescent Community Mental Health Teams. The National Recruitment Service of the HSE is currently working to recruit the necessary personnel and the posts are at various stages in the recruitment process. It is hoped that the bulk of the appointments will be made by the end of the year.
It is envisaged that the completion of the multi-disciplinary profile of current teams will facilitate further progress on the reduction in the waiting lists for CAMHS services. It is worth noting that despite an increase in demand for such services, the number of children waiting for an appointment reduced by 12% in the 12 month period to June 2012.
In terms of in-patient facilities, psychiatric bed capacity for children and adolescents has increased from 12 beds in 2007 to 44 at present - 12 in Dublin, 12 in Cork and 20 in Galway. Work on the second phase of the Child and Adolescent Unit at St. Vincent's Hospital, Fairview has recently been completed and this will increase capacity from 12 to 18 beds in Dublin by the end of 2012. The increase in bed capacity in recent years is reflected in an almost 50% decrease in admissions of children to adult units since 2008.
The Linn Dara Child and Adolescent Mental Health Facility at Cherry Orchard, Dublin has recently opened and a number of Child and Adolescent Community Mental Health Teams have moved in to the new premises. It is expected that the Day Hospital will be in operation by the end of the year. Thj HSE is also seeking tenders from contractors as part of the process to develop a 22 bed Child and Adolescent in-patient facility on the Cherry Orchard site. The closing date for receipt of tenders is 22nd November.
Finally, a 10 bed Child and Adolescent Forensic Mental Health Unit will be provided as part of the National Forensic Mental Health Project. The Unit will be based in Portrane, co-terminus with the new Central Mental Hospital which is expected to be operational by 2016.
29. Deputy Eamonn Maloney asked the Minister for Health if, following civil disturbances at a concert (details supplied), the promoter has reimbursed the Connolly and Mater hospitals, Dublin, for the costs incurred by the accident and emergency departments; and if he will make a statement on the matter. [48742/12]
View answerAs this is a service matter, it has been referred to the Health Service Executive for direct reply.
30. Deputy Barry Cowen asked the Minister for Health if his attention has been drawn to the concern amongst persons in the south east regarding a reconfiguration of hospital services in the region; his plans regarding same; and if he will make a statement on the matter. [48925/12]
View answerA key stepping stone towards the introduction of Universal Health Insurance will be to develop independent not-for-profit hospital trusts in which all hospitals will function as part of integrated groups. The rationale behind the establishment of hospital groups and trusts is to support increased operational autonomy and accountability for hospital services in a way that will drive service reforms and provide the maximum possible benefit to patients. Reform across the three domains of access, quality and resources is not achievable unless there is real clinical and managerial accountability at hospital level.
The work on hospital groups is not about downgrading hospitals. It is about the bringing together groups of hospitals to form single cohesive entities to allow maximum flexibility in management, budgets and service delivery. With specific regard to the South East there remains full commitment to the retention of Waterford as one of the 8 existing national cancer services with all the associated services required in the hospital. The Trauma Centre at Waterford will also be retained. The provision of other services at any hospital site will, of course, primarily be determined by the appropriate clinical programme for that service, taking account of the population which the hospital serves and services provided by other hospitals which are within a reasonable commute.
Last June I appointed Professor John Higgins to chair a Strategic Board on the Establishment of Hospital Groups. The Strategic Board has representatives with both national and international expertise in health service delivery, governance and linkages with academic institutions. A Project Team was established to make recommendations to the Strategic Board on the composition of hospital groups, governance arrangements, management frameworks and linkages to academic institutions.
In order to form these recommendations, the project team has carried out a comprehensive consultation process with all acute hospitals and other health service agencies. The consultation process included 2 days of meetings with the hospitals in the South East, on 9th July and again on 4th October. Submissions, including a significant number of submissions from representatives of the South East hospitals and citizens from that Region have also been received by the group.
Work is continuing on finalising a Draft Report on the recommendations outlined above for submission to the Strategic Board. This report will be considered by the Board when they meet on 14th November. When the Board have signed off on this Report it will be submitted to me and I will then bring it to Cabinet. The composition of Hospital groups will be a Government decision, taking into account the recommendations of that Report.
Hospital groups will be established on an administrative basis pending the legislation required to set up hospital trusts by 2014. Before those trusts are established the make-up and functioning of the Groups will be reviewed and if changes prove necessary then they will be made with Government approval when the hospital trusts are being formed.
31. Deputy Derek Keating asked the Minister for Health if he will report on the new forms recently issued to general practitioners for flu vaccinations in view of the fact that GPs have reported that the new forms take a considerable amount of extra time to complete by staff, require information that has already been submitted and is causing their system to be clogged up and the reason these new forms have been introduced during the middle of the programme [48744/12]
View answerAs this is a service issue, the question has been referred to the Health Service Executive for direct reply to the Deputy.
32. Deputy Aengus Ó Snodaigh asked the Minister for Health the action he will take to ensure the provision of care home places and other supports to allow the discharge of more than 600 acute hospital patients who are ready to be discharged but who cannot be discharged due to the lack of such supports and places; and if he will make a statement on the matter. [48973/12]
View answerGovernment policy is, in line with available resources, to support vulnerable older people to remain living at home and in their communities for as long as possible. Where this is not an option, for whatever reason, we support access to short-term or long-term residential care.
In relation to the figure of approximately 600 acute hospital patients referred to in the Deputy's question, the majority of these patients are awaiting discharge to either nursing homes or other care options. Figures provided to the Department show that, of the figure quoted by the Deputy, less than 10% over the period January-October 2012 have been delayed discharges due to awaiting provision of HSE Home Support services.
The HSE has been developing various operational initiatives to improve its approach to all relevant aspects of its Home Supports services. These include various new guidelines for Home Care, and a new Procurement Framework for approved agencies providing services on its behalf. While on-going developments have been designed to standardise and maximise the use of limited resources in the face of increasing demand, they are also intended to enhance quality, safety and other relevant aspects of service for both providers and care recipients alike. This has been a challenging year for the health services overall, including maintaining services in line with evolving resource pressures. The overall provision of home support services is therefore regularly reviewed at national and local levels, in the context of client need and resource availability.
Notwithstanding the recently announced reduction in HSE Home Support provision for the remainder of 2012, investment in these services remains significant with provision in the region of €320m expected for Home Help and Home Care Packages this year. Decisions in relation to the provision of home help hours will continue to be based on a review of individual needs.
33. Deputy Denis Naughten asked the Minister for Health when he will publish his Department's report on mortality rates at acute hospitals; his views on whether his failure to acknowledge the inaccuracy of the figures at Roscommon County Hospital has damaged the reputation of the hospitals and its staff; and if he will make a statement on the matter. [48749/12]
View answerIt is essential to have a health system that is transparent and accountable. Information needs to be collected, analysed and intelligently interpreted in order to allow the health system and population it serves to monitor what it is doing, recognise where improvements are occurring and identify potential problems, so that actions can be taken to rectify them.
It makes sense to use available data and information to support important issues such as patient safety and quality of the care. The Hospital Inpatient Enquiry Scheme (HIPE) system is the largest system providing information on hospital care in this country.
With this in mind, the Chief Medical Officer of my Department has been working on a report entitled ‘Health Care Quality Indicators in the Irish Health System: Examining the Potential of Hospital Discharge Data’ . This includes the measure of recorded 30 day in-hospital mortality rates following heart attack.
The work to date demonstrates the value of using HIPE as a tool to derive knowledge and understanding of health care quality. However, this work has also uncovered variation in the accuracy of data as reported through the HIPE system. Some individual hospitals have looked into the origin of this variation and attributed it to inaccuracies in both the medical chart and the subsequent coding of information that is then inputted by individual hospitals in the HIPE system.
I am concerned about this finding in relation to data quality given its potential patient safety implications. I believe that, arising from this, there is a duty on all hospitals to address measures that can ensure that the information which they record and report is accurate.
Concerns have been raised by certain hospitals and clinicians that the report, which seeks only to examine quality of data, could be either inadvertently or deliberately misinterpreted as making inferences on quality of care. I understand this concern. However, I do not accept that the solution is to disregard these data. Where that source of information is found to be flawed the solution is to improve it. These data have been collected by hospitals and the hospitals themselves must be accountable for the quality of them.
Therefore, the CMO in conjunction with the HSE and the Economic and Social Research Institute (ESRI), wrote to every public hospital in the country in 2012 requesting that they ensure that the information they recorded and reported for 2011 and 2012 was accurate.
It is expected that the report will be finalised and published in the near future.
34. Deputy Dessie Ellis asked the Minister for Health if he has carried out an audit of the cumulative effects of cuts to funding for disability services in recent years; if his attention has been drawn to the fact that such cuts are now threatening the very existence of basic services; and if he will ensure that no further cuts to funding of services for persons with disabilities will be imposed in the forthcoming budget 2013; and if he will make a statement on the matter. [48962/12]
View answerExpenditure on health services for people with a disability in 2012 will be in the region of €1.4 billion. The HSE National Service Plan 2012 provides for a 3.7% reduction in budgets but makes it clear that there is scope for achieving efficiencies of 2%, thereby limiting as much as possible the impact on front line services. Despite this reduction, which is similar to that applied across all care areas in the Health sector, the HSE has undertaken to maximise the provision of services within available resources by providing for the following in 2012:
- 9,100 people in residential places
- 18,600 day service places
- 6,300 people receiving respite residential support
- 1.64 million hours of Personal Assistant / Home Support Hours
As you know, I recently published the Value for Money and Policy Review of Disability Services which identifies fundamental issues that need to be addressed in the way in which HSE-funded disability services are managed and operated, and lays the groundwork for the introduction of a significant restructuring of the Disability Services Programme through:
(i) migration from an approach which is predominantly organised around group-based service delivery towards a model of person-centred, individually chose, supports; and
(ii) implementation of a more effective method of assessing need, allocating resources and monitoring resource use.
I must also stress that the nature of the core underlying deficit within the HSE, taken together with the requirements nationally to bring our public spending deficit down by 2015, will make 2013 and 2014 extremely challenging for all sectors, not just Health. I will be doing all possible to ensure that as much protection as possible is afforded to the disability sector, and the Social Care area as a whole.
