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Thursday, 14 Feb 2013

Written Answers Nos. 1-25

Accident and Emergency Services Provision

Questions (11)

Martin Heydon

Question:

11. Deputy Martin Heydon asked the Minister for Health the actions taken to tackle overcrowding and the use of trolleys in the accident and emergency department in Naas General Hospital, County Kildare, and the impact of these measures; and if he will make a statement on the matter. [7551/13]

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Written answers

In Naas General Hospital the first five weeks of 2013, compared to same period in 2011, there has been a 52% decrease in the number of patients waiting on trolleys., i.e., the number of patients on trolleys has more than halved.

Immediately following my appointment, I set out to address the issues which have been causing unacceptable delays in patients being treated in our hospitals. I established the Special Delivery Unit (SDU), as set out in the Programme for Government. The SDU is working closely with hospitals to unblock access to acute services by improving the flow of patients through the system. Since its establishment, there have been significant improvements in waiting times for unscheduled care, against a background of reduced funding for health, reconfiguration of services, a very challenging socio-economic climate, a growing number of older people and an overall increase in life expectancy.

Hospital Acquired Infections

Questions (12, 39, 343)

Niall Collins

Question:

12. Deputy Niall Collins asked the Minister for Health his response to the recent Health Information and Quality report that indicates that patients are at severe risk of infection in six hospitals; and if he will make a statement on the matter. [7502/13]

View answer

John Paul Phelan

Question:

39. Deputy John Paul Phelan asked the Minister for Health the actions taken to tackle MRSA in hospitals; the impact of these measures; and if he will make a statement on the matter. [7545/13]

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Nicky McFadden

Question:

343. Deputy Nicky McFadden asked the Minister for Health the current preventative measures taken by hospitals to limit the spread of hospital acquired infections; if the regulatory regime could be strengthened to incorporate the monitoring of private hospitals; and if he will make a statement on the matter. [7955/13]

View answer

Written answers

I propose to take Questions Nos. 12, 39 and 343 together.

I am pleased to inform the Deputies that MRSA rates are at a 6-year low and would like to assure the Deputy that the management of Healthcare Acquired Infections (HCAIs) including MRSA is a key patient safety issue for my Department and the Health Service Executive (HSE) and a number of significant initiatives have been developed to address that important public health issue. These include the HSE's National Infection Control Plan which was launched in March 2007. A National Surveillance System was also established by the HSE to collect data and provide information to monitor HCAIs in our health system along with the establishment of the Clinical Care Programme for HCAIs.

In relation to the recent Health Information and Quality Authority's (HIQA) Reports my Department and the HSE recognise that the HIQA inspection of hospitals against the National Infection Prevention and Control Standards is an important element of the overall strategy to reduce HCAIs across healthcare in Ireland. I welcome the positive comments on the 14 Hospitals inspected. Likewise, both my Department and the HSE recognise that improvement is still necessary in some areas.

With regard to hand hygiene the findings of the Authority would suggest that a culture of hand hygiene best practice needs to become more operationally embedded at all levels. I wish to emphasise that it is of vital importance that healthcare workers recognise their personal responsibility to protect patients by maintaining their own hand hygiene.

To date the HSE has published three national audits on hand hygiene practices with a fourth due in the next six to eight weeks. These reports have shown a level of hand hygiene improving from 78% to 82% against a national target of 90% by the end of 2013. To improve hand hygiene a series of actions are in place a key element of which is the continuing hand hygiene audits. These are happening both in the acute sector and in the long stay area as well.

Other actions include:

- the existing 2005 guidelines on hand hygiene are being revised and will be published this year

- a hand hygiene e-learning programme is being piloted in Dublin North East

- a training video for staff on the WHO 5 Moments for hand hygiene concept

- revised hand hygiene posters were introduced across the system in the summer of 2012

- a major section on website on hand hygiene

- in collaboration with the Department of Education an educational programme for schools - E-Bug

- a monthly national HCA implementation group monitors and reviews all HCA activity in the health system.

All 12 hospitals audited by HIQA are now being asked to develop quality improvement plans that prioritise changes necessary to fully meet the National Standards for the Prevention and Control of Healthcare Associated Infections. These plans must be published by the hospitals concerned on the Internet within six weeks of the publication of HIQA's reports.

All hospitals will receive a letter shortly indicating general outcomes of HIQA investigations and lessons to be learnt.

With regard to the prevention of the spread of MRSA it should be noted that the number of cases of MRSA has fallen by 55% between 2006 and 2011 (from 592 to 263 cases) and the downward trend is holding per statistical returns to date. Individual hospital MRSA rates are also collected and published – annually for 2006 and 2007 and quarterly from 2008 onwards. These results provide a good benchmark into the future to enable us to measure effectively the progress of each hospital on their performance in infection prevention and control. The data can be used by individual hospitals to monitor their progress in the control of HCAIs and the regular reports allow for public assessment of that progress.

Finally, officials of my Department are currently working on the Licensing of Health Facilities Bill which will provide for a mandatory system of licensing for public and private health service providers. The legislative proposals are being prepared broadly in line with recommendations made in the Report of the Commission on Patient Safety and Quality Assurance and are designed to improve patient safety by ensuring that healthcare providers do not operate below core standards which are applied in a consistent and systematic way. The intention is to have a proportionate system which has the confidence of the public. Standards and other requirements will be enforceable through inspection and imposition of sanctions as necessary. Licensing will be targeted at areas which are not currently subject to regulation. It is expected that outline proposals for the new system of licensing should be finalised in the near future.

Accident and Emergency Services Provision

Questions (13)

Frank Feighan

Question:

13. Deputy Frank Feighan asked the Minister for Health the actions taken to tackle overcrowding and the use of trolleys in the accident and emergency department in Sligo General Hospital; the impact of these measures; and if he will make a statement on the matter. [7567/13]

View answer

Written answers

In Sligo General Hospital in the first five weeks of 2013, compared to same period in 2011, there has been a 65% decrease in the number of patients waiting on trolleys at the hospital. Immediately following my appointment, I set out to address the issues which have been causing unacceptable delays in patients being treated in our hospitals. I established the Special Delivery Unit (SDU), as set out in the Programme for Government. The SDU is working to unblock access to acute services by improving the flow of patients through the system. Since its establishment there has been significant improvements in the waiting times for unscheduled care against a background of reduced funding for health, reconfiguration of services, a very challenging socio-economic climate and a growing number of older persons with an overall increase in life expectancy.

There was significant progress during the course of 2012 in reducing the number of patients waiting on trolleys. Over 2012 there were 20,352 less patients waiting on trolleys in comparison to 2011, representing an overall reduction of 23.6%.

With particular regard to Sligo General Hospital, the SDU is satisfied that the hospital is engaged in ensuring that emergency patients are seen in a timely manner, focussing on working to achieve the national targets for unscheduled care. Specific measures taken have included the opening of a 15 bedded Medical Short Stay Unit adjacent to the Emergency Department and the Acute Assessment Unit. This ward has had the impact of improving the streaming of medical patients throughout the hospital as well as a continued reduction of patients accommodated on trolleys overnight.

Accident and Emergency Services Provision

Questions (14)

Patrick O'Donovan

Question:

14. Deputy Patrick O'Donovan asked the Minister for Health the actions taken to tackle overcrowding and the use of trolleys in the accident and emergency department in Mid-Western Regional Hospital, County Limerick; the impact of these measures; and if he will make a statement on the matter. [7570/13]

View answer

Written answers

In the Mid Western Regional Hospital in the first five weeks of 2013, compared to same period in 2011, there has been a 9% decrease in the number of patients waiting on trolleys. Immediately following my appointment, I set out to address the issues which have been causing unacceptable delays in patients being treated in our hospitals. I established the Special Delivery Unit (SDU), as set out in the Programme for Government. The SDU is working to unblock access to acute services by improving the flow of patients through the system. Since its establishment there has been significant improvements in the waiting times for unscheduled care against a background of reduced funding for health, reconfiguration of services, a very challenging socio-economic climate and a growing number of older persons with an overall increase in life expectancy.

There was significant progress during the course of 2012 in reducing the number of patients waiting on trolleys. Over 2012 there were 20,352 less patients waiting on trolleys in comparison to 2011, representing an overall reduction of 23.6%.

With particular regard to the Mid-Western Regional Hospital, the SDU is satisfied that the hospital is engaged in ensuring that emergency patients are seen in a timely manner, focussing on working to achieve the national targets for unscheduled care. The opening of an Acute Medical Unit in the hospital as well as Medical Assessment Units at St John's and the Mid-Western Regional Hospital Nenagh have alleviated the pressures on the Emergency Department by enabling Medical Physicians to take direct referrals from GPs. Other measures planned include converting some in-patient beds to medical short stay beds. By grouping these patients together under the care of Acute Medical Physicians it is hoped to increase the number of medical discharges within 48 hours, thus freeing up capacity.

General Practitioner Services

Questions (15, 320)

Brendan Smith

Question:

15. Deputy Brendan Smith asked the Minister for Health the progress that has been made on securing a new general practitioner contract; and if he will make a statement on the matter. [7499/13]

View answer

Joanna Tuffy

Question:

320. Deputy Joanna Tuffy asked the Minister for Health the date on which he intends to engage in discussions with the Irish Medical Organisation to examine reform of primary care services; and if he will make a statement on the matter. [7820/13]

View answer

Written answers

I propose to take Questions Nos. 15 and 320 together.

The Programme for Government provides for the introduction of a new General Medical Services (GMS) General Practitioner (GP) contract with an increased emphasis on the management of chronic conditions, such as diabetes and cardiovascular conditions. It is envisaged that the new contract, when finalised, will focus on prevention and will include a requirement for GPs to provide care as part of integrated multidisciplinary Primary Care Teams.

The Department and the HSE are currently examining the changes that need to be made to the GMS contract to facilitate the introduction of Universal Primary Care. There have been discussions with the Department of Jobs, Enterprise and Innovation, the Department of Public Expenditure and Reform and the Competition Authority with regard to Competition Law.

I have recently had discussions with the Irish Medical Organisation (IMO) during which I outlined our policy in relation to free GP care. I would expect to engage in further discussions with the IMO as the legislation progresses.

Medicinal Products Supply

Questions (16, 76)

Billy Kelleher

Question:

16. Deputy Billy Kelleher asked the Minister for Health the reason asthma sufferers' access to medication is subject to significant geographical variation; and if he will make a statement on the matter. [7481/13]

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Michael Moynihan

Question:

76. Deputy Michael Moynihan asked the Minister for Health the reason there continues to be geographical inequity of access to omalizumab and xolair medication, with asthma sufferers in the Health Service Executive south region particularly disadvantaged; and if he will make a statement on the matter. [7482/13]

View answer

Written answers

I propose to take Questions Nos. 16 and 76 together.

Xolair (Omalizumab) is indicated as additional therapy for the prophylaxis of severe persistent allergic asthma in patients who cannot be controlled with the standard treatments.

This medicine is being prescribed nationally. This is administered in a hospital setting by a health care professional, namely a nurse, under the care of a consultant.

In relation to Cork University Hospital (CUH) I have been advised by the HSE that there is a Drugs and Therapeutics Committee in CUH whose primary objective is to assist the Executive Management Board (EMB) and hospital management in:

(i) The formulation of policies for safe and cost effective prescribing.

(ii) Supporting the process of managing the hospital’s drugs budget.

This committee has not recommended the use of these drugs to the EMB at CUH. Following the recent submission of a business case for the use of these medicines, it is being proposed that the newly appointed Clinical Director for Medicine, would meet with the consultants involved to further discuss their business case with a view to bringing a recommendation on this matter to the Acute Hospital Manager Group if required. For additional information please see below link for the Asthma Programme which may be of some assistance. http://www.hse.ie/eng/about/Who/clinical/natclinprog/asthmaprog.html

HSE Planning

Questions (17, 56, 353)

Mary Lou McDonald

Question:

17. Deputy Mary Lou McDonald asked the Minister for Health when the Health Service Executive Regional plans will be published; and if he will make a statement on the matter. [7455/13]

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Seán Crowe

Question:

56. Deputy Seán Crowe asked the Minister for Health when the Health Service Executive implementation plan will be published; and if he will make a statement on the matter. [7456/13]

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Caoimhghín Ó Caoláin

Question:

353. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he will provide a breakdown of the Health Service Executive budget in 2012 on a regional basis and the allocation for 2013 for each HSE region; if he will outline the additional moneys being allocated in each HSE region in 2013; and if he will make a statement on the matter. [8002/13]

View answer

Written answers

I propose to take Questions Nos. 17, 56 and 353 together.

Details of the 2012 budget on a regional basis are available in the HSE's regional plans which can be found on their website. Outturn figures for 2012 will be finalised in the HSE's Appropriation Account at the end of March. 2013 allocations will be available in the 2013 regional plans which are expected to be published by the end of February in parallel with the Operational Plan.

Accident and Emergency Services Provision

Questions (18)

Catherine Byrne

Question:

18. Deputy Catherine Byrne asked the Minister for Health the actions taken to tackle overcrowding and the use of trolleys in the accident and emergency department in St. James's Hospital, Dublin; and the impact of these measures. [7561/13]

View answer

Written answers

In St. James' Hospital in the first five weeks of 2013, compared to same period in 2011, there has been a 13% decrease in the number of patients waiting on trolleys.

Immediately following my appointment, I set out to address the issues which have been causing unacceptable delays in patients being treated in our hospitals. I established the Special Delivery Unit (SDU), as set out in the Programme for Government. The SDU is working closely with hospitals to unblock access to acute services by improving the flow of patients through the system. Since its establishment, there have been significant improvements in waiting times for unscheduled care, against a background of reduced funding for health, reconfiguration of services, a very challenging socio-economic climate, a growing number of older people and an overall increase in life expectancy.

In December 2012, there were 20,352 fewer patients waiting on trolleys in comparison to December 2011, representing an overall reduction of 23.6%. However, the overall progress made has to be secured and continually improved upon, and the SDU continues to engage at all levels with hospitals to do this. The work of the SDU with executive management teams in hospitals (CEOs, Directors Of Nursing and Clinical Directors) has seen local leaders and experts driving the change required to reduce the numbers of patients waiting on trolleys and improve standards for patients.

Another major contributing factor in reducing waiting times has been the implementation of new clinical care pathways, based on international clinical evidence, which has enabled improved planning of services to ensure optimal resource utilisation. An escalation protocol has been introduced by SDU liaison officers to assist with hospitals which are experiencing particular difficulties. This involves conference calls between key decision makers to review the situation and agree actions. This usually includes Directors of Performance, Directors of Unscheduled and Scheduled Care, the National Clinical Director, the National Director of Clinical Programmes and senior HSE managers, including all HSE Regional Directors.

Key actions agreed during this conference may include:

- Opening of additional capacity in the hospital;

- Ensuring the presence of senior clinical decision makers to maximise patient discharges from occupied beds;

- Utilising available capacity in residential facilities for approved patients;

- Consideration of adjustments to elective (scheduled) care in the short term.

The SDU has therefore planned well for the possibility of surges in demand in ED-related hospital services and the better management of the surges has mitigated their impact. The system has been clearly responsive in the way this has been done. It is very heartening to see the level of commitment and actions that have been taken to cope with very difficult winter circumstances.

There are consistent reports of high attendances at emergency departments at present, with increasing numbers of frail elderly presenting with acute viral and respiratory-related illness. Clinical Directors across the country have reported that all staff, including consultants, nurses, allied health staff and management have been working extremely hard to address these pressures. These exceptional efforts will continue but the nature of many of the patients is such that they require extended inpatient care, which is resulting in additional trolley waits in emergency departments. The SDU has been in constant contact with regional management teams, the National Clinical Directors and National Leads for Clinical Programmes. The situation is being actively managed at a national level and in addition, small teams of SDU staff are visiting key hospitals to ensure that all possible actions to ameliorate the present situation are being implemented. The impact of these measures is seen in the reduction of numbers of patients on trolleys during the day. The objective of the measures being implemented at hospital level and by the HSE is to continue to manage the downward trend on the number of patients waiting until the system stabilises.

Trolley figures in hospitals are managed a number of times a day through an internal counting system known as TrolleyGAR – which refers to the trolley count and alert levels: green for within acceptable limits, amber for approaching acceptable maximum limits and red for above acceptable maximum limits. These counts take place at 8am, 2pm and 8pm each day.

With specific reference to St James' Hospital, the hospital has advised that they have robust internal controls and processes in place to ensure that Emergency Department volumes and wait times are managed consistently and appropriately. The hospital has also advised that it constantly seeks to deliver improvements in terms of Emergency Department access and overall patient experience. The figures from 18 January 2013 to 11 February 2013 (25 days, 75 counts) show red for only 21 counts, red for all three daily counts on only one occasion and one day with green for all counts. The hospital has invoked its escalation procedures in response to the ED demand surge. It has opened additional beds and is working with the HSE on accelerated discharge of patients to home care and long term stay. The monitoring of numbers of people on trolleys in St James's will continue.

Primary Care Centre Provision

Questions (19)

Patrick Nulty

Question:

19. Deputy Patrick Nulty asked the Minister for Health if provision for community kitchen facilities to be utilised by community groups and non-governmental organisations can be incorporated into the construction of Corduff primary care centre in Dublin 15, which is included in the Health Service Executive capital spending plan. [7069/13]

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Written answers

There are no plans to include community kitchen facilities in the proposed Corduff primary care centre. However the usual facilities will be provided for staff working in the facility.

Graduate Nursing Scheme

Questions (20, 35, 49, 346, 347, 359)

Timmy Dooley

Question:

20. Deputy Timmy Dooley asked the Minister for Health the savings he would expect to make from the graduate nurse recruitment scheme; and if he will make a statement on the matter. [7489/13]

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Seamus Kirk

Question:

35. Deputy Seamus Kirk asked the Minister for Health if he will discontinue the graduate nurse recruitment scheme; and if he will make a statement on the matter. [7507/13]

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Robert Troy

Question:

49. Deputy Robert Troy asked the Minister for Health the services he will cut in the event of the graduate nurse recruitment scheme not being taken up; and if he will make a statement on the matter. [7515/13]

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Róisín Shortall

Question:

346. Deputy Róisín Shortall asked the Minister for Health the action he proposes to take to ensure the recruitment of 1,000 directly employed nurses in 2013 in view of the very low take up of his graduate nurses scheme. [7973/13]

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Róisín Shortall

Question:

347. Deputy Róisín Shortall asked the Minister for Health the total average monthly cost of an agency nurse and the reason he will not recruit graduate nurses on the standard pay-scale. [7974/13]

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Bernard Durkan

Question:

359. Deputy Bernard J. Durkan asked the Minister for Health the number of student nurses likely to be offered employment in the context of the recently announced initiative in this regard; when the posts are likely to be filled; and if he will make a statement on the matter. [8034/13]

View answer

Written answers

I propose to take Questions Nos. 20, 35, 49, 346, 347 and 359 together.

The recruitment of graduate nurses under this scheme, which is currently in train, will continue. The HSE will accept applications on an ongoing basis for Phase 1, covering registered general nurses for the acute hospital setting and the community, from 2012 graduates and also those who graduated in 2010 and 2011. Further recruitment will continue during 2013. Phase 2, which will cover Mental Health, Intellectual Disability, Midwifery and Paediatrics, will launch in the coming days. There will also be opportunities for those who graduate in 2013 to participate in due course. The scheme was introduced on the assumption that intake would be spread over a period, especially since the scheme was being introduced some months after most 2012 graduates completed their training.

The initiative will give nursing and midwifery graduates an employment opportunity and facilitate their professional development. They will be able to avail of a suite of educational programmes including intravenous canulation and training in anaphylaxis treatment. It has also been agreed that participants will be facilitated in obtaining a certificate in advanced healthcare skills to cover areas such as health assessment and pharmacology.

The Minister for Public Expenditure and Reform approved this employment initiative on the basis that participants would not be counted in health service staff numbers and that it would contribute to savings on unsustainable levels of agency and overtime expenditure. The HSE's National Service Plan for 2013 provides for a saving of €10m in the current year, arising from the introduction of this scheme. This level of saving will need to be achieved regardless of uptake. Based on the fifth point of the staff nurse salary scale, the average monthly cost to the health service of an agency nurse is approximately €5,000 including administration costs,VAT, PRSI and allowances. Given the requirement on the HSE to reduce numbers employed and to maximise savings, there is only very limited scope to offer permanent nursing posts at present.

The graduate nurse/midwife scheme represents an opportunity for a substantial number of recently-qualified nurses and midwives to work in Ireland for a two-year period and to gain valuable experience and additional skills at a time when job opportunities in the public service are, regrettably, very limited. Graduate nurses and midwives are of course entitled to choose whether to participate in the initiative or to pursue their careers elsewhere but I would hope to see a steady increase in applicants over the coming months. I consider that the boycott of the scheme by the nursing representative bodies is ill-judged and I would ask them to reconsider their opposition to this measure.

Traveller Community

Questions (21)

Seán Crowe

Question:

21. Deputy Seán Crowe asked the Minister for Health in view of the appalling health profile of Travellers evident in the all-Ireland Traveller health study report published in 2010, when he will develop an action plan-update the national Traveller health strategy to address Traveller health inequalities; and if he will make a statement on the matter. [7457/13]

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Written answers

The All Ireland Traveller Health Study (AITHS) was carried out in 2007 and the findings were published in September 2010 with a follow up Birth Cohort Study published in September 2011. is was a comprehensive study of the health and social status of the Traveller community in Ireland and was carried out by the School of Public Health, Physiotherapy and Population Science, University College Dublin on behalf of Travellers, with the direct involvement of Travellers. e findings of the Study provide a strong evidence base for assessing existing and future service delivery and allowed the identification of a range priorities and means of addressing these.

The following priority areas for action were identified to address the findings of the Study:

- Mental Health;

- Suicide;

- Men’s Health;

- Addiction/Alcohol;

- Domestic Violence;

- Diabetes;

- Cardiovascular Health.

The HSE have already put in place measures to address these agreed priority areas and the Traveller Health Advisory Forum within the HSE is in the process of preparing a detailed action plan. In addition, the forthcoming Health and Wellbeing Framework will put in place new structures which will focus on the cross sectoral social determinants of health and will incorporate actions relating to addressing health inequalities among marginalised groups such as Travellers.

Garda Vetting of Personnel

Questions (22)

Michael Colreavy

Question:

22. Deputy Michael Colreavy asked the Minister for Health if he will detail the efforts he has made and if he will make to ensure prompt processing of Garda vetting applications, with particular reference to those of potential staff members at health care facilities; the contact he has had with the Department of Justice and Equality, in this regard; and if he will make a statement on the matter. [7450/13]

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Written answers

Garda vetting of relevant health service staff has my full support. While Garda vetting is a matter for employers in the first instance, I am not aware of excessive delays in relation to the vetting of potential staff members.

It is the case that the vetting of potential staff can extend the duration of the appointment process, particularly at times when a significant volume of clearances may be required. I am of the view, however, that it is essential that the vetting process is not compromised. Officials in my Department had contact with officials of the Department of Justice and Equality last year in relation to the National Vetting Bureau (Children and Vulnerable Persons) Act 2012. This, however, was not connected to the issue raised by the Deputy.

Hospitals Building Programme

Questions (23)

Caoimhghín Ó Caoláin

Question:

23. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the communications he had with the Health Service Executive in relation to building projects at Wexford General Hospital and at St. Luke's Hospital, Kilkenny; and if he will make a statement on the matter. [7447/13]

View answer

Written answers

The method and timescale for the delivery of health care infrastructure is a dynamic process which is constantly evolving to take account of changing circumstances, including the feasibility of implementation. There will always be more construction projects than can be funded by the Exchequer and the Health Service Executive must prioritise infrastructure projects within its overall capital envelope.

I requested that the HSE accelerate the projects in both Wexford and in Kilkenny and for very good reasons. At Wexford General Hospital the admissions lounge is in a portakabin-style building, as is the medical assessment unit at St Luke’s Hospital Kilkenny.

The new Wexford project comprises an emergency department, a maternity delivery suite and theatre and the necessary equipping. A main entrance / new concourse will also be provided. The project is under construction and is making good progress. It is expected to be completed and operational in mid to late 2014.

The new Kilkenny project comprises an emergency department, a medical assessment unit and a day services unit including endoscopy. Construction commenced in 2012 and the project is expected to be completed and operational in mid to late 2014.

Both projects were approved for inclusion in the HSE capital programme in 2008 and have been included in all of the HSE’s multi-annual Capital Plans since then.

My decisions fully supported the Government priority which is to improve conditions for patients and reduce overcrowding in Emergency Departments through the delivery of improved accommodation including medical assessment units.

As you will be aware, one of the concerns over many years has been capacity issues in the Emergency Departments. Since 2006 capital funding has been made available for an A&E Initiative to provide a series of admission lounges and medical assessment units in order to relieve pressure on A&E departments. Continuing to address these capacity issues has always been a fundamental aspect of HSE’s Capital Plans. The 2008 Capital Plan contained funding to complete developments underway, deliver new A&Es and to upgrade and extend existing departments. The Wexford and Kilkenny projects were part of this initiative to address capacity.

Following the 2009 Budget and Supplementary Budget the HSE’s capital allocation was reduced by about 32%. As a consequence, certain projects were paused or deferred. Those projects which were in construction or at the equipping stage were completed, whereas those which were at earlier stages of development such as appraisal or design were paused / deferred once those stages were completed. The projects deferred included the Wexford and St Luke’s Kilkenny projects.

Both projects had advanced sufficiently by 2011 which enabled me to make my decision to accelerate them. Planning permission was in place and both had undergone the design phase. No projects were delayed, held or omitted from the capital programme to accommodate these projects.

I was delighted to receive an additional €12 million from the Department of Public Expenditure and Reform in order to expedite the sorely needed facility in Wexford General Hospital. Given that savings were achieved in the construction area due to reduced costs associated with the economic downturn it was also possible to expedite the St Luke’s project.

The Department of Public Expenditure and Reform sanctioned the 2011 Capital Plan which included these much needed projects.

Medical Products

Questions (24)

Brian Stanley

Question:

24. Deputy Brian Stanley asked the Minister for Health if his attention has been drawn to the concerns specific to people with epilepsy regarding the implications for their medication of generic substitution, including scientific evidence of the need for absolute precision in dosage and format of drugs for use in case of seizures; if he will address these concerns; and if he will make a statement on the matter. [7471/13]

View answer

Written answers

Under the Health (Pricing and Supply of Medical Goods) Bill, the Irish Medicines Board has statutory responsibility for establishing and publishing a List of Interchangeable Medicinal Products.

In deciding whether to add a group of medicinal products to the List of Interchangeable Medicinal Products, the Board must be satisfied that each medicinal product which falls within the group:

(a) has the same qualitative and quantitative composition in each of its active substances as each of the other medicinal products which fall within the group;

(b) is in the same pharmaceutical form as, or in a pharmaceutical form that is appropriate for substitution for, each of the other products in the group; and

(c) has the same route of administration as each of the other medicinal products which fall within the group.

In addition, the Bill provides that the Board is not permitted to add a group of medicinal products to the List of Interchangeable Medicinal Products where:

- there is a difference in bioavailability between the medicinal products and the interchangeable medicinal products which currently fall within the group of interchangeable medicinal products which may lead to a clinically significant difference in efficacy between them, and

- any of the medicinal products cannot be safely substituted for any one or more of the other medicinal products in the group.

I would like to emphasise that in making a decision to add a medicinal product to a group of interchangeable medicinal products or a group of medicinal products to the List of Interchangeable Medicinal Products the Board is obliged to have regard to the criteria as set out in the Bill and that these criteria fully reflect the recommendations set out in the Joint Department of Health/HSE report 'Proposed Model of Reference Pricing and Generic Substitution' (the Moran Report, 2010) regarding criteria for interchangeability.

To further enhance the patient safety aspect of generic substitution, Section 13 of the Bill allows a prescriber to indicate on a prescription that a branded interchangeable medicinal product should, for clinical reasons, not be substituted.

I am satisfied that these provisions address the concerns raised by the Deputy. I met with the Irish Epilepsy Association in January and explained this position.

It is also important to point out that generic medicines must meet exactly the same standards of quality and safety and have the same effect as the originator medicine. All of the generic medicines on the Irish market are required to be properly licensed and meet the requirements of the Irish Medicines Board.

Hospital Staff

Questions (25, 41, 82, 88, 97)

Michael Colreavy

Question:

25. Deputy Michael Colreavy asked the Minister for Health the measures he will take to address excessive working hours and issues of appropriate training and supervision and career progression opportunities for non-consultant hospital doctors; and if he will make a statement on the matter. [7451/13]

View answer

Seán Fleming

Question:

41. Deputy Sean Fleming asked the Minister for Health the measures in place within the health services to ensure that the EU working time directive is being complied with; and if he will make a statement on the matter. [7490/13]

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Dara Calleary

Question:

82. Deputy Dara Calleary asked the Minister for Health the way he plans to reduce the burden on non-consultant hospital doctors; and if he will make a statement on the matter. [7501/13]

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Michael McGrath

Question:

88. Deputy Michael McGrath asked the Minister for Health the action he proposes to take about junior hospital doctors working shifts of unsafe duration; and if he will make a statement on the matter. [7509/13]

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Clare Daly

Question:

97. Deputy Clare Daly asked the Minister for Health his plans to deal with the excessive hours worked by junior doctors, with particular reference to addressing 36 hour shifts as a critical issue of health and safety. [7440/13]

View answer

Written answers

I propose to take Questions Nos. 25, 41, 82, 88 and 97 together.

The Government is committed to achieving compliance with the European Working Time Directive in respect of non-consultant hospital doctors (NCHDs) by 2014. I have emphasised to the Health Service Executive the high priority the Government and I attach to this issue.

In January 2012, a detailed plan for the achievement of compliance by NCHDs with the Working Time Directive was submitted to the EU Commission. The plan affirmed Ireland's commitment to achieving compliance with the Directive over a three-year time period. It committed to implementing the measures necessary, including new work patterns for medical staff, transfer of work undertaken by NCHDs to other grades and the organisation of hospital services to support compliance.

The HSE National Service Plan 2013 states that there will be a particular focus in the acute hospital service on the achievement of compliance with the European Working Time Directive amongst the non-consultant hospital doctor workforce. The Executive is currently finalising its National Operational Plan to support the implementation of the National Service Plan. This will specify in greater detail the actions to be taken in relation to EWTD compliance. The HSE was asked by my Department in January to ensure that clear responsibility is placed with a hospital CEO and a senior manager and/or clinical lead for the achievement of specified improvements in compliance, such that the end 2014 target will be met.

As part of the measures agreed between health service management and the consultant representative bodies at the Labour Relations Commission in September 2012, consultants have a key role in supporting the implementation of required revisions to NCHD work patterns and working hours. These include ward-based rostering, use of cross cover at SHO level, replacement of NCHD hours by Advanced Nurse/Midwifery Practitioner hours where appropriate, transfer of certain duties to other staff and other measures set out in Ireland's 2012 Plan to drive EWTD compliance.

I want to ensure that NCHDs can progress to consultant level. However, it is not sustainable, in the light of the State's serious financial difficulties, to continue to recruit at the previous rates. If we are to continue to provide consultant-level career opportunities for doctors and, subject to the limitations on available resources, to replace consultants who retire and where possible expand overall capacity, this can only happen on the basis of a lower-cost model.

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