Written Answers Nos. 16-28
16. Deputy Thomas P. Broughan asked the Minister for Health if he will report on the progress made to date in developing a national mental health information system as provided for in the Health Service Executive's national service plans for 2012 and 2013 [39930/13]
View answerThe National Director of Mental Health Services in the HSE has prioritised the National Mental Health Information System Project to identify the national business requirements for a Mental Health ICT System. This is to deliver a clinical information and service delivery management system, encompassing an electronic service user mental health record. An allocation of €405,275 from the additional €35 million provided for mental health in 2013 was identified for this purpose.
Significant work has been undertaken recently to consult with a range of health professionals and clinicians, together with service user representatives, across mental health services to clarify the requirements for such a system. It is expected that this consultation will be concluded within the next 6-8 weeks.
A Project Structure for the National Mental Health ICT Project has been agreed and work is in train to establish each of the elements as soon as possible. A Steering Group has been identified to progress the Project and will be advised by a Stakeholder Group, to be chaired initially by the National Director of Mental Health Services. The components of the Project will be managed by a full-time Project Manager who will work with a Project Team, and arrangements for the identification and release of the Project Team are progressing.
The HSE expects to make a decision by the end of the year on the feasibility of extending and developing existing systems or whether there will be a need to tender for a new system. Thereafter, full national implementation of a mental health Information Systems is a three to five-year process.
17. Deputy Maureen O'Sullivan asked the Minister for Health his plans for the implementation of the recommendations of the steering group report on the national substance misuse strategy; and if he will make a statement on the matter. [40064/13]
View answerProposals are currently being finalised on foot of the recommendations in the Steering Group Report on a National Substance Misuse Strategy 2012. These proposals cover all of the areas mentioned in the report, including legislation on minimum unit pricing; controls on alcohol advertising and sponsorship; labelling of alcohol products; measures on access and availability of alcohol and a social responsibility levy on the drinks industry.
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 has been 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.
18. Deputy Robert Troy asked the Minister for Health his plans to help persons with asthma; and if he will make a statement on the matter. [40009/13]
View answerThe National Clinical Programme for Asthma, which commenced in 2011, is one of a number of chronic disease programmes established in the HSE’s Clinical Care Directorate aimed at bringing a systematic approach to changes in how services for patients are delivered. Current estimates suggest that there are approximately 450,000 people with doctor-diagnosed asthma in Ireland.
The initial focus of the work of the Programme has been primarily on three main areas:
1. The development and implementation of national asthma guidelines based on international best practice for acute and ongoing asthma management and in relation to this, national asthma education initiatives for patients and health care professionals;
2. The organisation and better integration of national asthma services at primary and secondary care levels through development of a national model of care; and
3. A national project of auditing acute asthma deaths.
Work in relation to Asthma Guidelines has included:
Acute adult asthma guidelines and associated care pathways, treatment protocols and care bundles have been developed for use in all care settings (primary and secondary care levels), in conjunction with other relevant programmes and the Irish College of General Practice (ICGP). These include:
An in-hospital practical asthma education programme for nurses to underpin and support the implementation of the acute adult guidelines; and
General management asthma guidelines for use in all health care settings especially in primary care.
The Acute Adult Emergency Guidelines are available through the HSE website. This user friendly resource will facilitate all health care staff in optimising the management of adult patients attending services with an acute asthmatic episode.
Guidelines for acute paediatric asthma have also been completed and should be available soon on the HSE website. An associated educational programme is being developed at present.
The National Asthma Programme is developing a National Model of Care (MOC) for Asthma with an implementation plan which will detail how physicians, nurses, and other health care professionals will work with engaged patients to make the clinical decisions most appropriate to their circumstances; and to collaborate with specialist colleagues in providing a safe, seamless patient experience within the health system in Ireland. This is a key deliverable of the National Asthma Programme for 2013. As 85 per cent of asthma is managed in primary care without the need for hospital specialist services, the Programme is aiming to provide at primary care level a yearly programme of assessment for asthma called Chronic Disease Watch (CDW) – Asthma, also known as Asthma Check. Asthma Check, which has been submitted to the ICGP for review, outlines the step-by-step process for the implementation of guideline based asthma management in primary care to deliver optimal outcomes for patients.
The Model of Care will also focus on:
Improving access to hospital based specialist asthma services from primary and secondary care services, through Scheduled / Rapid access asthma services (adult/paediatric), and access to specialist asthma therapies.
Improving links through Clinical / Asthma Nurse Specialists within the community services.
Developing and implementing a standard referral pathway to asthma services.
Developing structured assessment and review protocols throughout the system.
Establishing uniform discharge protocols.
Facilitating access to accurate asthma diagnostics.
Examining solutions to develop and subsequently implement an Asthma database / register linked into all care levels (GP, Community Pharmacist and Hospital).
The draft model of care has been circulated for stakeholder consultation. The National Asthma Programme is aiming to have the Model of Care published by the end of this year.
Implementation of the National Clinical Programme for Asthma, which was included in the HSE's 2013 Operational Plan is ongoing and will continue in 2014.
19. Deputy Thomas P. Broughan asked the Minister for Health if persons with a long-term mental health condition will be considered for inclusion in the first phase of the roll-out of free primary care; and if he will make a statement on the matter. [39931/13]
View answer27. Deputy Willie O'Dea asked the Minister for Health the engagement the Department has had with general practitioners regarding the proposed introduction of free GP care for under fives; and if he will make a statement on the matter. [40002/13]
View answer275. Deputy Bernard J. Durkan asked the Minister for Health the position regarding the provision of free general practitioner health care; and if he will make a statement on the matter. [40310/13]
View answerI propose to take Questions Nos. 19, 27 and 275 together.
The Government is committed to introducing, on a phased basis, a universal GP service without fees within its term of office, as set out in the Programme for Government and the Future Health strategy framework. It is a matter for Government to determine policy in this area. There has been no Government decision, at this stage on the details of the roll-out of a universal GP service, such as a proposal for a specific age cohort. When the Government has taken a policy decision in this area, I will engage with all relevant stake-holders, as appropriate, in relation to implementation and administrative arrangements.
The introduction of a universal GP service constitutes a fundamental element in the Government's health reform programme. The current Government is the first in the history of the State to have committed itself to implementing a universal GP service for the entire population. A well functioning health system should provide equal access to health care for its patients on the basis of health needs, rather than ability to pay. The principles of universality and equity of access mean that all residents in Ireland should be entitled to access a GP services that is free at the point of use.
It has become 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, as outlined initially in the Programme for Government, is likely to be overly complex and bureaucratic. 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. 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.
However, the Government is firmly committed to introducing a universal GP service within this term of office. The Cabinet Committee on Health has discussed the issues relating to the roll-out of the universal GP service. In doing so, it has considered the delay in the initial step and 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.
It has been agreed that a number of alternative options should be set out with regard to the phased implementation of a universal GP service without fees. As part of this work, consideration is being given to the approaches, timing and financial implications of the phased implementation of this universal health service. A range of options are under consideration with a view to bringing developed proposals to Government shortly.
20. Deputy Billy Timmins asked the Minister for Health the reason for the price differential between medication sold in Northern Ireland and here; the way he plans to close this gap; and if he will make a statement on the matter. [39929/13]
View answerThe prices of drugs vary between countries for a number of reasons, including different prices set by manufacturers, different wholesale and pharmacy mark-ups, different dispensing fees and different rates of VAT.
The State has introduced a series of reforms in recent years to reduce pharmaceutical prices and expenditure. These have resulted in reductions in the prices of thousands of medicines. Price reductions of the order of 30% per item reimbursed have been achieved between 2009 and 2013; the average cost per items reimbursed is now running at 2001/2002 levels.
A major new deal on the cost of drugs in the State was concluded with the Irish Pharmaceutical Healthcare Association (IPHA) in October last. It will deliver a number of important benefits, including
significant reductions for patients in the cost of drugs,
a lowering of the drugs bill to the State,
timely access for patients to new cutting-edge drugs for certain conditions, and
reducing the cost base of the health system into the future.
The IPHA agreement provides that prices are referenced to the currency adjusted average price to wholesaler in the nine EU member states. The prices of a range of medicines were reduced on 1 January 2013 in accordance with the agreement.
The gross savings arising from this deal will be in excess of €400m over 3 years. €210 million from the gross savings will be available to fund new drugs.
A new agreement has also been reached with the Association of Pharmaceutical Manufacturers in Ireland (APMI), which represents the generic drugs industry. From 1 November 2012, the HSE will only reimburse generic products which are priced at 50% or less of the initial price of an originator medicine. This represents a significant structural change in generic drug pricing and should lead to an increase in the generic prescribing rate. It is estimated that the combined gross savings from the IPHA and APMI deals will be in excess of €120 million in 2013.
The Health (Pricing and Supply of Medical Goods) Act 2013, which came into operation on the 24th of June, introduces a system of generic substitution and reference pricing. This legislation will promote price competition among suppliers and ensure that lower prices are paid for these medicines resulting in further savings for both taxpayers and patients.
Under the Act, the Irish Medicines Board (IMB) is responsible for the assessment for interchangeability of medicines. Generic substitution will be introduced incrementally with the IMB prioritising those medicines which will achieve the greatest savings for patients and the State. The Board is in the process of reviewing an initial 20 active substances, which equates to approximately 1,500 individual medicines. They include statins, proton pump inhibitors, angiotensin-converting-enzyme (ACE) inhibitors and angiotensin II receptor blockers.
The first List of Interchangeable Medicines, containing groups of atorvastatin products, was published by the IMB on the 7th August. The second and third lists containing groups of esomeprazole and rosuvastatin products were published on 20th and 24th September respectively. Once the IMB has assessed the initial 20 priority products, then a further list of priority products will be identified and assessed by the IMB and the process will continue until all medicinal products on the reimbursable list have been assessed.
Once a List of Interchangeable Medicines is published by the IMB a two stage price reduction process gets under way. First, under the terms of the 2012 APMI Agreement, the price of all relevant products fall by 20%, e.g. Atorvastatin prices were reduced from 1st September. Secondly, the legislation also provides that the HSE may set a reference price for each group of interchangeable products published on the List of Interchangeable Products with a view to introducing further significant price cuts.
Reference pricing involves the setting of a common reimbursement price, or reference price, for a group of interchangeable medicines. It means that one reference price is set for each group or list of interchangeable medicines, and this is the price that the HSE will reimburse to pharmacies for all medicines in the group, regardless of the individual medicine’s prices. It is expected that the first reference price for atorvastatin products will be implemented by November and, subsequently, reference prices for esomeprazole and rosuvastatin products will be implemented by the HSE in accordance with the timelines set out in the legislation. Reference prices will ensure that generic prices in Ireland will fall towards European norms.
21. Deputy Terence Flanagan asked the Minister for Health the steps he is taking to address delayed discharges from acute hospitals in the Dublin region; and if he will make a statement on the matter. [39924/13]
View answer53. Deputy Pearse Doherty asked the Minister for Health the estimated number of older persons and others requiring long-term residential care who are hospital in patients ready for discharge but awaiting residential places; and if he will make a statement on the matter. [40035/13]
View answerI propose to take Questions Nos. 21 and 53 together.
The operational definition of a delayed discharge is “A patient who remains in hospital after a senior doctor (consultant or registrar grade) has documented in the medical chart that the patient can be discharged.” The number of delayed discharges nationally, as at 17th September 2013, is 653. Of these, 529 are reported as awaiting discharge to long term nursing care; the discharge of the others may be delayed for a number of reasons, including identification of suitable placements to address complex individual care needs or convalescent care requirements, community assessment of needs, or provision of specific aids by the community to facilitate discharge to home.
Whilst it is acknowledged that not all patients affected by delayed discharge are older persons, it is accepted that the majority of such patients are from this cohort. Although nationally ED attendances are down by over 5%, presentations by older persons (65+ yrs) are increasing. Up to mid-September 2013, the number of older persons admitted to hospital has increased by 17% over the equivalent period in 2012 and a significant number of these patients have co-morbid conditions and complex needs.
The HSE has put in place a number of initiatives to address this including increased allocations of Fair Deal approvals, the temporary prioritisation of Fair Deal referrals for patients in acute hospitals, the temporary prioritisation of referrals to long stay facilities from acute hospitals for older persons with complex needs and the improved targeting of appropriate homecare packages for older persons.
23. Deputy Seán Ó Fearghaíl asked the Minister for Health his views on the recent Health Information and Quality Authority hospital hygiene reports; and if he will make a statement on the matter. [39998/13]
View answerThe prevention and control of Health care Associated Infections (HCAIs) is one of my priorities in protecting patient safety. HCAIs represent a major cause of preventable patient harm and increased health care costs.
Established as an independent statutory body under the Health Act 2007, the Health Information and Quality Authority's (HIQA) mandate extends across the quality and safety of the public, private and voluntary sectors. Since late 2012 the Health and Information Quality Authority (HIQA) has been carrying out a monitoring programme against the National Standards for the Prevention and Control of Health care Associated Infections (HCAIs), 41 of which have been completed. Both I and my Department welcome the publication of HIQA’s reports and note the concerns raised in these, and indeed, previous reports about hand hygiene practices particularly among medical staff. With regard to hand hygiene the findings of the Authority suggest that hand hygiene best practice needs to become more operationally embedded at all levels.
Achieving a culture of patient safety in which best practice in hand hygiene is embedded requires actions at all levels. It is the responsibility of management and clinical leadership to make this a priority and ensure that the correct conditions to allow for the improvements in hand hygiene compliance are in place.
It must be emphasised that it is of vital importance that health care workers recognise their personal responsibility to protect patients by maintaining their own good hand hygiene. It is extremely disappointing to note that despite the Health Service Executive’s (HSE) initiatives to develop an organisational culture of hand hygiene, a significant number of health care staff, including doctors, are still not adhering to the basic principles of hand washing.
I very much support the HSE’s ongoing work through its national programme of activity to raise awareness amongst staff, monitor compliance with national standards and to take action to reduce HCAIs in hospitals. A key element of this programme is the HSE’s continuing bi-annual hand hygiene audits which occur in both the acute sector and in the long stay area as well. Additionally, from July of this year it has become mandatory for all staff to receive hand hygiene training as part of staff induction and an education programme every two years is being put in place. The HSE audits have shown an encouraging improvement in hand hygiene compliance with a most recent figure of 84.3% compliance overall (October 2012).
The Director General of the HSE has instructed that all hospitals act immediately on the following:
Ensure that a member of the senior management team is responsible for hygiene. This person must give a report to the facility management team on the facilities performance against the 2006 cleaning manual with a remediation plan and on the facilities performance multimodal hand hygiene plan by the end of 2013.
Ensure that there is a hygiene programme in place by the end of 2013 which clearly demonstrates the hospital’s commitment to hygiene, specifically focusing on patient care equipment, the patient environment and hand hygiene. The programme should be based on the WHO multimodal framework.
Ensure that 100% staff have received hand hygiene education and training by June 2014.
Hospitals are to provide monthly reports on progress to the National Director for Acute Services. The HSE is also working with the main medical professional bodies to address the issue of doctor attitudes and behaviour around hand hygiene.
The Chief Medical Officer (CMO) of the Department of Health has written to the Chair of the Health and Social Regulatory Forum asking that the Forum consider the matter and submit proposals as to how it might adopt a common approach to raise awareness of hand hygiene in particular and support and reinforce compliance with this very important patient safety issue. It has also been agreed that the CMO will meet with the Director General of the HSE to discuss the issue of governance in the control and prevention of HCAIs.
24. Deputy Seamus Kirk asked the Minister for Health if he is satisfied recent events at Stewarts, Dublin 20 and St. Michael’s House, Ballymun do not undermine the commitment in the programme for Government to ensure the quality of life of persons with disabilities is enhanced; and if he will make a statement on the matter. [40011/13]
View answerThis Government currently provides funding of over €1.5 billion to the Disability Services Programme through the HSE’s National Service Plan for 2013, and is committed to protecting frontline services for people with disabilities to the greatest possible extent.
In 2013 the HSE is seeking to maximise the provision of services within available resources and is committed to maintaining a consistent level to that provided in 2012, by providing the following specialist disability services:
residential services to over 9,000 people with a disability;
day services to over 22,000 people with intellectual and physical disabilities;
respite residential support for over 7,500 people with intellectual and physical disabilities;
1.68m hours of Personal Assistant / Home Support Hours.
With regards to Stewart’s Hospital the HSE has confirmed that Stewarts Care have agreed placements with all families that fully meet the needs of the young people who are completing their education this year at Stewarts Care. This has come about as a result of reconfiguration of services and on-going dialogue between the HSE and Stewarts Care. I understand that families have confirmed their satisfaction with the services offered.
In relation to St Michael's House, under the Health Act 2004, the HSE is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services, including disability services. The HSE either directly provides or contracts disability agencies such as St Michael’s House to provide a range of disability services through service level arrangements.
St Michael’s House received over €70 million in 2012 in funding from the HSE to provide a range of services to approximately 1,660 children and adults with an intellectual disability in over 170 centres in the Greater Dublin Area and Navan Co. Meath.
The HSE and St Michael's House work in close collaboration with regard to the funding and delivery of services to people with an intellectual disability. As a voluntary agency, St Michael’s house are obliged to work within the resources available to them and in that regard have introduced significant efficiencies over recent years to remain within budget. The HSE has advised that these changes to date have not resulted in service contraction.
The Haddington Road Agreement (HRA) sets out measures relating to productivity, cost extraction and reform which together intends to achieve a required pay bill reduction of €150m identified in the HSE Service Plan 2013. The agreement provides a framework and opportunities for managers within the health services, including agencies such as St Michael's House, to reduce their costs associated with agency and overtime and a wide range of other pay costs, particularly through measures such as additional working hours and revised rates in respect of overtime.
The HSE has advised the Department of Health that the recent application of additional budget cuts under the HRA has presented a significant challenge to St Michael's House. A process is now under way between the HSE and St Michael’s House to identify the impact of these budget reductions on services. The Department of Health has received assurances from the HSE that both organisations are committed to working within the terms of the HRA to ensure that services are impacted upon only as a measure of last resort.
25. Deputy Brendan Smith asked the Minister for Health the numbers awaiting placement through the nursing homes support scheme; and if he will make a statement on the matter. [40006/13]
View answerThe total budget for long-term residential care in 2013 is €974m. The HSE operates a national placement list to enable it to operate within the budget for the Nursing Homes Support Scheme. All applicants who are approved for funding are put on the placement list in chronological order by the date of determination of their application. Funding issues to applicants in this chronological order to ensure equity nationally. The HSE makes every effort to match available funding to demand by releasing funding on a weekly basis.
On the 20th September there were 330 people on the national placement list. All applicants with a date of determination up to and including the 5th September had been approved for funding.
26. Deputy Gerry Adams asked the Minister for Health when the national action plan on rare diseases will be published; if a Health Service Executive clinical director will be appointed to co-ordinate implementation of the plan; if a State registry and rare disease information office will be established; and if he will make a statement on the matter. [40031/13]
View answerWork on the drafting of a National Plan is well under way with publication of it earmarked for the end of the year.
As the particular queries raised by the Deputy are service matters, I have asked the Health Service Executive to respond directly to the Deputy.
28. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he will ensure, without further delay, the provision of bilateral cochlear implants for all deaf children who require them. [40030/13]
View answerBeaumont Hospital is the centre for delivering Ireland’s national cochlear implant programme, with surgical provision for patients under six years being carried out in the Children’s University Hospital Temple Street. Since the programme commenced in 1995, over 700 patients have received cochlear implants. Beaumont Hospital carried out ninety cochlear implants in 2012 (42 children and 48 adults).
The HSE has developed a proposal, in liaison with Beaumont Hospital, to introduce a bilateral cochlear implant programme in Ireland. It is planned that the programme will be located in Beaumont Hospital. This is a complex development and the HSE has engaged with many stakeholders in the proposal development. Introduction of bilateral cochlear implantation will involve additional staff, equipment and capital works and will be dependent on additional funding being made available to support its commencement. The proposal is being considered as part of the 2014 Estimates process.
