Wednesday, 20 Mar 2013

Written Answers Nos. 71-88

Hospital Bed Numbers

Questions (76)

Sandra McLellan

Question:

76. Deputy Sandra McLellan asked the Minister for Health the current number of acute public hospital beds and the number in March 2010; and if he will make a statement on the matter. [13793/13]

Written answers

Minister for Health

In relation to the specific query raised by the Deputy, as this is a service matter it has been referred to the HSE for direct reply.

Health Service Recruitment

Questions (77, 78, 125)

Martin Ferris

Question:

77. Deputy Martin Ferris asked the Minister for Health if, in view of the very small numbers applying, he will set aside the scheme of recruitment of fully qualified nurses on two year contracts at 80% of the salaries of their colleagues, and replace it with recruitment of required nurses in the normal manner to address staffing problems in our public hospital system; and if he will make a statement on the matter. [13786/13]

Charlie McConalogue

Question:

78. Deputy Charlie McConalogue asked the Minister for Health if he will provide an update on the graduate nurse recruitment programme; and if he will make a statement on the matter. [13845/13]

John Browne

Question:

125. Deputy John Browne asked the Minister for Health if he will provide a progress report on his graduate nurse recruitment programme; and if he will make a statement on the matter. [13853/13]

Written answers

Minister for Health

I propose to take Questions Nos. 77, 78 and 125 together.

Applications from graduate nurses under this scheme will continue to be accepted by the HSE. In line with normal practice, the HSE will aim to facilitate applicants with offers of appointment to posts in the part of the country for which they have expressed a preference.

The HSE has decided that applications for Phase 1, covering registered general nurses for the Acute Hospital setting and the Community, will be accepted on a rolling basis for 2012 graduates, and also those who graduated in 2010 and 2011. Phase 2, which covers General, Mental Health, Intellectual Disability and Midwifery Mental Health, Intellectual Disability, Midwifery launched in mid-February.

Recruitment will continue during 2013. Paediatrics will launch at a later stage and there will also be opportunities for those who graduate in 2013 to participate. 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. 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.

Pharmacy Services

Questions (79)

Pádraig MacLochlainn

Question:

79. Deputy Pádraig Mac Lochlainn asked the Minister for Health if his attention has been drawn to the concern of people with epilepsy that generic substitution is not appropriate in the case of antiepileptic medications, AEDs; if he will frame an appropriate exclusion in the Health (Pricing and Supply of Medical Goods) Bill 2012, as is the case in other jurisdictions; and if he will make a statement on the matter. [13781/13]

Written answers

Minister of State at the Department of Health

As the Deputy will be aware, the Health (Pricing and Supply of Medical Goods) Bill, passed Committee Stage yesterday. Under the Bill, 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.

Question No. 80 and 81 answered with Question No. 37.

Question No. 82 answered with Question No. 38.

Question No. 83 answered with Question No. 18.

General Medical Services Scheme

Questions (84)

Catherine Murphy

Question:

84. Deputy Catherine Murphy asked the Minister for Health his views on recent reports that citizens in possession of a medical card are finding it extremely difficult to access general medical services; his further views on whether some medical card holders are similarly finding it extremely difficult to switch doctors; if his attention has been drawn to any areas in which this is a particular problem; the steps he will take to tackle such occurrences; and if he will make a statement on the matter. [13740/13]

Written answers

Minister of State at the Department of Health

I have been advised by the HSE that there are instances where doctors may decline to take on extra patients due to the number of patients already on their General Medical Services (GMS) list. In cases where an eligible person is having difficulty accessing a General Practitioner's GMS list, they should contact either their HSE Local Health Office or the HSE's Central Medical Card Office, who will assist them in getting access to a GP in their area.

The HSE has also advised that it is unaware of any difficulties for medical card holders in relation to changing their "Doctor of Choice". However, if the Deputy wishes to provide information about a particular case, will arrange to have the matter investigated further.

Home Care Packages

Questions (85, 114)

Seán Ó Fearghaíl

Question:

85. Deputy Seán Ó Fearghaíl asked the Minister for Health the measures he will take to help children with life-limiting conditions and their families who are caring for them; and if he will make a statement on the matter. [13871/13]

Seán Ó Fearghaíl

Question:

114. Deputy Seán Ó Fearghaíl asked the Minister for Health if he will introduce a paediatric care package for children with life-limiting illnesses; and if he will make a statement on the matter. [13870/13]

Written answers

Minister of State at the Department of Health

I propose to take Questions Nos. 85 and 114 together.

The issue of the provision of home care packages for children with life-limiting conditions is complex. This group includes children who may require short to medium term care, children who have a disability and require long-term care and also sick children for whom there is no reasonable hope of a cure and who are expected to die.

The national policy document Palliative Care for Children with Life-limiting Conditions in Ireland – a National Policy (2010) provides the foundation and sets out clear direction for the development of an integrated palliative care service for children and their families, across all care settings. Following the publication of the policy document the National Development Committee for Children’s Palliative Care (NDC) was established by the Health Service Executive. The committee is co-chaired by the HSE and the Irish Hospice Foundation. The Committee has overall responsibility for overseeing the implementation of the national policy recommendations. The committee’s emphasis on partnership is reflected in its membership comprising statutory, voluntary, professional, and parent involvement. Lauralynn and The Jack & Jill Foundation are members.

In October 2012 the HSE regions were asked to indicate the total previous 12 month spend on home nursing care for children with life-limiting conditions. This amounted to €8.58m. However, it is widely acknowledged that due to financial coding issues within the system the total spend is actually significantly higher than this amount. It is also acknowledged that children with life-limiting conditions, and particularly children with palliative care needs, are prioritised within the regions and every effort is made to provide home care packages to these children and their families.

The HSE is aware that a more systematic/coherent approach is needed around the provision of funding for home care packages for children.

It is also concerned that proper governance arrangements are in place to ensure that the care being provided is clinically sound and that those providing the care to this cohort of children are adequately trained. To this end a working group has been established in HSE Dublin Mid-Leinster. The group has identified the total spend on home care packages for children and has implemented a standardised financial coding system. It is intended that this approach will be replicated across all four regions.

In addition to this the National Development Committee has commenced its work on the development of standards for the provision of home and out-of-home respite care. This will be done in partnership with current voluntary providers such as the Jack and Jill Foundation and Lauralynn’s Children’s Hospice.

One of the national policy recommendations was the employment of eight children’s Outreach Nurses. One of the responsibilities of these Nurses is to facilitate a co-ordinated support structure for children with life-limiting conditions and their families. The Nurse will identify the needs of each child and ensure that families are appropriately linked in to local services. Three nurses are in place (Drogheda, Limerick and Waterford); the fourth will take up her post at the end of March (Temple Street); and the remaining four nurses should be in place within 6-8 weeks (Crumlin, Mullingar, Cork and Galway).

The first Consultant Paediatrician with a Special Interest in Paediatric Palliative Medicine has also been appointed to Crumlin Hospital. The support structure for these children and their families includes health care staff across a range of disciplines. Some of these staff require additional training on working with children with life-limiting conditions. In order to address this, a national programme of continuing professional education on caring for children with life-limiting conditions has been established in Crumlin Children’s Hospital.

Question No. 86 answered with Question No. 7.

Hospital Waiting Lists

Questions (87, 139)

Dara Murphy

Question:

87. Deputy Dara Murphy asked the Minister for Health the measures that have been taken to tackle inpatient and day case waiting lists for children in Cork University Hospital; the measures that have been taken to tackle the number of patients on trolleys in Cork University Hospital; the impact of these measures; and if he will make a statement on the matter. [14271/13]

Peter Fitzpatrick

Question:

139. Deputy Peter Fitzpatrick asked the Minister for Health the measures that have been taken to tackle inpatient and day case waiting lists in Our Lady of Lourdes Hospital, Drogheda, County Louth; the measures that have been taken to tackle the number of patients on trolleys in Our Lady of Lourdes Hospital; the impact of these measures; and if he will make a statement on the matter. [14293/13]

Written answers

Minister for Health

I propose to take Questions Nos. 87 and 139 together.

In 2011, I established the Special Delivery Unit in my Department as set out in the Programme for Government. The aim of the SDU is to unblock access to acute services by improving the flow of patients through the system. The SDU's Scheduled Care Team focused initially on waiting times for in-patient and daycase elective surgery. For 2012, a target was set that no adult should wait longer than 9 months for inpatient or daycase treatment. By the end of December 2012, the number of adults having to wait more than 9 months for inpatient and day case surgery nationally had fallen to 86. This was down from 3,706 in December 2011, representing a 98% decrease.

I am determined that the progress made in 2012 be maintained and improved upon. For 2013, the target is that no adult should be waiting longer than 8 months for inpatient or daycase treatment. It is important to recognise that the progress made in 2012 does not mean the problem is solved, and 2013 will of course be extremely challenging. For example, winter pressures in Emergency Departments have impacted on scheduled care waiting times. However, in the coming months, as winter pressures ease, the SDU will work towards re-balancing scheduled care to maintain the improvements seen in 2012 and to achieve the new 2013 target. Since its establishment of the SDU there has been significant improvements in the waiting times for unscheduled care against a background of reduced funding for health, reconfiguration of services and a challenging socio-economic climate. Hospitals across the country have experienced a surge in presentations to ED, as would be expected in the winter months, resulting in high demand for admissions and a consequent rise in trolley waits. Recent outbreaks of influenza have created additional logistical difficulties in relation to the admission, movement and discharge of patients in some hospitals. Those hospitals have released media messages advising non-attendance and restrictions on visiting. The SDU continues to monitor ED activity closely, engaging with key hospitals via teleconference and on-site meetings, collaborating in putting in place a range of measures to assist with patient flow and reviewing the available data for trends in relation to the reported levels of high activity.

Despite these pressures the year on year improvements continue nationally. Numbers recorded on trolleys at the end of 2012 showed a marked improvement of 23.6% less than 2011 which equates to 20,386 fewer people. From 1st January to 15th March, there has been a total of 15,220 patients on trolleys: this is a reduction of 2,258 patients or 12.9% on the equivalent period last year. Priority now is to reduce long waiters (over 9 hours) as we move to a six hour patient journey target. The SDU and the Patient Safety & Quality Directorate are currently in communication to agree a mechanism of capturing and responding in instances where a Hospital reports one or more patients breaching 24 hours on a trolley on one or more occasion.

With regard to the specific hospitals referred to, I have asked the HSE to respond directly to the Deputies concerned.

Question No. 88 answered with Question No. 23.