Thursday, 13 Feb 2014

Written Answers Nos. 41-61

General Medical Services Scheme Administration

Questions (41)

Billy Kelleher

Question:

41. Deputy Billy Kelleher asked the Minister for Health if he will provide an update on the negotiation of a new GP contract; and if he will make a statement on the matter. [6922/14]

Written answers

Minister of State at the Department of Health

The Programme for Government provides for the introduction of a new GMS GP contract with an increased emphasis on the management of chronic conditions, such as diabetes and cardiovascular conditions. It is envisaged that the new contract, when finalised, will focus on prevention and will include a requirement for GPs to provide care as part of integrated multidisciplinary Primary Care Teams.

As part of Budget 2014, the Government announced that it will commence the roll-out of a universal GP service by providing all children under 6 years with access to a GP service without fees. The implementation of this measure will require primary legislation which is currently being drafted. The Government is providing new, additional funding of €37 million to meet the cost of implementing this service. Preparations are proceeding with a view to commencement of the new service for children under 6 years by June/July 2014. In this regard, the Department and the HSE have prepared a draft contract to facilitate the introduction of the service.

A consultation process started on 31st January 2014 relating to the content and scope of the contract. I met with key stakeholders - the Irish College of General Practitioners, the Irish Medical Organisation and the National Association of General Practitioners – to brief them on Government policy concerning the introduction of a universal GP service without fees and in particular, on the first phase concerning children under 6 years. Advertisements were published in the national newspapers on 1st February 2014, inviting the general public and other interested parties to submit their views on the contract to the HSE. The draft contract is available for review on the HSE website at www.hse.ie/under6contract and the closing date for receipt by the HSE of written submissions is 21st February 2014.

In parallel with the public consultation on the content and scope of the contract, the Department of Health and the HSE is engaging in an exercise to develop a fee structure which will be the subject of further discussion with relevant stakeholders. The setting of the fee rates will be a matter for the Minister for Health, subject to the provisions of the legislation currently being drafted.

Under the auspices of the Cabinet Committee for Health, work is continuing on the development of a scheme for the provision of a GP service without fees to the entire population. This includes consideration of approaches, timing, administrative and financial implications of a range of options with a view to bringing developed proposals to Government. The extension of GP services without fees will have full regard to and ensure compatibility with developments in relation to Universal Health Insurance. When Government has made decisions on these proposals, further work will be carried out in relation to the GP contract to enable full implementation of universal GP care.

Hospital Accommodation Provision

Questions (42)

Seán Kyne

Question:

42. Deputy Seán Kyne asked the Minister for Health if capital investment is being considered for a new unit that will alleviate the pressure at peak time in the context of the high capacity levels at University Hospital Galway, which is in the Galway-Roscommon hospital group; and if he will confirm if Merlin Park is being used for step-down purposes to alleviate pressure on other health facilities. [6850/14]

Written answers

Minister for Health

As this is a service matter, I have asked the HSE to respond directly to the Deputy.

Question No. 43 answered with Question No. 19.

Disability Services Funding

Questions (44)

Éamon Ó Cuív

Question:

44. Deputy Éamon Ó Cuív asked the Minister for Health the funding being provided for disability services in 2014; the progress made to date in relation to the provision of services for school leavers in 2014; and if he will make a statement on the matter. [6698/14]

Written answers

Minister of State at the Department of Health

The Government is providing funding of €1.4 billion to the Disability Services Programme in 2014, including an additional €14m to address the priority needs identified by the Minister for Health and advised to the Health Service Executive (HSE). The additional funding includes €7m for the provision of new places for school-leavers and rehabilitative (life-skills) training graduates.

The HSE, through its Occupational Guidance Service, is working with schools, service providers, young people and their families to identify training needs and explore suitable options for school-leavers graduating in 2014. Many young people with disabilities will progress to further education or vocational training funded by the Department of Education and Skills. For those young people who will require ongoing HSE-funded supports, the HSE has established a National Oversight Group to coordinate a timely response to processing applications for day services and rehabilitative training places. As a result, new arrangements have been put in place for a centralised regional application process.

The HSE have informed me that they are liaising with disability agencies and the National Council for Special Education to supply the necessary information to parents and students on the new application process. The deadline for applications was the 1st of February, however some flexibility will be given since the application process is in its first year. The next stage in the process will be to identify and agree the supports required for each individual, identify the service providers who have the capacity to respond to those support needs, and agree the allocation of additional resources to support individual placements. A communications process with all stakeholders will be put in place by the end of March, and young people and their parents will be advised of the placement which will be available to them by the end of June 2014.

HSE National Service Plan

Questions (45)

Caoimhghín Ó Caoláin

Question:

45. Deputy Caoimhghín Ó Caoláin asked the Minister for Health his views on the divisional plans recently published by the Health Service Executive. [6917/14]

Written answers

Minister for Health

The 2014 HSE National Service Plan was published on 18th December last and sets out the health and social care services that the Executive is to deliver during the course of this year. The 2014 Service Plan was the first Service Plan prepared by the newly established HSE Directorate, set up under the Health Service Executive (Governance) Act 2013. Under this new legislative framework health and social care services are now organised on a Divisional basis with specific budgets allocated to each Division. These Divisions include Acute hospitals, Mental Health, Social Care (including Elderly & Disability), Primary Care (including PCRS), and Health and Wellbeing.

The detail of health and social services to be provided by each of these Divisions is outlined in the recently published Divisional Operational Plans. I very much welcome the fact that the focus in each Divisional Plan is on (i) ensuring the delivery of sustainable health services, (ii) Quality and Patient Safety (which underpins all service delivery), Staff (at the heart of patient care), and Performance Management Culture (with a key focus in 2014 on Quality & Safety, Activity, and Financial performance). The Divisional Operational Plans were published on 30th January last and are available on the HSE website.

Maternity Services

Questions (46)

Robert Troy

Question:

46. Deputy Robert Troy asked the Minister for Health if maternity services at Midland Regional Hospital, Mullingar are on a par with those provided at similar hospitals; if all the recommendations of the Health Information and Quality Authority report into the death of Savita Halappanavar have been implemented; if not, the timeframe for same; and if he will make a statement on the matter. [6939/14]

Written answers

Minister for Health

I am aware of the concerns of many pregnant women throughout the country and would like to assure them that Ireland is a safe country in which to have a baby. Compared to neighbouring countries, we have low rates of perinatal deaths, and the rates continue to fall. The perinatal mortality rate is estimated by the ESRI at 5.9 per 1,000 live births and stillbirths in 2012 – a decline of 31% since 2003.

The actions required to address the recommendations in the HIQA Report into the death of Savita Halappanavar are being undertaken across our health services with a view to improving patient safety and providing a more patient-centred model of care. An implementation plan is now in place, overseen by the HSE's Director of Acute Hospitals and is being monitored closely by both my Department and the HSE. I received a progress report recently and am pleased that progress has been made in addressing both local and national recommendations. Monthly updates on progress will be provided.

The Deputy might also like to note that my Department, in conjunction with the HSE, will develop a new National Maternity Strategy this year. This will provide the strategic direction for the optimal development of our maternity services to ensure that women have access to safe, high quality maternity care, in a setting most appropriate to their needs. The Strategy will ensure that going forward our services are fit for purpose and in accordance with best available national and international evidence. Development of the Strategy will necessitate a review and evaluation of current services. In that context, maternity services provision at Midland Regional Hospital, Mullingar will be examined.

Question No. 47 answered with Question No. 34.

Disability Services Funding

Questions (48)

Finian McGrath

Question:

48. Deputy Finian McGrath asked the Minister for Health if he will support the Prosper Fingal disability group and the services it provides in 2014; and if he will make a statement on the matter. [6899/14]

Written answers

Minister of State at the Department of Health

Prosper Fingal was established in 1978 as a parents and friends organisation (formerly called The Fingal Association for the Handicapped), to provide a local day service for adults with a moderate or mild learning disability. The aim of the organisation is to "enable people with disabilities develop their true potential towards full and independent participation in society". Prosper Fingal provides personal and social services to adults with an intellectual disability on behalf of the Health Service Executive under Section 39 of the Health Act 2004. Services are provided through a Service Arrangement which is reviewed on an annual basis.

The Government currently provides funding of approximately €1.4 billion to the Disability Services Programme through the HSE's National Service Plan for 2014. In 2014, the HSE is seeking to maximise the provision of services within available resources and to maintaining a consistent level to that provided in 2013, 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 6,000 people with intellectual and physical disabilities;

- 3.7 million hours of Personal Assistant / Home Support

Additional funding of €14 million has been provided to address the priority needs within disability services identified by the Minister and advised to the HSE. This includes:

- €7 million to provide additional places for school-leavers and those leaving Rehabilitative training,

- €3 million to provide emergency placements, and

- €4 million to deliver the required increase in services for children with disabilities, including autism, and to reduce waiting lists under the Progressing Disability Services for Children and Young People (0-18s) Programme.

In addition a total of 150 people will be facilitated to move from institutions to homes in the community.

In relation to the specific queries raised by the Deputy, as these are service issues they have been referred to the HSE for direct reply.

Ambulance Service Response Times

Questions (49)

Dara Calleary

Question:

49. Deputy Dara Calleary asked the Minister for Health if he is satisfied with ambulance response times; the terms of references for the Health Information and Quality Authority review of the service; and if he will make a statement on the matter. [6930/14]

Written answers

Minister for Health

The National Ambulance Service (NAS) uses the response time targets set out in the HSE National Service Plan. For ECHO (life-threatening cardiac or respiratory) 999 calls, the Service exceeded its 2013 response time target of 70% of patient-carrying vehicles on scene within 18 minutes 59 seconds. The DELTA (life-threatening other) response time performance was 4% below the national target of 68%. In 2014, the targets have increased to 80% for both call types.

I am aware that concerns have been raised recently concerning ambulance service response times. In the circumstances, I have asked HIQA to bring forward its planned review of pre-hospital emergency care, which had been due to commence in Q2 2014.  The Authority will review the governance arrangements of pre-hospital emergency care services to ensure the timely assessment, diagnosis, initial management and transport of an acutely ill patient to an appropriate healthcare facility. Planning for the review has now commenced and HIQA is currently in the process of designing an Assessment Framework against the National Standards for Safer Better Healthcare.

I should also explain that the NAS will undertake its own capacity review, to determine current and future service delivery needs. This process will examine a number of areas, including staff numbers and skill mix, as well as resource distribution.

Question No. 50 answered with Question No. 39.

Cancer Incidence

Questions (51)

Billy Kelleher

Question:

51. Deputy Billy Kelleher asked the Minister for Health his views on the recent UN report which forecasts a major increase in the incidence of cancer over the next 20 years; and if he will make a statement on the matter. [6926/14]

Written answers

Minister for Health

The third World Cancer Report was published recently by the International Agency for Research on Cancer (IARC). This report outlines the scale of the growing cancer burden worldwide and urges governments to implement measures for the prevention and early detection of cancer. Meanwhile, the latest projections from the National Cancer Registry indicate that the incidence of cancer in Ireland is expected to double by 2040. They attribute this in the main to demographic changes such as population size and an aging population.

However, although demographic change will be the main factor driving an increase in cancer numbers in Ireland and worldwide, the National Cancer Registry indicates that trends in risk factor prevalence, such as tobacco use, the consumption of alcohol, diet, overweight/obesity and lack of physical exercise will also have an impact. Also, the welcome expansion of population-based screening for breast, cervical and colorectal cancers is likely to increase the cancer detection rate in the short-term. Ireland has focused on improving the quality of cancer services through reorganisation and expansion and has achieved significant improvement in the rates of cancer survival in recent years. Five-year survival rates for all cancers has increased to 56.4% for people diagnosed between 2003-2007, compared to 49.6% for people diagnosed between 1998-2002.

In regard to prevention, the recently published policy document Towards a Tobacco Free Ireland aims to achieve a decrease in smoking prevalence and to denormalise tobacco in society. Legislation in relation to alcohol is being drawn up and Healthy Ireland - a Framework for Improved Health and Wellbeing 2013-2025 sets out the whole of Government approach to making Ireland a healthier nation.

Speech and Language Therapy

Questions (52)

Joe Higgins

Question:

52. Deputy Joe Higgins asked the Minister for Health the measures he will take to ensure that a child (details supplied below) in Dublin 15 will receive immediate access to speech and language therapy in view of the fact that the application was first made in 2011. [6798/14]

Written answers

Minister of State at the Department of Health

As the particular issue raised by the Deputy relates to an individual case, this is a service matter for the Health Service Executive. Accordingly, I have arranged for the question to be referred to the HSE for direct reply to the Deputy.

Question No. 53 answered with Question No. 22.

Question No. 54 answered with Question No. 30.

Medicinal Products Availability

Questions (55, 63)

Michael Moynihan

Question:

55. Deputy Michael Moynihan asked the Minister for Health the number of hospitals in which access to the asthma medication omalizumab (Xolair) is provided to patients; and if he will make a statement on the matter. [6947/14]

Michael Moynihan

Question:

63. Deputy Michael Moynihan asked the Minister for Health the reason progress has not been made in providing access to the life-changing medication for severe asthma, omalizumab (Xolair), to patients in Cork University Hospital; and if he will make a statement on the matter. [6946/14]

Written answers

Minister for Health

I propose to take Questions Nos. 55 and 63 together.

In relation to the specific queries raised by the Deputy, as these are service matters they have been referred to the HSE for direct reply.

Question No. 56 answered with Question No. 35.

Accident and Emergency Services Provision

Questions (57)

Seán Ó Fearghaíl

Question:

57. Deputy Seán Ó Fearghaíl asked the Minister for Health the measures being put in place to address overcrowding in the emergency department at Tallaght hospital; and if he will make a statement on the matter. [6934/14]

Written answers

Minister for Health

The Department of Health, the HSE SDU and the INMO are at one in regarding trolley waits to be an unacceptable feature of the Irish healthcare system which must be addressed. However, year to date on a national basis we are 2.9% ahead of 2013 and 33.7% ahead of the baseline 2011 trolley count. These percentages are equivalent to 237 and 4,015 fewer patients on trolleys respectively.

Tallaght hospital is experiencing an unprecedented surge in the number of people attending the Emergency Department. The CEO of Tallaght Hospital has categorically stated that it is not the case that the health of patients is under threat. He has provided assurances that the situation is being actively managed and that the hospital is providing adequate patient care.

I have been advised by the HSE that a small number of day case procedures have been cancelled and these patients have been notified. As is standard practice when EDs are experiencing a surge of attendances, other measures to be utilised include using closed beds, beds designated for day procedures, treatment rooms and where no other option remains, by putting additional beds onto wards. No-one considers this last option to be desirable, but it has been shown to be clinically safer than leaving patients in over-crowded Emergency Departments. It is also acknowledged that additional patients bring additional responsibilities for front line staff, but this has always been the case at peak times. By placing patients in wards, they are removed to a less stressful environment, where they are afforded a greater measure of comfort, privacy and dignity, and where their clinical needs can be appropriately managed.

With regard to staffing issues, the number of nurses has increased from February 2013, with 938 nurses currently employed at Tallaght, 30 of whom were recruited in the last month. Further recruitment is ongoing.

Medical Card Data

Questions (58)

Billy Kelleher

Question:

58. Deputy Billy Kelleher asked the Minister for Health the number of discretionary medical cards he expects there to be at the end of 2014; the number there was at the end of 2013; the number of new discretionary medical cards issued in 2013; the number withdrawn in 2013; the number of discretionary medical cardholders who were awarded a non-discretionary medical card in 2013; and if he will make a statement on the matter. [6924/14]

Written answers

Minister of State at the Department of Health

As I have put on the record of the House on more than one occasion, there is no such entity as a discretionary medical card. There is only one medical card. Medical cards provided on the basis of means or where discretion is involved are identical and provide access to the same set of health services.

Under the Health Act, 1970 eligibility for a Medical Card or a GP Visit Card is determined on the basis of an assessment of financial means. Eligibility may be granted if the applicant cannot arrange general practitioner, medical and surgical services, for themselves and their dependants, without undue financial hardship. It is important to note discretion is not a stand-alone exercise but has been and remains, an integral part of the assessment process for a medical card.

As at 1st January 2014, the number of medical cards granted on the basis of the exercise of discretion was 50,294 and the number of GP Visit Cards granted on the basis of the exercise of discretion was 25,793. As at 1st January 2013, the number of medical cards granted on the basis of the exercise of discretion was 62,987 and the number of GP Visit Cards granted on the basis of the exercise of discretion was 15,972.

As the Deputy will be aware, fluctuations in the number of cards awarded on a discretionary basis can, in part, be attributed to the fact that more people, who previously were marginally over the normal qualifying limit, became eligible under review for medical cards under the normal qualifying scales. They were previously recorded on the medical card register as having had eligibility for a medical card granted on a discretionary basis and now, based on their financial income, are recorded on the register simply as eligible for a medical card.

The HSE is not in a position to speculate on the number of medical cards that are likely to be issued on grounds of discretion in 2014.

Services for People with Disabilities

Questions (59)

John Browne

Question:

59. Deputy John Browne asked the Minister for Health if the reduction in staff levels in the health services mean that, with regard to disability services, the capacity does not exist to implement Government policy; and if he will make a statement on the matter. [6945/14]

Written answers

Minister of State at the Department of Health

The vision for the Health Service Executive's Disability Services Programme is to contribute to the realisation of a society where people with disabilities are supported, as far as possible, to participate to their full potential in economic and social life, and have access to a range of quality personal social supports and services to enhance their quality of life. The Health Service Executive National Service Plan 2014 and the recently published 2014 Operational Plan for the Social Care Division outline the quantum of specialist services, the key reform initiatives and the additional investment in 2014 which it has assured me will give effect to this vision in 2014. The HSE will spend €1.4 billion and employ a staff level of approximately 15,000 whole time equivalents in 2014 to provide specified levels of services.

The Key Priorities for Disability Services in 2014 include the following measures which reflect the Government's policy on transforming disability services

- Implementation Framework – Value for Money and Policy Review

- People moving from institutional settings to homes in the community

- Reconfiguration of day services and services for young people leaving school / rehabilitation programmes

- Disability services for children and young people (0-18s)

- Service user involvement and quality in the development of services

In 2014 the HSE will provide the following quantum of service in support of Government policy:

- Provide Residential Support Services for almost 9,000 people with disabilities.

- Provide Day Services for 22,000 people with disabilities.

- Provide staffing in Children's Disability Services equivalent to 9 Children's Disability Network Teams.

- Commence assessments under the Disability Act 2005 on behalf of more than 4,500 children.

- Provide residential Respite Services for nearly 6,000 people with disabilities.

- Provide 1.3m hours of Personal Assistance to more than 1,800 people with disabilities.

- Provide 2.4m hours of Home Support to more than 8,000 people with disabilities.

2014 will see an additional investment of €14m and 130 additional staff to:

- Provide places for an estimated 1,200 young people leaving school or Rehabilitative Training nationwide - 35 additional staff - €7m.

- Provide "emergency" placements for people with disabilities whose care or family circumstances have changed and who now require an immediate and unplanned service response - 15 additional staff - €3m.

- Roll out a new model of assessment and intervention, the objective of which is to provide one clear referral pathway for all children (0 – 18s), irrespective of their disability, where they live or the school they attend - 80 additional therapy staff - €4m.

The delivery of high quality and safe services will remain an important focus in 2014. A particular focus will be placed on the implementation of the Health Information and Quality Authority standards for residential services for people with a disability.

Maternity Services

Questions (60)

Lucinda Creighton

Question:

60. Deputy Lucinda Creighton asked the Minister for Health if he will outline, since the Health Information and Quality Authority report into the standards of maternity care at the hospital where a person (details supplied) died almost a year ago, the subsequent recruitment that has taken place for all hospitals in maternity care here, as indicated was necessary in the report; and if he will make a statement on the matter. [6893/14]

Written answers

Minister for Health

My Department is ensuring that the actions required to implement the recommendations of the HIQA Report into the death of Ms Halappanavar are being undertaken across our health services with a view to improving patient safety and providing a more patient-centred model of care. A Progress Report by the HSE's National Director of Acute Hospitals, who has been assigned responsibility for this body of work, was forwarded to my Department on 23rd January last. Progress in implementing both local and national recommendations are well under way and will continue throughout the year. The Deputy will understand that implementation of some of the recommendations will necessarily require a longer time period beyond the current year.

Following on from the Authority's Report I have listed five key priorities in relation to patient safety:

- Patient Safety has been made a priority within the HSE's Annual Service Plan through specific measures focused on quality and patient safety including Healthcare Associated Infections, Medication Safety and implementation of Early Warning Score systems.

- My Department is leading the development of a Code of Governance which will clearly set out employers' responsibilities in relation to achieving optimal safety culture, governance and performance.

- I have asked HIQA to ensure that my patient safety priorities are included in the monitoring programme against the National Standards for Safer Better Care.

- My Department, in conjunction with the HSE, will develop a new National Maternity Strategy this year to provide the strategic direction for the optimal development of our maternity services.

- I have instructed the National Clinical Effectiveness Committee (NCEC) to commission and quality-assure four priority national guidelines on Sepsis, Clinical Handover, Maternal Early Warning Score and Paediatric Early Warning Score. This body of work is in progress.

In relation to recruitment I would like to advise the Deputy that despite our falling birth rates, increased numbers of midwives have been employed in the health service. The number of Staff Midwives employed at the end of 2010 was 1,178 (WTE's). By the end of 2013, the number had increased to 1,341, including 20 recently qualified midwives participating in the Graduate Nursing/Midwifery Programme. This increase reflects the capacity of the HSE to appoint critical front-line staff where it is necessary to do so, notwithstanding overall recruitment constraints.

Palliative Care for Children

Questions (61)

Seán Ó Fearghaíl

Question:

61. Deputy Seán Ó Fearghaíl asked the Minister for Health if the Health Service Executive will be providing paediatric care packages for children with life-limiting conditions; and if he will make a statement on the matter. [6933/14]

Written answers

Minister of State at the Department of Health

In 2010, the Department of Health published "Palliative Care for Children with Life-limiting Conditions in Ireland - A National Policy". The report contains 31 recommendations which are being implemented under the aegis of the National Development Committee which is a multi-stakeholder representative group, chaired by the Health Service Executive (HSE). The national policy provides the framework for the development of services for children with life-limiting conditions and their families. The policy places significant emphasis on supporting families and health care professionals to provide care for children in their own homes.

A programme of care for children with life-limiting conditions is being jointly funded by the HSE and the Irish Hospice Foundation. The programme includes the appointment in 2011 of the first Paediatric Consultant with a Special Interest in Palliative Care based in Crumlin. As well as supporting other paediatricians, the Consultant also provides clinical support and advice to maternity hospitals and neonatologists. The programme has also provided eight Children's Outreach Nurses whose role is to ensure that children being cared for at home by their families, have access to co-ordinated and supportive services.

The nurses liaise closely with statutory and voluntary service providers including local GPs, Public Health Nurses, Disability Services, the Jack and Jill Foundation and LauraLynn's Children's Hospice etc. An evaluation of the outreach nursing component of the Children's Palliative Care Programme is planned to take place this year. This will provide information on how the programme is working to-date and provide pointers for future development. The study will be undertaken on behalf of the Irish Hospice Foundation, the HSE and the Department of Health.

Another aspect of the children's programme is the provision of structured education programmes for all health care staff who care for children with life-limiting conditions. This is being delivered in partnership with Our Lady's Children's Hospital in Crumlin. These programmes will help ensure that children and their families will have the necessary care and support provided to them, regardless of the location of that care.

In the HSE's National Service Plan for 2014, the key priority in relation to children is to develop and integrate community based paediatric palliative care services. In 2012, HSE regions spent approximately €8.58 million on home nursing for children with life-limiting conditions. However, it is widely acknowledged that because of how the financial system is set up, this figure did not capture all relevant expenditure and that the total spend was significantly higher. It is also acknowledged that children with life-limiting conditions, and particularly children with palliative care needs, are prioritised within HSE regions. Every effort is made to care for these children to the maximum extent possible, including home care for the children and their families.

In addition to this, the Palliative Care National Development Committee has commenced working on the development of a model for the provision of Hospice at Home care. This is being carried out in partnership with current voluntary providers such as the Irish Hospice Foundation, LauraLynn's Children's Hospice and the Jack & Jill Foundation.

In 2013, the budget for Palliative Care Services was €72m. The budget for 2014 is almost €73m.