Written Answers Nos. 44-57
44. Deputy Seán Crowe asked the Minister for Health his views on the study commissioned by the Irish Nurses and Midwives Organisation showing that significant understaffing in our public hospitals adversely affects patient care; and if he will make a statement on the matter. [57015/12]
View answerThe information available from the study referred to by the Deputy, which was undertaken on behalf of the Irish Nurses and Midwives Organisation, is quite limited. Other studies have cited figures which suggest that Ireland has a more favourable nurse-to-patient ratio than the United Kingdom.
At present, some 1650 nurses/midwives graduate per annum from our Universities and other colleges. The Department of Health has recently completed a review of undergraduate nursing and midwifery education programmes. As part of this review an analysis of the number of student places required to ensure sufficient numbers of nurse and midwife graduates was completed. This indicates that the overall numbers of students at undergraduate level meets demand.
The Government has determined that, in line with its commitment to reduce the size of the public service, health sector employment numbers must be reduced substantially in 2013 and 2014. Spending on health services will also have to be very tightly controlled. The cumulative impact of staff reductions from this year and previous years represents a significant challenge for the health system in delivering services. The priority is to reform how health services are delivered in order to ensure a safe, more productive and cost-effective health system.
Directors of Nursing/Midwifery will continue to examine closely improvements in flexible working arrangements, changes to rosters, changes to the role of staff and other approaches to address any impact on patient safety and the quality of care. The capacity for specialist practice in nursing has been expanded in recent years with a view to ensuring high quality safe patient care. This includes developing clinical specialists, advanced practitioners and enhancing the role of staff nurses and midwives through the development of initiatives such as ordering x-rays and prescribing of medicinal products.
The Croke Park Agreement has been crucial to the health service’s ability to manage through the very difficult circumstances of recent years. The flexibility and adaptability shown by staff has meant that even with reducing staff numbers, service levels have largely been maintained and indeed performance in relation to Emergency Departments and hospital waiting lists has markedly improved.
The continued reduction in staffing increases the need for reform and the HSE is committed to fast-tracking new, innovative and more efficient ways of using reduced resources under the Croke Park Agreement.
In this regard, I have recently approved recruitment of up to 1,000 graduate nurses on two-year contracts under a Placement Scheme for Graduate Nurses and Midwives that will support the retention of qualified graduates within the Irish health system.
The HSE will be proceeding to put this scheme into effect and will be inviting applications early in 2013. Under the scheme, graduate nurses/midwives will be able to gain valuable work experience post graduation, benefiting from mentoring and skills development.
The scheme will facilitate a reduction the use of agency staffing and overtime and support service delivery.
45. Deputy Dessie Ellis asked the Minister for Health if he will rule out call-out charges for ambulance services in view of the imposition of a call-out charge for the fire service by Dublin city Council; and if he will make a statement on the matter. [57010/12]
View answerDublin Fire Brigade provides an ambulance service on behalf of the HSE National Ambulance Service (NAS). There is no charge for 999 ambulance call outs. However, it is understood that Dublin Fire Brigade charges for fire engine call outs.
47. Deputy Michael Colreavy asked the Minister for Health if any of the 1,201 public nursing home beds closed from January 2011 to August 2012 will be reopened in 2013; and if he will make a statement on the matter. [57009/12]
View answerThere are at present 129 public units providing residential care (long-term and short-term) for older people in Ireland. The Health Service Executive has recently completed a review of each of these units. The review has focused on a number of areas including each unit’s ability to meet the Health Information and Quality Authority standards in terms of staffing availability; environmental matters such as the age & structure of the home; and factors including location and stock.
The review will provide a basis for discussions between the Department and the HSE with a view to developing an overall set of proposals for the future delivery of residential care to my colleague Minister Reilly. The re-opening of beds, if possible, will be considered in the context of these proposals.
49. Deputy Pearse Doherty asked the Minister for Health if he will provide an update on the current position regarding the development of new primary care centres; and if he will make a statement on the matter. [57016/12]
View answerProgress is being made in the delivery of primary care centres. Primary care infrastructure is being delivered using three initiatives which are - direct build, the leasing initiative, and the PPP initiative announced in July 2012.
The Capital Plan 2012-2016 - year 2012 has been approved and contains provision for the delivery of eight primary care centres. The HSE has begun the procurement of design teams for Cork City (St Mary's Orthopaedic Hospital campus) Finglas, Corduff, Grangegorman, and Monaghan Town (Monaghan General Hospital campus). At this time, given the project size, the HSE best estimate for completion is late 2014. The Ballinamore project is at tender stage and its estimated completion date is Q1 2014. The Manorhamilton project is expected to be completed by end Q1 2013. The Sligo Town facility will be located at Nazareth House; this project is expected to commence in 2013 and its completion date is estimated at 2014.
Using the leasing initiative the HSE has delivered primary care infrastructure at 29 locations. The HSE is continuing its collaboration with the private sector to progress suitable locations. Information on locations progressing will be published in the Executive's 2013 National Service Plan.
The current position with regard to the PPP initiative for primary care infrastructure, the current position is that the HSE is engaging with the NDFA as required to progress the programme. The HSE is currently analysing the available sites in each location and engaging with the GPs in each location to determine their interest in participating in the primary care centre development. The HSE has commenced the procurement of design teams and technical advisors to progress the design and planning submissions for the primary care centre sites and the preparation of the PPP procurement documents. Up to 20 of the 35 locations announced will be offered to the market subject to a) agreement between the local GPs and the HSE on active local GP involvement in the centres and b) site suitability and availability. While it is not possible, at this time, to give start and completion dates for any of the individual 20 potential locations, it is expected that these primary care centres will be completed in 2016.
Work is underway on the Executive's multi-annual Capital Plan 2013-2017. The draft Plan will be submitted to my Department in due course. My Department will then review the proposals and follow up with the HSE where further details may be required. The draft Capital Plan 2013-2017 will require my approval with the consent of the Minister for Public Expenditure and Reform.
50. Deputy Thomas P. Broughan asked the Minister for Health the progress that has been made on introducing regulations for psychotherapists and counsellors; and if he will make a statement on the matter. [56887/12]
View answerThe Health and Social Care Professionals Council (the Council) and the 12 registration boards to be established under the Health and Social Care Professionals Act 2005 (the Act) are responsible for protecting the public by regulating health and social care professionals. The Council was established in March 2007 and is working to put in place the necessary structures for registration, education and fitness to practise for the 12 health and social care professions designated under the Act.
The first registration board to be established, the Social Workers Registration Board, was established in August 2010, and the associated Social Workers Register opened for receipt and processing of applications on 31st May, 2011. A second registration board, the Radiographers Registration Board, was established on 16th December, 2011 and its register is expected to be established in the near future. Three further registration boards, the Dietitians Registration Board, the Occupational Therapists Registration Board, and the Speech and Language Therapists Registration Board have been established with effect from 1st November 2012. It is also proposed to establish the Physiotherapists Registration Board in early 2013.
All the registration boards and their registers for the remaining designated professions should be established by 2015.
Currently, the following twelve health and social care professions are designated under the Act: clinical biochemists, dietitians, medical scientists, occupational therapists, orthoptists, physiotherapists, podiatrists, psychologists, radiographers, social care workers, social workers and speech and language therapists. In addition, the proposed rationalisation of the Opticians Board into the Council will see another two professions, optometrists and dispensing opticians, being regulated under the Act towards the end of next year or early 2014.
Under the Act, the Minister for Health may designate other health and social care professions if he considers that it is in the public interest to do so and if the specified criteria have been met. While my immediate priority is to proceed with the establishment of the registration boards for the professions currently designated under the 2005 legislation, I am committed to bringing counsellors and psychotherapists within the ambit of the Act as soon as possible.
There are a number of issues still to be clarified, however. These include decisions on whether one or two professions are to be regulated, on the title or titles of the profession or professions, and on the minimum qualifications to be required of counsellors and psychotherapists. A report from Quality and Qualifications Ireland (QQI) is due next year and will establish standards of knowledge, skills and competence to be acquired by students of counselling and psychotherapy. This will allow for the regulation of education courses for the future. In addition, CORU will need to assess the adequacy of the wide range of qualifications held by existing practitioners to establish their eligibility for registration.
51. Deputy Robert Troy asked the Minister for Health if the timescale for the introduction of Universal Health Insurance in 2016 is feasible; and if he will make a statement on the matter. [57086/12]
View answer62. Deputy Pádraig Mac Lochlainn asked the Minister for Health if rights based legislation will be introduced to ensure patients’ rights to care across our health and personal social services, especially given the his intention to introduce universal health insurance based on competing private insurance companies; and if he will make a statement on the matter. [57019/12]
View answerI propose to take Questions Nos. 51 and 62 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 access is based on need, not on income. Under UHI, every individual will be insured and will have equal access to a standard package of primary and acute hospital services, including acute mental health services. A new Insurance Fund will subsidise or pay insurance premiums for those who qualify for a subsidy. The new UHI system will be underpinned by a robust legislative framework and grounded in principles of open enrolment, lifetime cover and community rating.
In moving to a system of UHI, there are a number of key stepping stones that are necessary to pave the way for the introduction of universal health insurance including: the strengthening of primary care services to deliver universal primary care with the removal of cost as a barrier to access for patients; the work of the Special Delivery Unit in tackling waiting times and establishing hospital groups, and the introduction of a more transparent and efficient "Money Follows the Patient" funding mechanism for hospitals.
The reform programme is a major undertaking that requires careful planning and sequencing over a number of years. The Programme for Government acknowledges that full implementation of UHI will take some time to achieve. Future Health: A Strategic Framework for Reform of the Health Service 2012-2016 highlights the importance of a step-by-step evidence-based approach to achieving an effective, equitable and efficient system. Work on the critical building blocks is underway and it is anticipated that by 2016 much of the necessary groundwork will be in place to ensure that we are well placed to proceed with implementation of UHI.
Finally, in designing the future UHI system and associated legal and regulatory framework, it is important to acknowledge that, as is the case with all countries, we must make choices in meeting healthcare demands with finite resources. This involves legitimate policy choices to be debated and resolved as part of the democratic process.
52. Deputy Catherine Murphy asked the Minister for Health the number of ambulance calls responded to by the Health Service Executive National Ambulance Service in 2008, 2009, 2010, 2011 and to date in 2012; the average time it takes to successfully deliver a patient to hospital from the point a call is made for the same periods; the number of ambulances available during the same period listed by location; and if he will make a statement on the matter. [56891/12]
View answerThe HSE National Ambulance Service (NAS) provides emergency pre-hospital care and emergency patient transport. When a 999 ambulance call is received, the caller is connected with the ambulance command and control centre for that region. The details of the call are recorded on a Computer Aided Dispatch System (CAD), with the Advanced Medical Priority Dispatch System (AMPDS).
AMPDS is designed to triage a call, so that the most appropriate resource is dispatched to the patient. The system allows an ambulance to be dispatched while the caller is still providing details of the patient’s condition. The controller can also provide pre-arrival instructions to the caller, to allow initial medical assistance to be available and administered to the patient without delay.
In all cases, in line with the Pre-Hospital Emergency Care Council Emergency Priority Dispatch Standard, the nearest available ambulance is tasked to the highest priority incident. The highest priority incidents are ECHO 1 (life-threatening cardiac and respiratory emergency) and DELTA 1 (life-threatening other emergency).
The number of calls responded to the National Ambulance Service (NAS) are as follows:
|
Year |
Number |
|
2008 |
459,121 |
|
2009 |
362,612 |
|
2010 |
354,354 |
|
2011 |
323,320 |
|
2012 (YT Aug) |
194,932 |
* This data includes Dublin Fire Brigade call volumes. The HSE has been continuously refining the data collection process, including definitions, which accounts for the reduction in volumes from 2008 onwards.
In 2009, the NAS redefined “ambulance calls” as being those actually responded to by NAS, resulting in a reduction in the recorded number of responses. In 2011, the HSE implemented a national policy for non-ambulance patient transport services, resulting in a further refinement as the NAS was no longer responsible for this service.
“Ambulance calls” relate to calls actually responded to by various resources including emergency ambulances, intermediate care vehicles, rapid response vehicles and motorcycle response units. “Ambulance calls” are further sub-categorised into:
AS1 999 Emergency
AS2 GP Urgent
AS3 Inter-Facility Patient Transfer (Non-Ambulant)
AS1 999 Emergency Calls are categorised into 6 levels of clinical acuity. Further detailed resources are available at:
http://www.phecit.ie/Documents/PHECC%20Standards/EMS%20Priority%20Dispatch%20Standard-V3.pdf
AS3 Inter-Facility Patient Transfer Calls are categorised into 5 levels of clinical acuity. Further detailed resources are available at:
http://www.phecit.ie/Documents/PHECC%20Standards/Inter%20Facility%20Patient%20Transfer%20Standard-V2.pdf
In relation to the average length of time to deliver a patient to hospital, journeys can take anywhere from minutes to a 12 hour round trip, depending on the type of request that the NAS is responding to. Given the variety of journeys undertaken, from routine patient transfers to emergency life-threatening calls, it would be difficult to quantify and would not be illustrative of service levels.
The NAS has just under 500 vehicles in its fleet, made up of 283 emergency ambulances, 124 response vehicles (cars, motorcycles, 4x4s), 28 intermediate care vehicles and some special purpose vehicles. The NAS is a national service and its fleet is deployed on a national basis as required. Vehicles are rotated through locations on a daily basis to meet capacity demands, as well as to ensure appropriate vehicle rotation to maximise the life span of the vehicles.
The NAS has invested in replacement emergency ambulances in recent years, as follows.
2008 - 67 vehicles
2010/2011 - 50 vehicles (remount programme)
2012 - 12 vehicles (remount programme)
Additional expenditure on vehicles in 2012 was focused on the purchase of an additional 9 intermediate care vehicles and 12 additional rapid response vehicles.
53. Deputy Dessie Ellis asked the Minister for Health the Health Service Executive funding or other resources allocated to or paid for services to a nursing home (details supplied) in County Wicklow in each of the past five years; and if he will make a statement on the matter. [57011/12]
View answerAs this is a service matter it has been referred to the Health Service Executive for direct reply.
54. Deputy Gerry Adams asked the Minister for Health his estimate of the savings to be made in 2013 from the agreement with the Irish Pharmaceutical Healthcare Association; and if he will make a statement on the matter. [57005/12]
View answerFollowing intensive negotiations involving the Irish Pharmaceutical Healthcare Association and the HSE and Department of Health, a major new deal on the cost of drugs in the State was concluded in October last. It will deliver a number of important benefits, including significant reductions for patients in the cost of drugs, a lowering of the drugs bill to the State, timely access for patients to new cutting-edge drugs for certain conditions and reducing the cost base of the health system into the future.
The Department of Health and the HSE have also successfully finalised discussions with the Association of Pharmaceutical Manufacturers in Ireland (APMI), which represent the generic industry, on a new agreement to deliver further savings in the cost of generic drugs. It is estimated that the combined gross savings from the IPHA and APMI deals will be in excess of €120 million in 2013.
55. Deputy Robert Troy asked the Minister for Health if he will provide details of the Health Service Executive recruitment of 1,000 graduate nurses and midwives to the public health services in early 2013; and if he will make a statement on the matter. [57085/12]
View answer184. Deputy Dan Neville asked the Minister for Health his views on correspondence (details supplied) regarding Health Service Executive recruitment; and if he will make a statement on the matter. [57306/12]
View answerI propose to take Questions Nos. 55 and 184 together.
The Health Service Executive will shortly be introducing an Employment Initiative/Placement Scheme for Graduate Nurses and Midwives. Under the scheme graduate nurses and midwives will be offered the opportunity to apply to take part in a two year placement programme in the public health services. In particular, the scheme has the potential to enable nurses with limited or no work experience post-graduation to gain such experience and to benefit from mentoring and skills development. The scheme is also intended to contribute to a reduction in expenditure on agency staffing and overtime in the health service. The HSE is proceeding with arrangements to finalise the details of the scheme, including the eligibility criteria, and will be inviting applications early in 2013. The health service will continue to recruit permanent staff where this is necessary and can be accommodated within the available financial resources and the employment ceiling set by Government.
56. Deputy Eamonn Maloney asked the Minister for Health when the ambulatory urgent care centre will be opened in Tallaght Dublin [57001/12]
View answerThe Dolphin report concluded that the existing plan for the Ambulatory and Urgent Care Centre in Tallaght must be revisited, in light of a decision made about the location of the National Children’s Hospital. The number and location of urgent care centres in the Dublin area must be determined now that the decision has been made to locate the new children's hospital on the St James campus. It is envisaged that there will be an urgent care centre or urgent care centres based on consideration of the geographical distribution of attendances and acuity of the patient. The location and number of such centres will be given careful consideration and this will be done urgently to reach a decision as soon possible.
57. Deputy Sean Fleming asked the Minister for Health the way he will honour his Programme for Government commitments to older people in 2013; and if he will make a statement on the matter. [57065/12]
View answerProtecting the vulnerable, including supporting older people to remain at home and in their communities for as long as possible, is a priority for this Government. The issues raised by the Deputy on progressing Programme for Government commitments for older people in relation to services are being considered in the context of finalising the HSE Service Plan 2013. Other commitments, such as developing a National Dementia Strategy, a National Positive Ageing Strategy, and reviewing the Nursing Homes Support Scheme are also progressing. However, the various commitments can only be achieved in the context of evolving service priorities and resource availability overall for 2013 or beyond.
