Hospital Services

Questions (83)

Charlie McConalogue

Question:

83. Deputy Charlie McConalogue asked the Minister for Health if he will ensure that Health Service Executive home help workers will receive priority consideration for suitable opportunities in hospital services; and if he will make a statement on the matter. [30019/13]

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Written answers (Question to Health)

The HSE recognises the importance of home help and home care in supporting older persons to live in their own homes and communities, in accordance with Government policy. The 2013 National Service Plan includes the provision of 10.3 million hours of home help service, the same level as planned for in 2012.

On 29 June 2012, the Labour Court recommended that the HSE and SIPTU should engage in relation to a range of contractual matters, including the provision of working hours to home helps. Subsequently, on 16th October 2012, it identified a number of possible options to be given consideration, including redeployment of home help staff. At a further hearing on 12th December 2012, it noted that management proposals to deal with the issues before the Court, would be encompassed in a comprehensive delivery model for home help services.

The parties subsequently met on a number of occasions under the auspices of the Labour Relations Commission, most recently on 30th April. While significant progress was made by the parties on a range of issues relating to the provision of working hours, the Commission is to refer a number of items, including redeployment, back to the Labour Court.

National Children's Hospital Status

Questions (84)

Aengus Ó Snodaigh

Question:

84. Deputy Aengus Ó Snodaigh asked the Minister for Health if he will provide a progress report on the development of the new National Children’s Hospital. [30394/13]

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Written answers (Question to Health)

The National Paediatric Hospital Development Board is the body with statutory responsibility for building the new children's hospital. Since the current Board was appointed in January, it has focused on a number of key issues at this critical early stage.

A key priority now for the project is the reconciliation of the design brief, which is required following the change in location. The design brief must reflect the outcome of the review of existing plans for an Ambulatory and Urgent Care Centre at Tallaght, which is almost complete. Decisions on the size, activity and infrastructure of urgent care centre(s) will affect those of the main hospital and hence the design brief. It must also reflect decisions on shared services at the new site, and a Shared Services Group has been established, focusing on identifying facilities which can be shared between St James's and the new children's hospital so as to optimise the significant clinical and operational benefits of co-location.

Procurement of a new design team has begun with the publication of a Prior Information Notice (PIN) on 13 June. This will be followed shortly by publication of the contract notice for the design team tender. Preliminary options have been examined for the general configuration of the new hospital on the St James's campus and these will be developed further by the design team once appointed.

The preparation of the site is being led by St James's Hospital, in line with their proposal to accommodate this development on their campus. A Decant Project Office is established on the St James's campus and is working closely with the Shared Services Group. In keeping with the strategy to maximise the efficiency of both schedule and financial resources, many enabling works are planned during this decant stage including carparking provision, decommission/demolition of buildings, diversion of existing services, new entry /exit provision and roads upgrade, and an upgrade of the Energy Centre to a campus wide facility for efficient/sustainable energy use.

The overall aim at this stage of the project is to secure planning permission by December 2014. This is a very large and very complex capital project, and is of huge importance for the provision of acute paediatric services for all children in Ireland. I am determined to ensure that it is completed as swiftly as possible, with optimal design and value for money.

Hospitals Policy

Questions (85)

Michael Moynihan

Question:

85. Deputy Michael Moynihan asked the Minister for Health the timeline for the implementation of hospital reconfiguration; and if he will make a statement on the matter. [30438/13]

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Written answers (Question to Health)

The Report on the establishment of Hospital Groups which I launched on 14 May is the most radical and most fundamental modernisation of our health system infrastructure since the State’s foundation. To achieve the most effective high quality outcomes for patients in the most cost efficient manner possible, the reform of the structures and governance for the delivery of hospital services is vital now.

Implementation of the recommendations of the Group’s Report has already commenced. I have personally visited the areas covered by each of the six groups with my Department and the Director General Designate of the HSE, explaining the policy objectives and listening to the questions the staff in each of those areas have about this policy implementation. The reaction has been positive. Professor John Higgins is also carrying out a debriefing exercise, supported by my Department and the HSE, to help ready the hospitals for the impending changes. Since the launch of the Report, he has held approximately 50 meetings with hospitals in this regard.

Implementation of the Report will be overseen by a National Strategic Advisory Group and driven by the HSE through the Hospital Groups Implementation team which is currently being established. I will appoint Chairs of each Group in the next few weeks. Advertisements to seek other board members will be placed in parallel with the process of appointing the Group Chairs and the subsequent appointment of group CEOs and management teams. All appointments will be made based on the competencies the individual brings to the Board in line with the HIQA report on Tallaght.

Within one year of the formation of Hospital Groups, individual groups will be required to submit a strategic plan which will outline its plans for future services within the group area. These strategic plans will determine the way services are provided within each group. The implementation of these plans by each group will then be rigorously reviewed, including all necessary due diligence checks, to see whether they are in a position to advance to Hospital Trust status after the necessary legislation is put in place. We know that the traditional practice of providing as many services as possible in every hospital is neither sustainable nor safe. The formation of acute hospitals into groups, each with its own governance and management, will provide an optimum configuration for hospital services to deliver high-quality, safe patient care in a cost-effective manner.

Health Reports

Questions (86, 124)

Gerry Adams

Question:

86. Deputy Gerry Adams asked the Minister for Health the measures he has taken in response to the Health Service Executive Report on the death of Savita Halappanavar; and if he will make a statement on the matter. [30391/13]

View answer

Gerry Adams

Question:

124. Deputy Gerry Adams asked the Minister for Health the measures he has taken to implement the recommendations of the inquest in the case of the Savita Halappanavar; and if he will make a statement on the matter. [30390/13]

View answer

Written answers (Question to Health)

I propose to take Questions Nos. 86 and 124 together.

Since the publication of the Coroner's Inquest recommendations on 19th April last and the HSE's Report recommendations published on 13th June last, considerable work continues in addressing both reports' recommendations. A number of the Coroner's recommendations relevant to University College Hospital Galway (UCHG) were already being implemented in the hospital by the time of publication of the Inquest finding on 19th April 2013. Since the Coroner reported UCHG has undertaken the following additional measures:

- The education of all staff in the recognition, monitoring and management of sepsis and septic shock;

- The implementation of early warning scoring systems;

- The introduction of a new multi-disciplinary team-based education and training programme in the management of obstetric emergencies, including sepsis.

- Communications processes have also been improved and new procedures for doctors’ handovers will be implemented.

The interim recommendations made by the HSE Investigation Team in December 2012, relevant to UCHG, have been implemented at the hospital. The HSE has received assurance from the hospital that any immediate safety concerns have been addressed. The HSE established a National Oversight Group in March 2013 to advise and oversee implementation of the recommendations of the investigation; the group will also oversee implementation of the forthcoming HIQA investigation and the recommendations of the Coroner's investigation will be incorporated into their work. Prior to the incident in Galway, significant work had already been underway as part of ongoing clinical and patient safety initiatives within the wider HSE, including the HSE Clinical Programme in Obstetrics and Gynaecology, Anaesthetics and Critical Care which has been working on a number of national guidelines for Obstetrics and Gynaecology.

Other work which addresses the report recommendations includes:

- The launch of the first National Clinical Effectiveness Committee (NCEC)-endorsed National Early Warning Score guidelines for care of the deteriorating adult patient (NEWS) in February. The NEWS is being implemented in 87% of acute adult hospitals in Ireland

- A multidisciplinary education and training programme in I-MEWS (Irish Maternal Early Warning Score) which was rolled out across all 19 maternity hospitals in April and a clinical guideline developed

- National Guidelines have been developed on pre-term, pre-labour rupture of membranes; these have been disseminated to all maternity hospitals

- A Clinical Care Pathway for the care of the critically ill pregnant woman is currently being finalised

- The HSE has established a working group to improve communications between all staff and disciplines in the management and handover of patient care and to develop, implement and audit compliance with guidelines in line with the Royal College of Obstetricians and Gynaecologists Guidelines on the ‘Responsibility of the Consultant on Call’

- The HSE will develop a national guideline setting out the correct procedures for the follow up of patient tests in hospitals

- Additional counselling services have been put in place in GUH and the requirement for such services for women and husbands/partners following miscarriage and other serious incidents during pregnancy is being communicated to all 19 maternity hospital units; an initial review of current services has been undertaken

- An audit of compliance with HSE Standards and Recommended Practices for Healthcare Records Management has commenced

- A number of working groups will be established to scope out and develop detailed work plans to implement the remainder of the recommendations. The Report's recommendations will be implemented on a phased basis with the most urgent work being prioritised for Phase 1 (April to December). The time line for completion of Phase 2 actions will be agreed in Quarter 3 of 2013 and submitted as part of Service Planning for 2014.

With the Chief Medical Officer (CMO) I met Prof. Robert Harrison, Chair of the Institute of Obstetrics and Gynaecology, on 19th June, to discuss the significant general obstetric and gynaecological professional practice issues across the wider acute maternity hospital services which have been raised by the Report, in order to determine how the Department and the Institute may collectively address them In addition, the CMO has written to the Medical Council and An Bord Altranais seeking each organisation’s early consideration of the HSE’s Report in the same context as above and their advice on any recommended actions deemed appropriate. I wish to assure the deputy that my Department and the HSE will follow up in implementing and developing all the recommendations of both the Coroner's Inquest and the HSE's Report in to Ms. Halappanavar's tragic loss in order to minimise the risk of such an event happening again.

Programme for Government Implementation

Questions (87)

Seamus Kirk

Question:

87. Deputy Seamus Kirk asked the Minister for Health if he is satisfied that he is honouring the commitments to older persons as set out in the programme for Government; and if he will make a statement on the matter. [30431/13]

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Written answers (Question to Health)

The Programme for Government committed to develop a National Carers' Strategy and a Nationals Alzheimer’s and other Dementia Strategy. It also included a commitment to complete and implement a National Positive Ageing Strategy.

The Carers' Strategy was published in July 2012 and the National Positive Ageing Strategy was published in April 2013. It is intended that a draft of the Dementia Strategy will be completed by the end of 2013. The Programme for Government contains commitments to develop and implement national standards for home support services that are subject to inspection by HIQA, to invest in more and better care for older people in the community and residential settings, and to ensure the eligibility criteria for home support services are consistently applied. The HSE, as part of the home care tender process introduced written standards of care in 2012. These standards covered such areas as:

- principles of service delivery

- confidentiality

- complaints procedure

- protection of service user

- consent policy

- governance and management

- workforce recruitment, training, staff development and supervision.

The purpose of these measures is to promote quality and safety and to provide a more standardised approach to service provision nationally.

The standards apply to all external providers, private and voluntary, who have been approved to provide home care funded through the Home Care Package Scheme. Each Local Health Office area monitors the service providers approved under this process to ensure that the standards are being adhered to. Audits are completed and quarterly reports are requested and reviewed. Supporting this is the ongoing monitoring and review carried out by healthcare professionals such as public health nurses.

Primary legislation will be required to introduce a statutory regulation system and some complex legal issue arises in this area. Other legislative priorities and issues of resources also need to be considered in progressing statutory regulation.

Finally, the Programme for Government contains a commitment to consider developing a secure and equitable system of financing for community and long-term care which supports older people to stay in their own homes. Work on a review of the Nursing Homes Support Scheme has already commenced. The Terms of reference for this review include:

- consideration of the balance of funding between long-term residential care and community based services, and

- consideration of the extension of the scheme to community based services.

Work will continue on the review of the Nursing Homes Support Scheme in the coming months with a view to completion by end 2013/early 2014.

Home Care Packages

Questions (88)

Billy Kelleher

Question:

88. Deputy Billy Kelleher asked the Minister for Health his plans to improve the regulation of home help and homecare services; and if he will make a statement on the matter. [30418/13]

View answer

Written answers (Question to Health)

I refer the Deputy to my reply to Parliamentary Question Number 524 of 18 June 2013. The position remains unchanged.

Mobility Allowance Eligibility

Questions (89, 108, 110, 611)

John Browne

Question:

89. Deputy John Browne asked the Minister for Health his plans to restore the mobility allowance after June; and if he will make a statement on the matter. [30026/13]

View answer

Dessie Ellis

Question:

108. Deputy Dessie Ellis asked the Minister for Health his plans for the proposed replacement of the mobility allowance and the motorised transport grant; the way recipients will be affected when current payments are scheduled to cease; if the review group has reported and the recommendations of same; and if he will make a statement on the matter. [30399/13]

View answer

Micheál Martin

Question:

110. Deputy Micheál Martin asked the Minister for Health if he will provide an update regarding the mobility allowance; and if he will make a statement on the matter. [30433/13]

View answer

Robert Troy

Question:

611. Deputy Robert Troy asked the Minister for Health the progress made on an alternative scheme to the mobility allowance scheme and motorised transport grant; and if he will make a statement on the matter. [30700/13]

View answer

Written answers (Question to Health)

I propose to take Questions Nos. 89, 108, 110 and 611 together.

The Government decided on 12th June last, to extend payments of Mobility Allowance to those currently in receipt for a further number of months, pending establishment of new statutory provisions to support the mobility needs of people with severe disabilities. The Government is very conscious of the needs of people with a disability who have relied on individual payments of Mobility Allowance to support their independence and will take all of this into consideration when making a decision on future arrangements.

Following detailed consideration of the Interim Report of the Review Group, which was established to seek an alternative method to provide for the priority transport needs of people in a manner that does not run counter to the Equal Status Acts, the Government has decided that new statutory provisions will be established to provide individual payments to people with severe disabilities who require additional income to address the costs of their mobility needs. The Government has agreed that an inter-departmental group, chaired by the Department of the Taoiseach, will now be asked to develop detailed proposals for the operation of the new scheme or schemes, including eligibility criteria and administrative arrangements, and should report back to Government by October.

The Final Report of the Review Group, which will include consideration of the wider issue of general transport for people with disabilities, will be submitted to Government in the coming weeks.

The Government has agreed that payments should temporarily continue to be made by the HSE to those persons currently in receipt of the Mobility Allowance for a further number of months, pending the commencement of new statutory provisions, on the basis that this would prevent hardship, and, on an interim basis, alleviate stress, anxiety and uncertainty among a vulnerable group in society.

The existing position regarding the Motorised Transport Grant remains as before, i.e. the scheme remains closed. The inter-departmental group will examine this issue as part of its considerations of how future statutory arrangements should operate.

Health Strategies

Questions (90)

Róisín Shortall

Question:

90. Deputy Róisín Shortall asked the Minister for Health the target date he is working to for the full implementation of the changes recommended in the model of care document for asthma; and if he will make a statement on the matter. [30028/13]

View answer

Written answers (Question to Health)

The National Model of Care for Asthma is currently being finalised and will be sent for stakeholder consultation after 30th June 2013. The Model of Care cannot be completed until stakeholder responses have been received and considered.

Hospital Services

Questions (91)

Denis Naughten

Question:

91. Deputy Denis Naughten asked the Minister for Health the steps he is taking to increase thrombolysis rates for stroke patients; and if he will make a statement on the matter. [30022/13]

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Written answers (Question to Health)

The implementation of the National Stroke Programme, since 2010 to date, has resulted in improved services for all stroke patients. One of the programmes early targets was to provide a national 24/7 stroke thrombolysis service and increase the rate of safe thrombolysis from a baseline of 1% (The Irish National Audit of Stroke May 2008), to 7% by the end of 2012.

The national stroke programme

- Developed a national stroke thrombolysis training programme in association with Royal College of Physicians of Ireland and directed by a senior stroke physician. To date this programme has been attended by >100 senior physicians.

- Established, as national policy, that all FAST score positive acute stroke patients are transported to hospitals providing stroke thrombolysis. This involves redirecting ambulances away from hospitals without acute stroke services.

- Provided national thrombolysis guidelines and protocols.

- Developed of a national Telemedicine System to support decision making and increase thrombolysis levels.

The Programme was assisted by the development of a public stroke awareness campaign by the Irish Heart Foundation. A national audit of stroke thrombolysis was carried out in 2012 by the HSE Quality & Patient Safety Directorate. It reported a national stroke thrombolysis rate of 9.5%, which is comparable to rates internationally. To increase national levels further larger centres outside Dublin will need to increase their thrombolysis rates. To achieve further gains will require real innovation such as the implementation of the Telemedicine Rapid Access to Stroke and Neurological Assessment (TRASNA) system. However for this to function we need co-operation and support of physicians skilled in administering the therapy. Negotiations in this regard are ongoing.

Pharmacy Services

Questions (92)

Seán Fleming

Question:

92. Deputy Sean Fleming asked the Minister for Health his vision for pharmacies in the health service; and if he will make a statement on the matter. [30429/13]

View answer

Written answers (Question to Health)

Pharmacists play an important role in the delivery of healthcare in Ireland.

Over the past two years, I have broadened the range of services provided by community pharmacists. They now provide the seasonal flu vaccination to patients, including adults in “at risk” groups. Pharmacists have recently commenced emergency hormonal contraception services. They provide advice on healthy eating, support with smoking cessation and importantly, advice to help patients manage their medications. In addition 65 community pharmacies participate in the community pharmacy needle exchange programme.

Implementation of the Future Health: A Strategic Framework for Reform of the Health Service 2012-2015 document, which was published in late 2012, is a priority for Government. Future Health sets out, at a high level, the main healthcare reforms, which will be introduced in the coming years to reshape the health system for the introduction of universal health insurance in 2016. Delivering on the Government’s goals in primary care will impact on primary care health professionals, including community pharmacists.

As part of implementation of Future Health, pharmacists will be expected to identify and contribute to implementing evidence-based and cost-effective solutions to ensure the effectiveness and sustainability of the healthcare system, by addressing key medication issues such as medicines wastage, inappropriate usage of medicines, supporting and improving chronic disease management and patient adherence to medication.

Under the Health (Pricing and Supply of Medical Goods) Act 2013, which was commenced on 19 June 2013, community pharmacists will play an important role in facilitating generic substitution. This legislation gives effect to the commitment in the Programme for Government that reference pricing and greater use of generics would be introduced to reduce the State’s drugs bill and the cost to individuals of their medicines. Through generic substitution pharmacists work with patients to promote the cost-effective use of medicines in order to achieve a sustainable health system.

Hospital pharmacy practice has significantly developed in recent years in order to meet the need for a clinical pharmacy service within hospitals for patients and to support clinical teams. The increasing complexity of new medicines and therapy regimes over the last 20 years in particular has meant that it has been necessary for hospital pharmacists to develop specialist clinical roles such as oncology, antimicrobial resistance (SARI), cardiovascular, neurology, respiratory and medication safety. Clinical pharmacy services within hospitals ensure the safe, appropriate, effective and cost-effective use of medicines for patients within secondary care. At the boundaries between primary and secondary care, there is scope for hospital pharmacists to make a significant contribution to promoting seamless care, and best use of medicines.

Pharmacists have been key contributors to the HSE Clinical Care Programmes, particularly in the management of chronic illnesses (such as diabetes, stroke, heart failure, COPD and asthma). Pharmacists working within the pharmaceutical industry also play a crucial role in maintaining the link between healthcare delivery and the Government’s policy approach to the forging of strong partnerships with industry.

Pharmacy education and training and continuing professional development for pharmacists is crucial in ensuring pharmacists are competent to take on new roles within healthcare delivery. A new five-year integrated Masters level pharmacy degree across the three schools of pharmacy in Ireland is proposed in line with best international practice and it will ensure newly qualified pharmacists are clinically-focussed and have the competencies, as part of the delivery of integrated healthcare, to support patients in managing increasingly complex medicines therapy. Continuing Professional Development for pharmacists will progress the development of pharmacy practice in line with international best practice and evolving healthcare needs.

International and national evidence demonstrates the significant impact pharmacists have in health gain for patients.

Mental Health Services Provision

Questions (93)

Brian Stanley

Question:

93. Deputy Brian Stanley asked the Minister for Health if he will detail the acute mental health services for children here; the numbers on waiting lists for same; the average, shortest and longest waiting times; and if he will make a statement on the matter. [30411/13]

View answer

Written answers (Question to Health)

Community child and adolescent mental health teams are the first line of specialist mental health services for children and young people (under 18), who are directly referred to Community CAMHS Teams from various sources. These include General Practitioners, Child Health Services, A&E Departments, Learning Disability Services, Adult Mental Health Services, or Primary Care services. In addition, direct referrals from educational services are also accepted but may sometimes require support from a General Practitioner.

All community-based CAMHS Teams screen referrals received. Those deemed to be urgent are seen as a priority, while those considered as routine are placed on a waiting list. During the period 1 October 2011 to 30 September 2012, a total of 9,973 referrals were accepted, which is an increase of 17% on the previous 12 months. A total of 8,671 new cases - or an increase of around 10% - was seen by community CAMHS Teams in the period October 2011 to September 2012, compared to 7,849 for the previous 12 months.

Of the 8,671 new cases seen, 967 (11.2%) were 16-17 years of age. Around 45% of new cases were seen within 1 month of referral, and some 66% within 3 months. Available statistics indicate that 10% of new cases waited between 3 and 6 months, 7% waited between 6 and 12 months, and 5% waited more than 1 year to be seen. About 12% did not attend their first appointment.

In-patient psychiatric treatment is usually indicated for children and adolescents with severe psychiatric disorders such as Schizophrenia, Depression, and Mania. Other presentations include severe complex medical-psychiatric disorders such as Anorexia/Bulimia. Admission may also be required for clarification of diagnosis and appropriate treatment, or for the commencement and monitoring of medication. An increasing incidence of the more severe mental health disorders in later adolescence may also generate more in-patient admissions.

In 2011, the opening of two new units at Bessboro, Cork and Merlin Park, Galway increased the total number of beds available to 44, further increasing to 52 when the Bessboro Unit is fully commissioned this year. Various other capital initiatives now underway are scheduled to bring the total number nationally to 76 bed places towards the end of 2014.

It is planned that the new National Paediatric Hospital will have a total of 20 In-patient beds, divided between Generic and specialist Eating Disorder beds, in line with recommendations contained in A Vision for Change. Plans for a secure Forensic 10 bed unit, also in line with A Vision for Change, and on the site of the new National Forensic Hospital at St. Ita’s, Portrane are at early planning stages and encompassed in the HSE Capital programme.

More detailed information on the type of issues raised by the Deputy is reflected in the HSE Service Plan, or is otherwise available direct from the Executive for national, regional or local data, including activity or performance indicators regularly updated in the public domain.

Alcohol Sales Legislation

Questions (94)

Thomas P. Broughan

Question:

94. Deputy Thomas P. Broughan asked the Minister for Health the progress made to date in bringing forward reforms to amend legislation in respect of the sale of alcohol to tackle the problem of binge drinking and over-consumption of alcohol. [30360/13]

View answer

Written answers (Question to Health)

The Report of the National Substance Misuse Strategy Steering Group, 2012 is the road map for the future direction of policy to deal with the use and misuse of alcohol. The Report specified that adults in Ireland drink in a more dangerous way than in any other country. In effect, Irish adults drank 11.6 litres of pure alcohol per capita in 2011. The Steering Group reported that if every adult drank at the low risk ceiling quantity of alcohol every week the per capita consumption would be reduced to 9.2 litres of pure alcohol. It also reported that one and a half million Irish drinkers drink in a harmful pattern.

Proposals are currently being finalised on foot of the Steering Group's recommendations. These proposals cover all of the areas mentioned in the report, including measures on access and availability of alcohol; controls on alcohol advertising and sponsorship; labelling of alcohol products, and legislation on minimum unit pricing. Minimum unit pricing is a mechanism of imposing a statutory floor in price levels per gram of alcohol that must be legally observed by retailers. Its primary function would be thus to discourage at risk levels of alcohol consumption and is targeted in particular at harmful and hazardous drinking. The Report also recommended that new low risk limits for alcohol consumption be introduced based on Irish standard drink of 10 grams of alcohol i.e 11 standard drinks or 112 grams of pure alcohol per week for women and 17 standard drinks or 168 grams of pure alcohol per week for men.

The Department of Health has consulted and negotiated with Government colleagues extensively, since the publication of the Report, in order to reach consensus on the most effective way to tackle the problem of alcohol misuse in society. The Cabinet Committee on Social Policy has considered these proposals and it is intended to bring forward a finalised package of proposals for consideration by Government shortly.

In the meantime, work on developing a framework for the necessary Department of Health legislation is continuing. A health impact assessment is being commissioned in conjunction with Northern Ireland as part of the process of developing a legislative basis for minimum unit pricing. The health impact assessment will study the impact of different minimum prices on a range of areas such as health, crime and likely economic impact.

Hospital Staff Issues

Questions (95, 112)

Bernard Durkan

Question:

95. Deputy Bernard J. Durkan asked the Minister for Health the extent to which adequate, consultant, medical and nursing staff levels remain available to meet requirements throughout the hospital services and primary care areas; if any particular deficiencies have been identified; and if he will make a statement on the matter. [30358/13]

View answer

Robert Troy

Question:

112. Deputy Robert Troy asked the Minister for Health if he is satisfied that vacancies in specialised areas that are exempt from the public sector embargo are being filled; and if he will make a statement on the matter. [30443/13]

View answer

Written answers (Question to Health)

I propose to take Questions Nos. 95 and 112 together.

The Government has decided that the numbers employed across the public service must be reduced in order to meet its fiscal and budgetary targets. In order to mitigate the impact on frontline services of the reduction in employment numbers, the priority is to reform how health services are delivered in order to ensure a more productive and cost effective health system. The additional working hours provided for in the Haddington Road Agreement are a pivotal element in this regard.

Subject to approval by senior managers, arrangements are in place in the HSE to allow the recruitment of staff where it has been established that there is an urgent service requirement. In addition, the HSE continues to fill a significant number of development posts in line with service priorities identified by Government.

Hospital Trusts

Questions (96)

Peadar Tóibín

Question:

96. Deputy Peadar Tóibín asked the Minister for Health the timeframe for the establishment of hospital groups and the timeframe of the development of hospital trusts; and if he will make a statement on the matter. [30403/13]

View answer

Written answers (Question to Health)

The Report on the establishment of Hospital Groups which I launched on 14 May is the most radical and most fundamental modernisation of our health system infrastructure since the State’s foundation. To achieve the most effective high quality outcomes for patients in the most cost efficient manner possible, the reform of the structures and governance for the delivery of hospital services is vital now.

Implementation of the Report will be overseen by a National Strategic Advisory Group and driven by the HSE through the Hospital Groups Implementation team which is currently being established. I will appoint Chairs of each Group in the next few weeks. Advertisements to seek other board members will be placed in parallel with the process of appointing the Group Chairs and the subsequent appointment of group CEOs and management teams. All appointments will be made based on the competencies the individual brings to the Board in line with the HIQA report on Tallaght.

Within one year of the formation of Hospital Groups, individual groups will be required to submit a strategic plan which will outline its plans for future services within the group area. These strategic plans will determine the way services are provided within each group. The implementation of these plans by each group will then be rigorously reviewed, including all necessary due diligence checks, to see whether they are in a position to advance to Hospital Trust status after the necessary legislation is put in place.

Diabetes Strategy

Questions (97, 133)

Thomas Pringle

Question:

97. Deputy Thomas Pringle asked the Minister for Health his plans to tackle diabetes nationwide, particularly paediatric diabetes; if he will commit to ensuring that the paediatric diabetes care posts are filled as soon as possible, to allow for the insulin pump service to be available to more than 130 diabetic children attending Letterkenny General Hospital, County Donegal. [30381/13]

View answer

Mick Wallace

Question:

133. Deputy Mick Wallace asked the Minister for Health the reasons for the current pace of development of diabetes health services in County Wexford; the reasons the Health Service Executive has not yet filled sanctioned posts in critical areas of diabetes care in the county (details supplied); and if he will make a statement on the matter. [30384/13]

View answer

Written answers (Question to Health)

I propose to take Questions Nos. 97 and 133 together.

The National Integrated Care Diabetes Programme is being implemented on a phased basis. The programme will improve patient access and manage patient care in an integrated manner across service settings, resulting in better outcomes, enhanced clinical decision making and the most effective use of resources.

The Government has approved funding for the appointment of 17 Integrated Care Diabetes Nurse Specialists (one per HSE Integrated Service Area)to support the phased roll out of the programme. These Diabetes Nurse Specialists will work 1 day per week in a hospital setting and 4 days per week in primary care. They will play a key role in the development of clinically sound collaborative links between primary care and secondary care providers and will also be an essential resource in empowering patients to achieve optimum diabetes control. To date 15 posts have been offered or accepted, subject to Garda clearance, etc. It is anticipated that all 17 positions will be filled soon.

Funding has also been secured to appoint 16 podiatrists and a number of these posts have been filled. Recruitment for the remaining posts is underway and the aim is to have them filled as soon as possible in 2013. With regard to paediatric diabetes, the HSE has advised that a national model of care to deliver CSII (insulin pump) therapy to children with type 1 diabetes under 5 years of age has been developed. Recruitment of 2.4 WTE nurses and 1.75 WTE dieticians has been agreed and is being progressed. In relation to the filling of diabetes posts in specific areas, I have asked the Health Service Executive to respond directly to the Deputy in these matters.

Hospitals Policy

Questions (98)

Jonathan O'Brien

Question:

98. Deputy Jonathan O'Brien asked the Minister for Health the opportunity that will be provided for stakeholders to engage in the process of consultation provided for in the Higgins Report on Hospital Groups; the timeframe and proposed structure of same; and if he will make a statement on the matter. [30412/13]

View answer

Written answers (Question to Health)

The Report on the establishment of Hospital Groups which I launched on the 14thMay is the most radical and most fundamental modernisation of our health system infrastructure since the State’s foundation. To achieve the most effective high quality outcomes for patients in the most cost efficient manner possible, the reform of the structures and governance for the delivery of hospital services is vital now.

Implementation of the recommendations of the Group’s Report has already commenced. I have personally visited the areas covered by each of the 6 groups with my Department and the Director General Designate of the HSE, explaining the policy objectives and listening to the questions the staff in each of those areas have about this policy implementation. The reaction has been positive. Professor John Higgins is also carrying out a debriefing exercise, supported by my Department and the HSE, to help ready the hospitals for the impending changes. Since the launch of the Report, he has held approx. 50 meetings with hospitals in this regard. The ongoing implementation of the Report will be overseen by a National Strategic Advisory Group, which will provide guidance and on-going direction to implementation of both the Hospital Groups Report and the Smaller Hospitals Framework and provide a forum to resolve issues and assist in the development of specific guidelines on the steps required for full implementation. At hospital level, implementation will be driven by the HSE through the Hospital Groups Implementation team which is currently being established.

In preparing the Hospital Groups Report, the project group carried out a comprehensive consultation process with all acute hospitals and other key advocacy groups which requested an opportunity to be consulted. In addition, a significant number of submissions were received by the project group. As the new Hospital Groups are formed and their management teams appointed, each Group will give consideration to the consultation processes appropriate to that individual Group and to how stakeholders may be engaged with those processes.

Departmental Expenditure

Questions (99)

Bernard Durkan

Question:

99. Deputy Bernard J. Durkan asked the Minister for Health the extent to which his Department's expenditure has remained on target with budgetary expectations for the current year in respect of all services; the areas, if any, showing a tendency to overspend; if he foresees any particular areas for special attention; and if he will make a statement on the matter. [30357/13]

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Written answers (Question to Health)

At the end of May the Department of Health is reporting an underspend of €15m on a gross expenditure basis on its Vote (Vote 38), €11m of which is attributed to current expenditure. The underspend is primarily owing to timing issues in a number of subheads. For instance, there has been less funding than anticipated drawn by some of the directly funded health agencies and there is a timing issue in relation to payments due to the World Health Organisation under Subhead C. However, these timing issues are expected to level out in the coming months. In the case of Subhead D which provides for statutory and non-statutory enquiries and miscellaneous legal fees and settlements, demands on this subhead are determined by the number of legal cases in process at any given time, but given the uncertain nature of legal cases there is always a need for some flexibility with this subhead. My Department will continue to monitor expenditure closely for the remainder of the year.

Universal Health Insurance Provision

Questions (100)

Brendan Smith

Question:

100. Deputy Brendan Smith asked the Minister for Health the timeframe for the introduction of universal health insurance; and if he will make a statement on the matter. [30445/13]

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Written answers (Question to Health)

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, everyone 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.

Earlier this year, in February, I published The Path to Universal Healthcare, a preliminary document on UHI which provides a comprehensive update on progress achieved to date in paving the way for the introduction of universal health insurance and sets out the main actions for the road ahead. It is available on the Department's website, www.doh.ie.

The Department is currently in the process of preparing a White Paper on Universal Health Insurance which will provide detail on the UHI model for Ireland in addition to the estimated costs and financing mechanisms associated with the introduction of universal health insurance. Broadly, this involves the development of detailed policy proposals covering issues such as the design of the UHI model, the scope and composition of the UHI basket of services and funding and financial support mechanisms for UHI. Work on the development of detailed policy proposals is proceeding with a view to publishing the White Paper as early as possible.

The health reform programme is a major undertaking that requires careful planning and sequencing over a number of years and full implementation of UHI will take some time to achieve. I anticipate that by 2016 the necessary groundwork will be in place to enable us to phase in implementation of UHI, as promised in the Programme for Government. I should add that it is my intention to consult widely as part of the reform implementation process.

Maternal Deaths

Questions (101)

Clare Daly

Question:

101. Deputy Clare Daly asked the Minister for Health the changes he intends to implement in relation to maternal mortality reporting and investigating procedures to improve the information gathered in order to assist in saving women's lives; and if he will make a statement on the matter. [30024/13]

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Written answers (Question to Health)

Statistics on causes of death are based on civil registration and compiled internationally by the World Health Organisation. In the most recent World Health Statistics Annual Report (2012), Ireland had the 13th lowest rate of maternal mortality out of 178 countries reporting data.

It is generally recognised internationally that official vital statistics can result in an underestimate of maternal deaths. In particular, indirect obstetric deaths resulting from previous existing disease or diseases which developed during the pregnancy may be missed in the official statistics. For this reason, Ireland established a Confidential Maternal Death Enquiry (MDE) system in 2009. In doing so, it linked itself with the United Kingdom’s Confidential MDE which has been acknowledged as a gold standard for maternal death enquiry in recent decades. MDE Ireland aims to promote safer pregnancy by conducting confidential reviews into maternal deaths, identifying learning points, and using its findings to formulate and disseminate recommendations.

The HSE's National Clinical Care Programme for Obstetrics and Gynaecology, which was put in place subsequent to the instigation of the work on this report, will be collaborating with health professionals to ensure that all learning from enquiries into tragic events related to pregnancy will be incorporated into service delivery to continue to ensure that care for mother and babies is as safe as possible. The Programme has been working on the development of national clinical guidelines in order to improve standardisation and to drive service quality. To date, 20 guidelines have been developed and six are under peer review.