Tuesday, 14 May 2013

Health Services Issues

Questions (109)

Thomas Pringle

Question:

109. Deputy Thomas Pringle asked the Minister for Health if he will reverse the recent cuts to services at St Michael's House; and if he will make a statement on the matter. [22627/13]

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Written answers

Minister of State at the Department of Health

As the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive for direct reply to the Deputy.

Long Stay Residential Units

Questions (110)

John Halligan

Question:

110. Deputy John Halligan asked the Minister for Health if he will explain his policy regarding the transfer of persons with disabilities living in long term residential homes, such as Cheshire Homes, to local authority housing; the financial rationale for this move; the way he intends to deal with concerns among many residents of these homes and their families that they will not be able to cope in independent living situations; and if he will make a statement on the matter. [22629/13]

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Written answers

Minister of State at the Department of Health

The Report “Time to Move on from Congregated Settings – A Strategy for Community Inclusion” proposes a new model of support in the community moving people from Congregated settings to the community in line with Government policy. The Report identifies that around 4,000 people (based on the 2008 census) with disabilities in Ireland live in congregated settings, defined as a residential setting where people live with ten or more people. It found that not withstanding the commitment and initiative of dedicated staff and management, a significant number of people were still experiencing institutional living conditions where they lacked basic privacy and dignity and lived their lives apart from any community and families. The HSE has established a National Implementation Group on Congregated Settings under the auspices of the National Consultative Forum, which is comprised of representatives from the HSE, Disability Umbrella Groups and service user representative organisations. This group is developing the implementation plan that will be rolled out at a regional and local level in full consultation with the appropriate stakeholders.

The implementation of the report poses significant challenges to many stake holders, including clients, families, disability service providers, the HSE, various Departments, statutory bodies and representative organisations. It will require a need for a major change programme. This radical change is not the sole responsibility of the HSE but rather a collaborative responsibility shared between the person with a disability, their family and carers, a multiplicity of agencies, the Government and society as a whole. To ensure the needs of people transitioning from congregated settings are fully taken into account during the process, the model of care for individuals will be based on a person-centred plan. This may change over time in line with an individual's needs and circumstances and the model of service delivery applicable at a particular time. The Report recognises a seven-year timeframe for the implementation of its recommendations. However, this timeframe should be treated with caution as there are a number of complexities involved due to multidimensional elements of implementation including, individual choice of accommodation, living arrangements and location, funding, and the future role of staff, training and skill mix.

The National Housing Strategy for People with Disability 2011-2016 provides for Government policy in relation to the deinstitutionalisation of people with physical, intellectual and mental health disabilities. This Strategy forms part of a coherent framework, in conjunction with the Government's mental health policy, A Vision for Change and the Report of the HSE Working Group on Congregated Settings, to support people with disabilities within communities with maximum independence and choice. As part of this process, some €1 million has been transferred from the Health Vote to the Housing Vote to provide for the ring-fenced social housing costs of up to 150 people leaving disability or mental health institutions in 2013. Those units will be additional to the overall social housing supports which are expected to be delivered through all supply mechanisms in 2013. As the specific queries about Cheshire Homes raised by the Deputy are service issues, they have been referred to the HSE for direct reply.

Respite Care Services

Questions (111)

Michael Colreavy

Question:

111. Deputy Michael Colreavy asked the Minister for Health the number of Health Service Executive respite care beds in the State at present and the number in 2010; if there are plans to increase the number of such beds; and if he will make a statement on the matter. [22574/13]

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Written answers

Minister of State at the Department of Health

As the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive for direct reply to the Deputy.

Patient Transport Provision

Questions (112)

Clare Daly

Question:

112. Deputy Clare Daly asked the Minister for Health if he will explain the ending of the transport service provided for patients in nursing homes to attend hospital appointments; and the action he will take regarding same. [22384/13]

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Written answers

Minister for Health

Patient transport is the responsibility of the HSE. However, people attending outpatient and hospital appointments are, in general, expected to make their own travel arrangements, using private or scheduled public transport. The exceptions are for dialysis, cancer (radiotherapy and chemotherapy) and post-operative transplant patients, where transport may be provided. In these cases, the patient's appointment or treatment should be directly related to the treatment. Transport may also be provided where, in the clinician's view, the patient would be unable to make the journey without clinical assistance or where the patient must be transported on a stretcher. Following implementation of the HSE's non-ambulance patient transport policy, responsibility for the arrangement and provision of non-ambulance transport has moved from the HSE National Ambulance Service to local health offices in each region. If a patient or his or her clinician considers that transport is required, the local health office should be contacted. 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.

Hospital Accommodation Provision

Questions (113, 142)

Michael McGrath

Question:

113. Deputy Michael McGrath asked the Minister for Health when the Higgins report on hospital reconfiguration will be published; and if he will make a statement on the matter. [22605/13]

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Brian Stanley

Question:

142. Deputy Brian Stanley asked the Minister for Health when the Higgins report will be published; and if he will make a statement on the matter. [22567/13]

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Written answers

Minister for Health

I propose to take Questions Nos. 113 and 142 together.

We know that the traditional practice of providing as many services as possible in every hospital is neither sustainable nor safe. The formation of Irish acute hospitals into a small number of groups, each with its own governance and management, will provide an optimum opportunity for hospital services to be configured to deliver high-quality, safe patient care in a cost-effective manner. Professor John Higgins chaired a Strategic Board on the establishment of Hospital Groups. I have received his report, which is based on a comprehensive consultation process and contains almost 60 recommendations on the formation, management and governance of hospital groups, all of which are strongly endorsed by the Strategic Board. I appreciate that this report and the related Government decision were anxiously awaited. As this is the most radical and most fundamental modernisation of our health system infrastructure since the State’s foundation, I took very seriously my obligation to consider the report closely and to assure myself and my Cabinet colleagues that it provides a robust basis to enable timely access to a high-quality and sustainable hospital service for those who need it. The Deputy will be pleased to learn that I submitted the report to the Government this morning for its consideration and decision. The report has been accepted. I will be publishing the report later this afternoon, together with the smaller hospitals framework.

Hospital Waiting Lists

Questions (114)

Jonathan O'Brien

Question:

114. Deputy Jonathan O'Brien asked the Minister for Health the action he will take to address the excessive waiting times for outpatient appointments across our hospital system; and if he will make a statement on the matter. [22555/13]

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Written answers

Minister for Health

In 2012 the National Treatment Purchase Fund (NTPF) initiated a national project to compile, for the first time, an Outpatient Waiting List database based on patient-level information from individual hospitals. Collaborating with individual hospitals, the SDU together with the NTPF and the HSE have developed the OP waiting list minimum dataset that allows for this data to be submitted to the NTPF from hospitals on a weekly basis. This builds on the work previously undertaken by the HSE Outpatient Data Quality Programme. Clear data on the OPD waiting list is now being reported for the first time, and is published on www.ntpf.ie. The waiting list for outpatients is updated monthly. The data show numbers waiting over the various time-bands for a first appointment at a consultant-led clinic. In a further enhancement of the reporting, future updates will for the first time include numbers reported by specialty in addition to the breakdown by hospital.

The total number of people waiting on the out-patient waiting list as at 3 May 2013, as advised by the NTPF, is 376,751. This is a reduction of 7,881 in comparison with the NTPF published figures to March 2013. The data also shows that of the total number of people waiting, some 199,513 (52.6%) are waiting less than six months and almost 278,666 (74%) are waiting less than 12 months. For 2013, a maximum waiting time target has been set of 12 months for a first time consultant-led outpatient appointment and this is reflected in the HSE Service Plan. Currently, the focus is on hospitals continuing the validation of waiting lists. All hospitals have been engaged in this process which is anticipated to be complete by mid-May 2013.

Reforming the delivery of outpatient services is being addressed through the Outpatient Service Performance Improvement Programme. This Programme encompasses the HSE, SDU, the NTPF and all hospitals providing outpatient services. It is a national programme being implemented between 2012 and 2015. The overall aim of the programme is to ensure timely, appropriate access to OP services so that the most appropriate member of the clinical team sees the right patient at the right time. Key elements of this large programme of reform will include ongoing validation of waiting lists, the systematic and standardised management of referrals from primary care, a reduction in unacceptably high “do not attend” rates and appropriate discharging from OP services when clinically appropriate to do so.

Question No. 115 answered with Question No. 102.

General Practitioner Services

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Bernard Durkan

Question:

703. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the total cost of free general practitioner services has been evaluated; and if he will make a statement on the matter. [23019/13]

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Written answers

Minister of State at the Department of Health (Deputy Alex White)

I propose to take Questions Nos. 116, 120, 122, 131, 655, 680, 693, 702 and 703 together.

The Government is committed to introducing, on a phased basis, a universal GP service without fees within its first term of office, as set out in the Programme for Government and the Future Health strategy framework. This policy constitutes a fundamental element in the Government’s health reform programme. There has been no change to the Government’s over-arching commitment to this goal. This Government is the first in the history of the State to have committed itself to implementing a universal GP service for the entire population. Having examined the progress made in the universal GP care plan, it became clear that the legal and administrative framework required to provide a robust basis for eligibility for a GP service based on having a particular medical condition is likely to be overly complex and bureaucratic for a short-term arrangement. Relatively complex primary legislation would be required in order to provide a GP service to a person on the basis of their having a particular illness. The assessment system for such an approach would have to be robust, objective and auditable in order to have the confidence of this House as well as the general public. This legislation would have to address how a person could be certified as having such an illness, and who could do this, and how to select the diagnostic basis for medical conditions. As well as primary legislation, there would be a need for secondary legislation to give full effect to this approach for each condition. While it would not be impossible to achieve this, it would take several months more to finalise the primary legislation, followed then by the preparation of statutory instruments. In my view, this would entail putting in place a cumbersome legal and administrative infrastructure to deal with what is only a temporary first phase on the way to universal GP service to the entire population.

The Cabinet Committee on Health has discussed the issues relating to the delay in the initial step of the roll-out of the universal GP service. In doing so, it has considered the importance of weighing the balance between, on the one hand, resolving the legal issues but with a further delay and, on the other hand, with the need to bring forward an important Programme for Government commitment with the minimum of further delay. No decision has been taken by the Cabinet Committee or by Government on changing the first step of the plan to extend GP care without fees to persons with chronic illnesses. Instead, it has been agreed that we should prepare and set out a number of alternative options with regard to the phased implementation of a universal GP service without fees. The Minister, Deputy Reilly, and I expect to report back to the Cabinet Committee in the near future. As part of this work, consideration will be given to the approaches, timing and financial implications of the phased implementation this universal health service. The Government has already made clear its commitment to delivering on the implementation of a GP service for the entire population by providing additional financial resources in the two most recent budgets. The HSE Vote now contains funding of €30 million for this year for an initial phase of the provision of GP services as part of this Programme for Government commitment.

Question No. 117 answered with Question No. 102.

Question No. 118 answered with Question No. 83.

Health Services Staff Issues

Questions (119)

Martin Ferris

Question:

119. Deputy Martin Ferris asked the Minister for Health further to Parliamentary Question No. 679 of 16 October 2012, the number of the 150 posts promised for child and adolescent mental health services that are now in place; and if he will make a statement on the matter. [22573/13]

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Written answers

Minister of State at the Department of Health

In 2012, a special allocation of €35 million was provided for mental health to be used primarily to further strengthen Community Mental Health Teams in both adult and children’s mental health services, to advance activities in the area of suicide prevention, to initiate the provision of psychological and counselling services in primary care and to facilitate the transfer of mental health service users from institutional to community based care. Some 414 posts were approved to implement the €35 million package of special measures. As at 29 April last, some 122 of the designated 150 posts for Child and Adolescent Mental Health Services have been filled, are under offer or awaiting clearance. The National Recruitment Service (NRS) of the HSE creates national panels in anticipation of vacancies. On occasion, however, it is difficult to fill some posts for various reasons including geographical location, international shortage of some grades, most notably clinical Psychologists etc. The NRS is working to ensure the remaining posts will be filled as soon as possible, subject to appropriately qualified candidates being available.