Written Answers Nos. 230 - 249
230. Deputy Brendan Ryan asked the Minister for Health if he will provide statistics for the number of medical cards awarded on a discretionary basis where the application exceeded the means test for the years 2011, 2012 and the first half of 2013. [33987/13]
View answerThe information sought by the Deputy is not readily available. However, I have asked the Health Service Executive to supply this information to me and I will forward it to the Deputy as soon as possible.
231. Deputy Martin Heydon asked the Minister for Health the processes that are in place to allow persons coming up to their seventieth birthday to make their applications for a medical card in advance of their birthday to ensure that they have the card in place by the time they turn 70; and if he will make a statement on the matter. [33994/13]
View answerI am advised by the HSE that people can apply for a medical card in the months leading up to their seventieth birthday. The application will be assessed under the National Income Guidelines for Over 70’s and will be put on hold until the day of their seventieth birthday. On this day the client will be notified of the outcome of this assessment. The length of time that it takes for a client to receive a decision on their medical card application depends on (1) whether the client submitted a complete application or not, and (2) if not how quickly the applicant responds to the subsequent request for additional information. The Primary Care Reimbursement Services aims to process all medical cards within 15 days of receipt of the application.
232. Deputy Thomas P. Broughan asked the Minister for Health the number of consultant ophthalmic surgeons currently working in Beaumont Hospital, Dublin 9; the number of persons on the waiting list for an appointment to see a consultant ophthalmic surgeon; the average waiting time for a patient to see a consultant; and the active steps being taken to tackle the waiting times. [34005/13]
View answerImproving access to outpatient services is a key priority for the Government. Collaborating with individual hospitals, the SDU, together with the National Treatment Purchase Fund (NTPF) and the HSE, has developed the outpatient waiting list minimum dataset. This allows data to be submitted to the NTPF from hospitals on a weekly basis and, for the first time, outpatient data is available on www.ntpf.ie. 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. The SDU and the NTPF will work closely with hospitals towards achievement of the maximum waiting time. In relation to the particular queries raised by the Deputy, as these are service issues, I have asked the Health Service Executive to respond directly to the Deputy in these matters.
233. Deputy Paschal Donohoe asked the Minister for Health when funding will be made available to allow for a home care package to be put in place following a recent discharge from hospital in respect of persons (details supplied) in Dublin 7; and if he will make a statement on the matter. [34011/13]
View answerAs this is a service matter it has been referred to the Health Service Executive for direct reply.
234. Deputy Billy Kelleher asked the Minister for Health when a person (details supplied) in County Tipperary will be given an appointment for a knee replacement at Waterford Regional Hospital. [34012/13]
View answerThe National Waiting List Management Policy, A standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, January 2013, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists. In relation to this particular query raised by the Deputy, I have asked the Health Service Executive to investigate the situation and respond directly to the Deputy in this matter.
235. Deputy Andrew Doyle asked the Minister for Health if he is concerned with the disconnect between the Health Information and Quality Authority, the body responsible for the regulation and inspection of nursing homes and the National Treatment Purchase Fund as the purchaser of care on residents behalf, in view of the fact that the NTPF may be taking a narrow definition of long-term care services and not taking into account the private and voluntary nursing home statutory responsibility under the national quality standards; and if he will make a statement on the matter. [34013/13]
View answerI do not believe that there is a disconnect between the Health Information and Quality Authority (HIQA) and the National Treatment Purchase Fund (NTPF). Under the Health Act 2007, statutory responsibility is given to the Chief Inspector of Social Services, part of HIQA, for the independent inspection and registration of all nursing homes, private and public. This responsibility is underpinned by a comprehensive regulatory framework and the National Quality Standards for Residential Care Settings for Older People in Ireland. All nursing homes are subject to the same core standards and regulations in relation to quality and safety in order to ensure the well-being of their residents.
In order to be an approved nursing home for the purposes of the Nursing Homes Support Scheme all private nursing homes, and voluntary nursing homes which previously received funding for long-term residential care under section 39 of the Health Act 2004, have a statutory obligation to negotiate and agree a price for the cost of long-term nursing home care with the NTPF. This is necessary due to the commitment by the State to meet the full balance of the cost of care over and above individuals’ contributions.
The cost of care covers:
- nursing and personal care appropriate to the level of care needs of the person,
- bed and board,
- basic aids and appliances necessary to assist a person with the activities of daily living, and
- laundry service.
The NTPF is independent in the performance of this function and, in carrying it out, it must ensure value for money for both the individual and the State. The NTPF negotiates with each nursing home individually and may examine the records and accounts of nursing homes as part of the process.
The NTPF assesses nursing home process under four criteria:
- costs reasonably and prudently incurred by the nursing home and evidence of value for money,
- price(s) previously charged,
- local market price, and
- Budgetary constraints and the obligation on the State to use available resources in the most beneficial, effective and efficient manner to improve, promote and protect the health and welfare of the public.
If price negotiations break down, a three stage review process can be invoked. Details of the process are set out on the NTPF website. Finally, it should be noted that the Nursing Homes Support Scheme is currently the subject of a review. This review will include an examination of the overall cost of long-term residential care in public and private nursing homes and the effectiveness of the current methods of negotiating/setting prices. It is envisaged that the review will be completed in late 2013/early 2014.
236. Deputy Brendan Griffin asked the Minister for Health if a medical device will be provided to a person (details supplied) in County Kerry; and if he will make a statement on the matter. [34022/13]
View answerThe HSE is responsible for the administration of the primary care schemes, therefore, the matter has been referred to the HSE for attention and direct reply to the Deputy.
237. Deputy Patrick Nulty asked the Minister for Health if his attention has been drawn to the fact that Ireland has the highest rate of hospital admission in the OECD for chronic obstructive pulmonary disease; the actions he is taking to reduce this very high level of hospital admission; and if he will make a statement on the matter. [34046/13]
View answerThe HSE National Clinical Care Programmes provide a national, strategic and co-ordinated approach to a wide range of clinical services. The programmes have three main objectives – to improve the quality of care, to improve access and to improve cost/value, effectiveness. The primary role is the development of models of care, guidelines and clinical pathways. In addition areas for process improvement are identified and direction provided to achieve these improvements. Currently there are 33 Clinical Programmes, one of which is the COPD Clinical Care Programme.
COPD is one of the commonest chronic diseases and is also one of the commonest reasons for admissions to hospital. The management of these patients by a structured programme of care including Outreach and Pulmonary Rehabilitation has been shown to reduce readmission rates and significantly reduce bed day consumption. The aims of the COPD Clinical Care Programme are to save 50 deaths a year from COPD, to reduce COPD admissions by 1,500 a year and to reduce readmission rates to 20% at 3 months. These aims are being achieved by decreasing morbidity and mortality through correct and early diagnosis, and by providing correct treatment based on best practice guidelines for treatment (self management, primary care and secondary or hospital care). In this regard, the Programme has developed a COPD Outreach Model of Care and a Pulmonary Rehabilitation Model of Care, and has also developed clinical guidelines which have been submitted to the National Clinical Effectiveness Committee which provides a framework for national endorsement of clinical guidelines and audit to optimise patient and service user care.
238. Deputy Patrick Nulty asked the Minister for Health the action he is taking to curb escalating hospital waiting lists in 2013 especially the number of patients waiting over six months for elective procedures; and if he will make a statement on the matter. [34047/13]
View answerIn July 2011 I established the Special Delivery Unit as set out in the Programme for Government with the aim of unblocking access to acute hospital services by improving the flow of patients through the system. A maximum wait time of 12 months for adults awaiting an inpatient or daycase procedure was set in 2011. The maximum wait time target was reduced to nine months in 2012 and this year the target maximum wait time for adults is eight months, as set out in the HSE Service Plan. For children awaiting an inpatient or daycase procedure the maximum waiting time target is 20 weeks and for those awaiting a routine GI endoscopy, it is 13 weeks. There is no six-month target in place.
Figures for inpatient and daycase waiting times are published on www.ntpf.ie. The published data shows a rise in inpatient and daycase waiting times since the end of last year. This follows the very significant achievements in reducing wait times at the end of 2012 and reflects the severe pressures on Emergency Departments in the early months of this year, which impacted on waiting times. In working towards the 2013 maximum wait times, the SDU together with the NTPF is working closely with hospitals to analyse performance, to agree mitigation plans and provide extra support as necessary and to optimise the use of hospital capacity.
239. Deputy Patrick Nulty asked the Minister for Health if his Department, the Health Service Executive or the Health Information Quality Authority has plans to monitor, collate and report on a regular basis on the death rates of patients undergoing major surgery at hospitals to identify variations if they exist, to address such variations with corrective action and to improve standards in hospitals by publishing such data; and if he will make a statement on the matter. [34048/13]
View answerIt is important for a health system and the people it serves that it collects, analyses and interprets high quality information about is performance against its objectives, including quality and safety objectives. This information can be used to inform decisions about the planning, design and delivery of services, to monitor and evaluate the effectiveness and safety of services and to identify areas of performance which may require further exploration and action. The Department of Health recognises this as an important issue and the office of the Chief Medical Officer in the Department has been focusing on this agenda. Currently, the Department is working with the HSE and HIQA on this agenda, focusing on generic quality and safety indicators. The Minister hopes to be in a position to announce further developments in this area towards the end of the year.
240. Deputy Patrick Nulty asked the Minister for Health if his attention has been drawn to the fact that according to a study of mortality after surgery in Europe, Ireland has one of the highest rates of post-operative mortality among 28 European countries surveyed; the action he is taking to reduce our high levels of post-operative mortality; and if he will make a statement on the matter. [34049/13]
View answerMy Department and the Health Service Executive (HSE) are extremely concerned in relation to the findings of the Lancet Study of mortality after surgery in Europe. While it has been acknowledged that there may be some methodological explanation for the results obtained, e.g. private hospitals not included and only 17 public hospitals participated, I can assure the Deputy that the findings are being taken seriously. In direct response the Royal College of Surgeons in Ireland (RCSI) has established a group to complete a full re-examination of the data collected for the EuSOS (European Surgical Outcomes Study) and to completely re-do the study.
The HSE is undertaking a number of general improvements in surgery provided in Irish hospitals. These include:
- the centralisation of complex cancer surgery to high expertise centres;
- the establishment of pre-operative assessment clinics for patients with planned surgery;
- promotion of the use of a safe surgery checklist in all surgical theatres;
- expansion of Intensive Care Unit capacity with new beds being opened in St James Hospital, Cork University Hospital, Tallaght and Drogheda;
- prospectively measuring mortality rates for a number of key conditions;
- increasing the use of simulation and human factors training, as used in the airline industry, as part of surgical training;
- developing surgical standards and training programmes in collaboration with the UK colleges of surgery.
The HSE has also been active in developing its data sources in order to improve the safety and quality of surgical treatments. The National Office of Clinical Audit (NOCA) has been established as a result of collaboration between the HSE Quality and Patient Safety Directorate and the Royal College of Surgeons in Ireland. The primary purpose of NOCA is to establish sustainable clinical audit programmes at national level which will ultimately improve outcomes for Irish patients. It is intended that the Irish Audit of Surgical Mortality (IASM) will be the first audit stream from NOCA to be rolled out nationally. It will be based on the methodologies used by the Scottish Audit of Surgical Mortality (SASM). The IASM will review all "in-hospital" deaths occurring to patients under the care of surgeons in Ireland. The overall aims of the audit are:
- to reduce surgical mortality through peer review processes
- and, crucially also, to examine the patient pathway with the aim of improving services for all surgical patients in Ireland.
241. Deputy Patrick Nulty asked the Minister for Health if his attention has been drawn to the fact that according to information published on a regular basis by the OECD, multi-payer health systems cost more in terms of expenditure as a percentage of GDP than single-payer health systems; if he will consider introducing a single-payer universal health insurance system rather than a multi-payer system; and if he will make a statement on the matter. [34050/13]
View answerThe 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. The Programme for Government states that "everyone will have a choice between competing insurers".
The Department is currently preparing a White Paper on Universal Health Insurance which will provide further 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. In terms of cost, the work necessarily includes consideration of mechanisms for ensuring both appropriate cost control and long-term sustainability of our health system.
Work on the development of detailed policy proposals is proceeding with a view to publishing the White Paper as early as possible. Ultimately, we are committed to learning from international experience and evidence and to introducing a model of universal health insurance that best fits the Irish system. More detail in relation to the overall process for producing the White Paper, including the projects, studies and policy appraisals that need to be undertaken, is set out in the preliminary paper on UHI, The Path to Universal Healthcare, published by the Department in February 2013 and available on its website, www.doh.gov.ie.
242. Deputy Joanna Tuffy asked the Minister for Health the position regarding plans for the land at Cherry Orchard Hospital, Ballyfermot, between the drug treatment centre and the houses in Whitethorn Estate; if there will be any new planting of trees or erection of a wall to protect the privacy of the residents following the felling of the existing trees; and if he will make a statement on the matter. [34062/13]
View answerManagement of the healthcare property estate is a service issue. Therefore, the Deputy's question has been referred to the HSE for direct reply.
243. Deputy Michael Healy-Rae asked the Minister for Health if he will consider removing the part of the Pharmacy Act that prohibits a bankrupt person from registering as a pharmacist; and if he will make a statement on the matter. [34065/13]
View answerSection 14(1)(f) of the Pharmacy Act 2007 provides that one of the requirements for registration as a pharmacist is that the person is not an undischarged bankrupt. Some technical amendments have been sought to the Pharmacy Act 2007 including an amendment to section 14(1)(f) to remove the restriction on a person who is an undischarged bankrupt from being registered in the Register of Pharmacists. These amendments are currently being examined and will be considered for inclusion as part of any future amendments to the Act.
245. Deputy Andrew Doyle asked the Minister for Health if he will ensure that any career breaks offered by the Health Service Executive are targeted in areas where there is an excess supply of labour; and if he will make a statement on the matter. [34086/13]
View answerSubject to overall parameters set by Government, the Health Service Executive has the responsibility to determine the composition of its staffing complement. In that regard, it is a matter for the Executive to recruit, manage and deploy its human resources to best meet the requirements of its Annual Service Plan for the delivery of health and personal social services to the public.
The Deputy may wish to note that my Department recently authorised the HSE to operate a special Incentivised Career Break Scheme in the HSE as well as in organisations/bodies funded under Section 38 of the Health Act 2004. The scheme was a targeted measure to contribute towards the numbers reduction required under the 2013 Employment Control Framework, and also an expenditure reduction measure. Some 2,500 valid applications were received for the scheme, a large proportion of which were from frontline health professionals. To date, the overall numbers approved for departure immediately or on a deferred basis later in the year are approximately 360. The scope for release of further staff under this scheme is under consideration by the HSE.
246. Deputy Seán Ó Fearghaíl asked the Minister for Health if he will ensure that a person (details supplied) in County Kildare is given an appointment date with a consultant; and if he will make a statement on the matter. [34096/13]
View answerIn relation to the particular query raised by the Deputy, as this is a service issue, I have asked the Health Service Executive to respond directly to the Deputy in this matter.
247. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he will provide in full detail of the process for the awarding of the contract for a primary care centre (details supplied) in County Dublin; if the latest contract was agreed as a result of a fully competitive tendering process, the detail of same; the current stage of development; and if he will make a statement on the matter. [34122/13]
View answerThe management and delivery of the healthcare infrastructure programme is a service issue. Therefore the Deputy's question has been referred to the HSE for direct reply.
248. Deputy Bernard J. Durkan asked the Minister for Health if a review of refusal of medical card will be undertaken in the case of a person (details supplied) in County Kildare; and if he will make a statement on the matter. [34136/13]
View answerThe Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible. The Health Service Executive operates the General Medical Services scheme, which includes medical cards and GP visit cards, under the Health Act 1970, as amended. It has established a dedicated contact service for members of the Oireachtas specifically for queries relating to medical cards and GP visit cards, which the Deputy may wish to use for an earlier response. Contact information has issued to Oireachtas members.
249. Deputy Bernard J. Durkan asked the Minister for Health if a reduction in nursing home charges may be undertaken in the case of a person (details supplied) in County Kildare; and if he will make a statement on the matter. [34137/13]
View answerAs this is a service matter it has been referred to the Health Service Executive for direct reply.
