Written Answers Nos. 227-235
227. Deputy Tony McLoughlin asked the Minister for Health when a person (details supplied) in County Leitrim will receive an appointment for orthodontic treatment; and if he will make a statement on the matter. [8536/14]
View answerThe HSE provides orthodontic treatment to patients based on their level of clinical need. An individual's access to orthodontic treatment is determined against a set of clinical guidelines and priority is given to patients with greatest needs. The HSE has been asked to examine the specific query raised by the Deputy and to reply to him as soon as possible.
228. Deputy Róisín Shortall asked the Minister for Health the progress made to date on the national asthma programme; if he will set out his plans and timelines for its full implementation; and if he will make a statement on the matter. [8540/14]
View answerThe HSE, through its Clinical Strategy and Programmes Division, established the National Clinic Programme for Asthma (NCPA), which is one of a number of chronic disease programmes aimed at bringing a systematic approach to changes in how services for patients are delivered.
The overarching aim of the Programme is to reduce the morbidity and mortality associated with asthma in Ireland and to improve clinical outcomes and the quality of life of all patients with asthma. A key component is the improved management of people with asthma in primary care, thereby, avoiding emergency attendance at General Practitioner (GP) out-of-hours services, at hospital emergency departments and in-patient admission services.
The initial focus of the work of the NCPA has been primarily on:
- The development and implementation of national asthma guidelines based on international best practice for acute and ongoing asthma management and national asthma education initiatives for patients and health care professionals; and
- The organisation and better integration of national asthma services at primary and secondary care levels through the development of a national model of care.
The acute adult and paediatric asthma guidelines and associated care pathways, treatment protocols and care bundles have now been developed for use in primary and secondary care settings. The Adult and Paediatric Emergency Asthma Guidelines are both available on the HSE website at http://www.hse.ie/eng/about/who/clinical/natclinprog/asthmaprogramme/.
The NCPA has also worked with the Irish College of General Practitioners (ICGP) in the development of "Asthma Control in General Practice", which is a guideline for managing a patient with asthma in primary care. This document is available on the ICGP website at http://www.icgp.ie/go/library/catalogue/item?spId=05FBC657-258C-42B5-B4F111ACAAE823E2.
Up to date information is available for patients and their families and carers. Easily accessible patient asthma education supports have been implemented, in conjunction with the NCPA's key stakeholder, the Asthma Society of Ireland (ASI), to assist guided self management for this chronic condition. These are available on both the HSE and ASI websites.
A self-learning asthma E-Learning 6 modular theoretical programme, based on the national evidence based guidelines and developed by the NCPA in conjunction with the ASI, is also freely available on both the HSE and ASI websites for any health care professionals who wish to update their knowledge. This will enable health care professionals to underpin their skill sets with theory. There is also a similar programme available for GPs on the ICGP website.
In addition, a practical workshop is being delivered by the respiratory Clinical Nurse Specialists for staff in primary and secondary care. This education programme will continue throughout 2014.
The NCPA has developed a National Model of Care (MOC) for Asthma, which details how physicians, nurses and other health care professionals will work with engaged patients to make the clinical decisions most appropriate to the patient's circumstances, while collaborating with specialist colleagues in providing a safe, seamless patient experience within the health system in Ireland. The Model of Care is currently at final stages of approval.
Implementation of the National Clinical Programme for Asthma is ongoing and will continue in 2014.
229. Deputy Róisín Shortall asked the Minister for Health the progress made to date on the national diabetes programme; if he will set out his plans and timelines for its full implementation; and if he will make a statement on the matter. [8541/14]
View answerThe National Integrated Care Diabetes Programme aims to improve patient access and manage patient care in an integrated manner across service settings, resulting in better outcomes, enhanced clinical decision making and the most effective use of resources. In particular, the Programme proposes to change the way care is delivered to people with Type 2 Diabetes and to support a National Model of Integrated Care. The Model, which is evidence based and clinically acceptable, is the result of an extensive consultation process and agreed by the relevant stakeholders. The aim is to facilitate the structured care of patients with uncomplicated Type 2 Diabetes in the Primary Care setting only while patients with complicated Type 2 Diabetes will be managed by primary and secondary care services.
The Diabetic Retinopathy screening and treatment initiative commenced in 2013 and was successful in inviting 30% of registered patients with diabetes for screening, as planned. In 2014, it is proposed to screen the remaining 70% of the diabetic population, as set out in the HSE's National Service Plan 2014. This screening is being carried out through the National Cancer Control Programme Office.
A National Model of Care for Type 2 Diabetes has been developed with the joint involvement of health care providers in primary, secondary and tertiary care sectors. The focus of the Model is the concept of "Integrated Care", where all health care providers come together to communicate effectively and coherently to manage a person with Type 2 Diabetes.
In summary, the Model recommends that:
- People with uncomplicated Type 2 Diabetes will be under the governance of their General Practitioner (GP), with the support of a multidisciplinary community based team and have a clearly defined pathway of care, and will be seen three times a year in a primary care setting.
- People with complicated Type 2 Diabetes will be under the governance of both their GP and a consultant endocrinologist in a secondary or tertiary care setting.
- People with Type 1 Diabetes or complex genetic or secondary causes of diabetes will have their diabetes related care under the governance of the consultant-led diabetes multidisciplinary team in a secondary or tertiary care setting.
As part of the phased roll out of the National Integrated Care Diabetes Programme and to support the Model of Care, the Government approved funding for the appointment of 17 Integrated Care Diabetes Nurse Specialists (one per HSE Integrated Service Area). These Diabetes Nurse Specialists will play a key role in the development of clinically sound collaborative links between primary care and secondary care providers and will also be an essential resource in empowering patients to achieve optimum diabetes control. To date, 16 of these posts have been filled or have start dates agreed and the remaining post will be filled as soon as possible in 2014.
230. Deputy Róisín Shortall asked the Minister for Health in respect of the provision of primary care centres by means of leasing arrangements with the private sector, if he will outline the system, if any, by which locations are prioritised to ensure limited resources are allocated to the areas of greatest need; and if he will make a statement on the matter. [8542/14]
View answerIn 2012 the HSE completed on a prioritisation exercise for all primary care centre locations. The primary care infrastructure model offers a good fit for public private financing.
In addition to the locations' ranks as a result of the prioritisation exercise, the mechanism and timescale for delivery of primary care infrastructure, including those to be delivered by the operational lease mechanism, is dependent on a number of factors including GP participation. GP commitment to sharing accommodation with HSE staff and delivering health care services from these facilities is essential for primary care centre delivery. Therefore locations cannot proceed unless GPs are prepared to engage in the process.
Regardless of the delivery mechanism, all potential primary care centres are also subject to suitable locations being offered/provided/available and to successful planning processes. In addition the operational lease mechanism is subject to market pressures such as the developers' access to sufficient financing. Delivery of primary care infrastructure is a dynamic exercise, constantly evolving to take account of changing circumstances including the feasibility of implementation.
As with all capital projects this programme must be considered within the overall capital envelope available to the health service. There will always be more projects than can be funded by the Exchequer. There is limited funding available for new projects over the period 2014-2018 given the level of commitments and the costs to completion already in place. Nevertheless, where possible, the HSE's capital programme will include provision to progress primary care centres with the highest ranking following the 2012 national prioritisation exercise by direct/own-build in the event that other delivery mechanisms are not feasible.
231. Deputy Róisín Shortall asked the Minister for Health the waiting time for a microsatellite instability, MSI, test for public patients after colon cancer surgery and chemotherapy in the north-east region; and if he will make a statement on the matter. [8544/14]
View answerThe Deputy's question relates to service delivery matters and accordingly I have asked the HSE to respond directly to her.
232. Deputy Clare Daly asked the Minister for Health if he will immediately engage with general practitioner representatives to agree a suitable contract for the under six medical card scheme in view of the serious problems identified by these representatives with the contract which has been drafted. [8556/14]
View answer233. Deputy Billy Kelleher asked the Minister for Health his views on assertions the draft contract for the provision of GP care to children aged under six is a completely one-sided document which places enormous responsibilities on the general practitioner with no balanced responsibilities included for the Health Service Executive or the Department, that it is not patient centred and is heavily focused on the bureaucracy and administrative requirements of the HSE; and if he will make a statement on the matter. [8568/14]
View answer234. Deputy Billy Kelleher asked the Minister for Health the reason the draft contract for the provision of general practitioner care to children aged under six makes no reference to the Medical Practitioners Act 2007; and if he will make a statement on the matter. [8569/14]
View answer235. Deputy Billy Kelleher asked the Minister for Health the reason the draft contract for the provision of general practitioner care to children aged under six contains a stipulation the service provider shall not do anything to prejudice the name or reputation of the Health Service Executive; the other contracts in the health service that contain such a clause; if the contract with hospital consultants contains such a clause; and if he will make a statement on the matter. [8570/14]
View answerI propose to take Questions Nos. 232 to 235, inclusive, together.
A public consultation process started on 31st January 2014 relating to the content and scope of a new GP contract to underpin the provision of GP care, free at the point of use, for all children aged under six years of age.
I met with key stakeholders on 31st January - 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 and the closing date for receipt by the HSE of written submissions is 21st February 2014.
This is the first public consultation of its kind. I welcome all views on the type of service to be delivered to children under this new arrangement and look forward to the results of the consultation process.
With reference to the specific clause in the draft contract to which Deputy Kelleher refers (Clause 28.4.4), it is intended to reflect and be protective of the HSE's interests given that the primary statutory obligations to provide general practitioner medical and surgical services will rest with the HSE. It is not in any sense intended to impose unwarranted or inappropriate restrictions on individual GP contractors in advocating on behalf of their patients.
A similar clause can be found in the form of agreement with Clinical Dental Technicians, which was introduced in 2011. The clause in question should be viewed in the context of the entire draft document, where the intent is to balance the duties, obligations and rights of both parties, while at the same time, having due regard to the overriding statutory obligations that will rest with the HSE.
I will be pleased to discuss this, and all other provisions contained in the draft contract, with a view to resolving any concerns which the GPs or their representatives may have.
In relation to Deputy Kelleher's question on reference to the Medical Practitioners Act, 2007, the Act is referred to in "Clause 1 Definitions and Interpretation" of the draft contract, in the context of the definition of "Service Provider".There are further references throughout the draft contract to the Irish Medical Council as the relevant competent regulatory body under the Medical Practitioners Act, 2007.
I wish to take this opportunity to reiterate that the document which has been put out for consultation is a draft. I have no doubt that there will be changes to the text following the consultation process. In particular, it is my intention to meet with the ICGP, the IMO and the NAGP in the coming weeks for detailed discussions on the scope and content of the draft contract. This will afford them the fullest opportunity to raise any and all issues which they may have regarding the draft contact and indeed, to make their own proposals as to how it may be improved.
