Written Answers Nos. 258 - 265
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Written Answers Nos. 258 - 265
258. Deputy Bernard J. Durkan asked the Minister for Health the extent to which steps have been taken to eliminate MRSA or other such infections throughout the hospital service; and if he will make a statement on the matter. [54693/13]
View answerThe prevention of Healthcare Associated Infections (HCAIs) and colonisation/infection of our patients with antimicrobial-resistant organisms (AMR) such as MRSA is one of my priorities in protecting patient safety. HCAIs represent a major cause of preventable harm and increased healthcare costs. While not all HCAIs are due to AMR a significant proportion are. HCAIs are not an inevitable consequence of healthcare - recent evidence suggests that up to 70% of HCAIs can be prevented depending on the type of infection and the baseline rate.
The approach to prevention and control of HCAIs is similar irrespective of whether or not it is caused by an antibiotic resistant bacteria. Therefore, the Health Service Executive (HSE) has a dual focus:
1. Implementing measures to prevent and control HCAIs including those caused by AMR such as MRSA
2. Implementing specific measures for AMR including MRSA;
- These are outlined in national guidelines which have been recently updated;
- Monitoring infections caused by AMR as outlined later in this response.
The HSE has implemented a number of national initiatives in this field for many years, including:
- SARI 2001-2010 which specifically outlined the national strategy for prevention of AMR and was launched by the Minister of Health in 2001;
- HSE ‘Say No to Infection’ which focused on both HCAIs and AMR;
- The RCPI & HSE national clinical programme for the prevention and control of HCAIs and AMR which commenced in late 2010.
Public reporting of HCAIs and AMR in Irish acute hospitals:
- HCAIs Prevalence Study 2006 and 2012;
- S. aureus bloodstream infection (reported quarterly since 2007) – this includes public reporting of MRSA rates per hospital;
- Alcohol hand rub consumption (reported bi-annually since 2007);
- Antibiotic consumption (reported bi-annually since 2007);
- Hand hygiene compliance (reported bi-annually since 2011)
The overall aim of the national clinical programme for the prevention and control of HCAIs and AMR is that every healthcare worker and all parts of the healthcare system recognise that the prevention and control of HCAIs and AMR is a key element of clinical and non-clinical governance. Our healthcare systems have processes in place to ensure safe healthcare is reliably delivered irrespective of the healthcare setting. The programme focuses on getting three basic practices right every time we care for our patients; these are hand hygiene, using antimicrobials appropriately (antimicrobial stewardship) & preventing medical device-related infections i.e. IV lines/drips, urinary catheters. If the above three measures are applied consistently and reliably every time healthcare workers care for their patients/residents/client then a significant proportion of HCAIs, including that caused by AMR will be prevented.
The Health Protection Surveillance Centre (HPSC) collates information from hospitals on healthcare associated infections and antimicrobial resistant organisms such as MRSA. Information is also published on an ongoing basis for S. aureus and MRSA bloodstream infection – published quarterly to hospital level since 2007. Notably, there has been an annual decrease in reported S. aureus BSI, from 1,251 (2010) to 1,060 (2012). To the end of Q1 2013, 18.6% were due to resistant S. aureus (MRSA), a reduction on 2012 (22.8%). I was pleased last week to launch and endorse the second National Clinical Guideline, Prevention and Control Methicillin-Resistant Staphylococcus aureus (MRSA). This National Clinical Guideline provides practical guidance on prevention and control measures for MRSA to improve patient care, minimise patient morbidity and mortality and to help contain healthcare costs. The guideline has been developed for all healthcare staff involved in the care of patients, residents or clients who may be at risk of or may have MRSA in acute hospitals, obstetrics and neonates, nursing homes/long stay residential units and the community.
While I welcome the reducing trend in reported rates of MRSA in Ireland which indicates a halving of MRSA since 2006, Ireland’s MRSA rates are comparably high with other countries. We must systematically build our actions and processes to continue to reduce the prevalence of MRSA in Ireland. This National Guideline is a significant pro-active step in this direction and I would like to acknowledge the work of the Clinical Advisory Group on healthcare associated infections - MRSA Guideline Committee of the Royal College of Physicians Ireland in developing this guideline.
259. Deputy Bernard J. Durkan asked the Minister for Health the extent to which waiting times at accident and emergency departments can be reduced further by identifying those requiring more serious interventions for attention at a different location within a hospital; and if he will make a statement on the matter. [54694/13]
View answerSince my appointment as Minister for Health, I have set out to address the issues which cause delays in patients being treated in our hospitals. I established the Special Delivery Unit, which is working to unblock access to acute services by improving patient flow through the system. Significant progress has been made on reducing the numbers of patients on hospital trolleys in Accident and Emergency Departments, against a background of reduced funding for health, reconfiguration of services and a very challenging economic climate. The Development of Assessment and Admission Facilities by the HSE have further reduced pressure on Emergency Departments. The recent National advancement of Acute Medical Units (AMU), Medical Assessment Units (MAU), Surgical Assessment Units (SAU) and Paediatric Assessment Units (PAU) are designed to ensure rapid alternative assessment and, where necessary, admission of emergency patients.
The primary function of such facilities is the immediate and early specialist management of patients, providing a dedicated location for the rapid assessment, diagnosis and commencement of appropriate treatment. Consultants, supported by a multidisciplinary team, carry out patient assessment and treatment. If required, patients can be admitted to the short stay medical beds within the unit for a short period for acute treatment and/or observation where the estimated length of stay is less than 48 hours. In smaller hospitals, admission may be to inpatient beds. A total of 29 AMUs / MAUs, 4 PAUs and 1 SAU are currently established and functioning. The total volumes of activity for these units in 2013 is as follows: AMU same day discharge: 37,662 / admission 26,342; PAS: 5447 attendances and SAU: 2139 attendances.
Year to Date trolley numbers in 2013 are down 13.1% on last year. This equates to a reduction of 8,446 patients on trolleys year on year. Compared to 2011, the year to date improvement is 34%, equivalent to a reduction of 28,913 patients on trolleys.
260. Deputy Bernard J. Durkan asked the Minister for Health the extent to which junior hospital doctors, nurses and consultant staff are available throughout the public hospital sector with particular reference to the need to ensure compliance with the working time directive; and if he will make a statement on the matter. [54695/13]
View answerAll staffing arrangements have to be considered in the light of the current budgetary pressures in the health service and the need to reduce the numbers employed throughout the public sector. Nonetheless, it is open to the HSE to continue to recruit NCHDs, nurses and consultant staff in circumstances where it has been established that there is an urgent service requirement and the recruitment can be accommodated within the budgetary and staff number limits in place. The number of consultants working in the public health sector has increased significantly in recent years, as this grade was exempt from the moratorium. At present, there are over 2,500 consultants, an increase of over 40% in the last decade, and the HSE continues to approve new posts and to recruit to fill vacant posts.
With regard to NCHDs, there is a recognised need to progress compliance, given the extent to which many currently exceed the provisions of the Directive. This is being addressed as a priority by HSE and hospital management. The immediate focus, involving the HSE, hospital management, the IMO and NCHDs, is on eliminating shifts in excess of 24 hours. In certain specialties the NCHD staff required are in short supply internationally. System reform, in particular the implementation of the Report on Hospital Groups and the Framework for the Development of Smaller Hospitals will assist, through achievement of a more focused and efficient deployment of NCHD staffing.
I am committed to improving the working-conditions of NCHDs, to ensuring that they can have a suitable career pathway within the Irish health system and to making all posts as attractive as possible. In July this year, I set up a working group chaired by Professor Brian MacCraith, President of DCU, to carry out a strategic review of the medical training and career structure of NCHDs. I see this as a modernising initiative which is needed urgently and which will, in future years, support the retention of sufficient numbers of doctors trained in Ireland within the system. I have recently received the interim report of the Group, to be published shortly, and the final report is to be submitted to me by June 2014.
The number of nurses engaged in the public health service has reduced over the past four years in accordance with Government policy, arising from the requirement that the numbers employed across the public service must be reduced in order to meet fiscal and budgetary targets. Nonetheless, there is a high degree of compliance across the nursing sector with the Directive. Again, the HSE can make essential appointments where it is essential to do so. It is currently undertaking an intensive recruitment campaign to recruit theatre nurses, given current shortages and the importance of filling these posts.
261. Deputy Bernard J. Durkan asked the Minister for Health the extent to which hospital waiting lists have been reduced; and if he will make a statement on the matter. [54696/13]
View answerFor 2013, as set out in the HSE Service Plan, the target maximum wait times for inpatient and day case treatment are: Adults 8 months, Children 20 weeks and Routine GI endoscopy 13 weeks. In July 2011, when the Special Delivery Unit was set up a total of 6,277 patients were waiting more than nine months for inpatient or daycase treatment. By the end of 2012, that number had been reduced by 98% for adults waiting over nine months for inpatient or daycase treatment and 95% for children waiting over 20 weeks for such treatment.
The early months of 2013, as anticipated, brought higher levels of Emergency Department admissions which, in turn, had a knock-on effect on scheduled care. However, the SDU in the HSE, together with the NTPF undertook a range of measures to address this, working closely with hospitals to analyse performance, to agree action plans and extra support as necessary and to ensure hospital capacity is being optimised. Since August we have reduced the numbers of adults waiting over 8 months by 78% from 6,800 on 22 August to 1,485 on 12 December. Similarly, we have reduced the numbers of children waiting over 20 weeks by 35% from 883 to 576 in the same period. GI Endoscopy procedures waiting over 13 weeks have fallen 72% from 1,405 at the end of August to 392 on 12 December.
With regard to outpatients, material provided by the HSE indicates that between 28.03.13 and 13.12.13 there has been a 10% reduction in total numbers waiting from 146,268 to 132,199, a 55% reduction in numbers waiting over12 months from 103,433 to 46,761, a 49% reduction in numbers waiting 12-24 months from 64,955 to 32,839, a 54% reduction in numbers waiting 24-36 months from 23,038 to 10,601, a 66% reduction in numbers waiting 36-48 months from 7,745 to 2,649 and 91% reduction in numbers waiting 48+ months from 7,695 to 672.
Finally it is also worth noting that in relation to unscheduled care year to date, the INMO have reported 13.1% fewer trolleys than in 2012. This equates to a reduction of 8,446 patients on trolleys year on year. Compared to the base year 2011, the year to date improvement is 34%, equivalent to a reduction of 28,913 fewer patients waiting on trolleys.
262. Deputy Bernard J. Durkan asked the Minister for Health the progress to date in respect of the primary care building programme; the total number of such centres already in place, those planned and the schedule for the future; and if he will make a statement on the matter. [54697/13]
View answerThe development of primary care is central to the Government's objective to deliver a high quality, integrated and cost effective health system. The development of primary care centres, through a combination of public and private investment, will facilitate the delivery of multi-disciplinary primary health care. In 2012 the HSE embarked on a prioritisation exercise for Primary Care Centres. However the prioritisation process is a dynamic exercise, constantly evolving to take account of changing circumstances including the feasibility of implementation.
It is the Government’s intention to develop as many primary care centres as possible using one of the following:
- direct build (by HSE);
- by way of leasing arrangements with the private sector;
- through Public Private Partnership.
Considerable progress has been made in the delivery of primary care centres and 34 centres have opened since March 2011.
Direct Build – In certain locations, the HSE will deliver primary care facilities either through refurbishment/extension of suitable properties or through new build. Since 2012, primary care infrastructure has been approved and is underway at 15 locations.
Operational lease - Significant progress has been achieved under this mechanism. Construction is underway at 6 locations and planning permission has been granted at an additional 23 locations.
PPPs - Of the 35 primary care centre locations announced under the Infrastructure Stimulus Package in July 2012, 16 locations have been identified as being suitable for the PPP model. The 16 locations are being developed by the HSE to be brought to a preliminary design and statutory planning process. It is expected that 10-14 sites (indicative number 12 based on affordability) will be delivered as part of a single PPP contract with the remaining centres to be procured by the HSE using other procurement means. While it is not possible, at this time, to give start and completion dates for any of the individual potential locations, the best estimate is that these primary care centres will be completed by late 2016.
In relation to the PCC infrastructure schedule for the future, there will always be more construction projects than can be funded by the Exchequer using the direct-build mechanism. The Health Service Executive must prioritise healthcare projects including primary care infrastructure within its overall capital envelope taking into account its existing capital commitments and costs to completion over the period. Future development of primary care centres will be set out in the HSE's Multi Annual Capital Plan.
263. Deputy Bernard J. Durkan asked the Minister for Health when the next phase of the Naas hospital development plan is expected to proceed; and if he will make a statement on the matter. [54698/13]
View answerLast May, I announced the introduction of Hospital Groups to provide for organisational change, giving more autonomy and better enabling the reorganisation of services in a well-planned manner. Naas General Hospital is part of the Dublin Midlands Hospital Group, which also includes the Coombe Women and Infants University Hospital, Midlands Regional Hospital Portlaoise, Midlands Regional Hospital Tullamore, St James's Hospital and Tallaght Hospital.
A Strategic Advisory Group is now being established which will oversee the establishment of Hospital Groups and the subsequent reorganisation of acute hospital services. Each group of hospitals will work together as single cohesive entities managed as one, to provide acute care for patients in their area, integrating with community and primary care. This will maximise the amount of care delivered locally, whilst ensuring complex care is safely provided in larger hospitals. Hospital Groups will be required, within one year, to develop a strategic plan which will outline their plans for future services within the group area and the role of hospitals within each group will be considered in detail in the context of this strategic plan.
In relation to the specific information sought by the Deputy, as this is a service matter it has been referred to the HSE for direct reply.
264. Deputy Bernard J. Durkan asked the Minister for Health the total number of medical cards in circulation in each of the past ten years to date; and if he will make a statement on the matter. [54699/13]
View answerThe table below details the number of medical cards in circulation over the previous ten years to date, as requested by the Deputy.
|
Date |
Number of Medical Cards |
|
End 2003 |
1,152,908 |
|
End 2004 |
1,145,083 |
|
End 2005 |
1,155,727 |
|
End 2006 |
1,221,695 |
|
End 2007 |
1,276,178 |
|
End 2008 |
1,352,120 |
|
End 2009 |
1,478,560 |
|
End 2010 |
1,615,809 |
|
End 2011 |
1,694,063 |
|
End 2012 |
1,853,877 |
|
End November 2013 |
1,853,877 |
265. Deputy Bernard J. Durkan asked the Minister for Health the extent to which staffing levels throughout the public hospital sector compare with similar staffing levels and access to resources with those prevailing in the private sector; and if he will make a statement on the matter. [54700/13]
View answerAs this is a service matter it has been referred to the Health Service Executive for direct reply.
