Questions Nos. 1 to 15, inclusive, answered orally.

Questions Nos. 16 to 95, inclusive, resubmitted.

Questions Nos. 96 to 104, inclusive, answered orally.

Accident and Emergency Services Provision

Question No. 106 answered with Question No. 101.

Questions (105)

Richard Boyd Barrett

Question:

105. Deputy Richard Boyd Barrett asked the Minister for Health if he will respond to recent reports of a significant deterioration of services in St. Vincent's hospital, Dublin 4, particularly in accident and emergency services, following the downgrading of the 24-hour accident and emergency unit in Loughlinstown hospital, County Dublin; and if he will make a statement on the matter. [14906/14]

View answer

Written answers (Question to Health)

The acute hospital service in HSE Dublin South East/Wicklow is provided through a collaborative arrangement across three sites, St. Vincent's University Hospital, St. Michael's Hospital and St. Columcille's Hospital. Work on reconfiguration of clinical services across these hospitals has been ongoing for some time, to bring service provision in line with best practice. As part of the reorganisation of services in this region, in November 2013, the emergency service at St Columcille's transferred to St Vincent's. In addition, St Columcille's opened a Local Injury Unit, open from 8am to 6pm, 7 days per week, and a consultant led Medical Assessment Unit, also open from 8am to 6pm, 7 days per week. Separating out the Local Injury Unit from the Emergency Department means that patient flow is improved within and between these hospitals.

Following this reconfiguration of services a redistribution of workload from the Emergency Department in St Columcille's was expected and planned for. During the planning phase it was acknowledged that there would be a three to six month phase while the new patient care pathways bedded down, and local patients and General Practitioners became familiar with the new arrangements. The patient flow between the hospitals is being monitored on an ongoing basis and has been reviewed and amended as required in the light of experience. I am advised by the HSE that St Vincent's Hospital Emergency Department is being appropriately managed, and is clinically safe. Staffing levels are kept under review to ensure that the staffing is appropriate to the volume of patients attending the Emergency Department. An analysis of the activity in St Vincent's Emergency Department for the period post reconfiguration shows that patient experience times remain favourable by comparison with other hospitals. There fewer people on trolleys and patient experience times continue to be among the best in Dublin.

I must emphasis that the rationale and policy context for implementing the change to emergency services is to provide a safer environment for patients and to ensure that patients receive the appropriate treatment in the appropriate setting. I would like to commend management and clinicians in the region who are committed to these changes in the interest of best possible patient care.

Question No. 106 answered with Question No. 101.

National Positive Ageing Strategy Implementation

Questions (107, 113)

Thomas P. Broughan

Question:

107. Deputy Thomas P. Broughan asked the Minister for Health his plans to increase provision of long-term residential care for elderly citizens; and his position on the future strategy for Ireland's long-term residential care sector recently published by Nursing Homes Ireland. [14705/14]

View answer

Billy Kelleher

Question:

113. Deputy Billy Kelleher asked the Minister for Health the plans that are in place to deal with the health needs of an ageing population; and if he will make a statement on the matter. [14861/14]

View answer

Written answers (Question to Health)

I propose to take Questions Nos. 107 and 113 together.

Like many other countries in Europe, Ireland's population is ageing rapidly. At the last Census in 2011, there were approximately 535,000 people aged over 65 in the population, representing an increase of 14.4% since 2006. By 2041 there will be an estimated 1.3 million to 1.4 million people aged over 65 years, representing 20-25% of the total population. The greatest increases are expected in the over-80 years age group, where numbers are expected to increase four-fold from 110,000 in 2006 to about 440,000 in 2041.

The Programme for Government committed to completing and implementing the National Positive Ageing Strategy (NPAS). The Strategy was published and launched in April 2013 outlining Ireland's vision for ageing and older people. The Strategy contains a large number of action areas around older people's participation in society, health and social care provision, financial and physical security, and the need for an evidence-based approach to policy making. Preparations are now in train for the implementation of the National Positive Ageing Strategy and the arrangements for this implementation will be finalised as soon as possible. The needs of our older people are, and will remain, a very high priority for me and for the Government, and the resources that are available will always be applied to provide the best possible mix of supports and services.

Residential care in Ireland is provided through a mix of public, voluntary and private nursing home facilities. Most of the residents receive significant financial support towards the cost of their care under the Nursing Homes Support Scheme. While there will always be a need for long-term residential care, older people have consistently said that they want to be facilitated and supported to stay in their own homes and communities for as long as possible. Accordingly the review of the Nursing Homes Support Scheme which is currently being undertaken will consider how residential and other supports and services should be balanced in the future to support older people in ways that best meet their wishes and that make the best possible use of available resources. As a first step, in 2014 an additional €23m is being provided to strengthen community and home-based services and to develop more flexible and responsive approaches to care. This is in addition to the budget of €315m already provided for home help and home care package services which are delivered to some 56,000 people at any one time.

With the above said, the Government is acutely aware of the implications for service requirements of the projected demographic trends, and all relevant information will be taken account of in future decisions. A key priority identified in the HSE's National Service Plan for 2014 is the implementation of a Single Assessment Tool (SAT) for older people. This standardised framework will uniformly assess dependency levels, allow resources to be targeted towards those with the greatest needs and enable supports and services to be designed in the most appropriate way possible. The first phase of implementation of the SAT will commence in 2014 with a minimum of 50% of all new entries to the NHSS, Home Care Package and Home Help Schemes assessed by the SAT in the last quarter of 2014, with full implementation of SAT by the end of 2015.

National Children's Hospital Status

Questions (108)

Caoimhghín Ó Caoláin

Question:

108. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the progress to date in the development of the new national children's hospital; and if he will make a statement on the matter. [14911/14]

View answer

Written answers (Question to Health)

The National Paediatric Hospital Development Board is responsible for this priority capital project, and is focused on delivering the new hospital on schedule, to optimal design and value for money. The Development Board is currently in the final selection phase of the process leading to the appointment of the Design Team. Short-listed architectural teams have been announced, and tender documents issued on 24 March to these and all shortlisted bidders across all design team disciplines.

The full design team is expected to be appointed in June and, following hospital design development, planning submission is expected in February 2015. A planning decision is expected in August 2015 and construction is scheduled to commence also in August 2015. Transition of services to the new children's hospital is expected to commence at the end of 2018. I also announced in January that satellite centres of the main hospital would be built on the campuses of Tallaght and Connolly hospitals. Each will provide urgent care and outpatient care, improving access for children in the Greater Dublin Area to these services and are expected to be complete in mid-2016.

The Children's Hospital Group is focused on ensuring the operational integration of the three existing children's hospital services well in advance of their move to the new hospital. This is of critical importance in ensuring the new hospital functions effectively from the outset.

Services for People with Disabilities

Questions (109)

John Browne

Question:

109. Deputy John Browne asked the Minister for Health the measures in place to help people with spina bifida; and if he will make a statement on the matter. [14879/14]

View answer

Written answers (Question to Health)

People with spina bifida and hydrocephalus receive a wide range of public health services from primary care including GP and community services through specialist disability services and acute hospital out patient and in patient services. The diagnosis, treatment and care of individuals with spina bifida and hydrocephalus requires input from all of these services and the qualified specialist people working in these areas.

The Children's University Hospital, Temple Street is the national tertiary care centre for spina bifida and hydrocephalus. I understand all infants born in Ireland with spina bifida are referred to Temple Street after birth for ongoing neonatal management. Children with spina bifida are seen by a multidisciplinary team at Temple Street including a Spina Bifida Nurse Specialist.

The HSE funds a range of community services and supports to enable each individual with a disability, including persons with spina bifida and hydrocephalus, to achieve his or her full potential and maximise independence, including living as independently as possible. Services are provided in a variety of community and residential settings in partnership with service users, their families and carers. Services are provided either directly by the HSE or through a range of voluntary service providers and community groups.

The HSE provides funding to Spina Bifida Hydrocephalus Ireland amounting to €798,031 in 2013. In addition, the HSE also provided funding of €128,152 in 2013 to the Mid West Spina Bifida and Hydrocephalus Association.

Spina Bifida Hydrocephalus Ireland has branches in all four provinces. It operates a professionally run National Resource Centre based in Clondalkin, Dublin, and provides further support in the form of a Family Support Team, a Youth and Respite Team and an advocacy and advice service providing guidance, advocacy, emotional and practical support to members from time of diagnosis through to adulthood. I would like to acknowledge the work of Spina Bifida Hydrocephalus Ireland and the significant role it has played in the lives of people with spina bifida and hydrocephalus.

Maternity Services Provision

Questions (110)

Seán Fleming

Question:

110. Deputy Sean Fleming asked the Minister for Health if he intends to reconfigure maternity services nationwide; and if he will make a statement on the matter. [14868/14]

View answer

Written answers (Question to Health)

As the Deputy will be aware, in May of last year, I published the Report on the Establishment of Hospital Groups. The formation of acute hospitals into a small number of groups will provide the optimum configuration for hospital services to deliver high quality, safe patient care. Each group will have at least one major university teaching hospital, a cancer centre and a maternity service, and is required to develop a strategic plan within one year of establishment. These plans will describe how the Group will: (i) provide more efficient and effective patient services, including for maternity care; (ii) reorganise these services to provide optimal care to the populations they serve; and (iii) achieve maximum integration and synergy with other groups and all other health services.

In terms of the reorganisation of maternity services, the recently published Chief Medical Officer's report on Portlaoise Hospital Maternity Services is also of relevance. That Report recommended that the Portlaoise Maternity Service should become part of a managed clinical network under a singular governance model with the Coombe Women & Infant University Hospital. The Report also recommended that other small maternity services around the country should be incorporated into managed clinical networks within the relevant hospital group. I have accepted all of the Report's recommendations. The rollout of such managed clinical networks work will be undertaken in the context of the implementation of Hospital Groups.

The Deputy may also wish to note that my Department, in conjunction with the HSE, is preparing a National Maternity Strategy which will provide the strategic direction for the optimal development of safe and high quality maternity services. The Strategy will incorporate a review and evaluation of our services and therefore provide us with the opportunity to take stock of current services and identify how the quality and safety of care provided to women and their babies can be further improved.

General Practitioner Services Provision

Questions (111, 124, 134)

Liam Twomey

Question:

111. Deputy Liam Twomey asked the Minister for Health the performance reviews in regards to the draft agreement for the provision of services to under six year olds; if he will provide details of the electronic initiatives; the person who will provide the guidelines to the Health Service Executive regarding these issues; the person in the HSE who will decide what medications and appliances GPs may prescribe; the person who will decide what are the most economic treatments in line with the HSE budgets; and if he will make a statement on the matter. [14707/14]

View answer

Niall Collins

Question:

124. Deputy Niall Collins asked the Minister for Health when he will publish a revised draft contract for GPs; and if he will make a statement on the matter. [14884/14]

View answer

Liam Twomey

Question:

134. Deputy Liam Twomey asked the Minister for Health regarding the draft agreement for the provision of services to under six year olds, if any concerns have been raised by the Data Protection Commissioner on sections dealing with the exchange of information by GPs and the Health Service Executive; and if he will make a statement on the matter. [14706/14]

View answer

Written answers (Question to Health)

I propose to take Questions Nos. 111, 124 and 134 together.

The Office of the Data Protection Commissioner has not raised concerns with the Department of Health or the HSE about sections of the draft agreement for the provision of services to children under six years that relate to the exchange of information between General Practitioners (GPs) and the HSE. However, it is the HSE's intention to consult with the Office of the Data Protection Commissioner with a view to ensuring that the contract, when finalised, is fully compliant with the requirements of data protection legislation.

The Department and the HSE have been working collaboratively for a number of years with the Irish College of General Practitioners (ICGP), under the auspices of the General Practitioner Information Technology (GPIT) Group, to further enhance the already impressive level of ICT deployment in general practice. Examples of the initiatives that are being progressed in general practice include specialist electronic referrals, general electronic referrals, secure e-mail, the management of client indices and electronic diagnostic messaging. Other potential areas where ICT deployment would be of benefit include electronic prescribing, clinician decision support functionality, electronic registers to support the management of chronic diseases, and shared electronic records to support the integrated care of patients within the primary care setting and between primary and secondary care clinicians.

It is envisaged that the draft contract for children under 6 years, when finalised, will facilitate the continued deployment of technology based solutions in general practice. In this context, it is hoped that the GPIT group will continue to fulfil its key collaborative role in facilitating the introduction of ICT initiatives through the consensus based approach that has worked well over the past number of years. In a similar vein, it is intended that the contract, in its final format, will support and encourage GPs to observe cost effective prescribing through, inter alia, decision support technology, as well as evidence based support and guidance from the HSE Medicines Management Programme. The provisions on prescribing practice in the draft contract are not intended to impose unwarranted interference on a GP's clinical judgement and autonomy. The details around how prescribing initiatives will be implemented will involve extensive and focused engagement with GPs who are, I believe committed to the efficient use of resources to ensure that we achieve the best possible outcomes for patients.

The concept of performance reviews is a well-recognised feature of contracts for service and for this reason has been included in this draft contract. I have noted the comments received on this matter as part of the public consultation process and I am open to accommodating the views of the key stakeholders in the final contract.

Regarding the publication of a revised draft contract, I am keen to ensure that the draft contract is subjected to a rigorous consultative process and I am quite prepared to amend the document, as appropriate, based on the feedback and commentary received. In this context, I have written to the Irish Medical Organisation (IMO) to assure them that the Department and the HSE are fully prepared to engage meaningfully with them and are prepared to negotiate with them on all aspects of the scope and content of the proposed contract. I have also explained that there will be an opportunity for their input on the fee structure, which will be addressed by means of a related consultation process.

I trust that the IMO will accept my invitation to commence negotiations with the Department and the HSE. I am confident that a process of open discussion has the potential to significantly enhance the draft contract for patients, GPs, the HSE and the Department, thus helping to progress our common goal of free GP care at the point of access.

Children in Care

Question No. 113 answered with Question No. 107.

Questions (112)

Michael Moynihan

Question:

112. Deputy Michael Moynihan asked the Minister for Health his response to the criticisms of the child and adolescent mental health services in the recent report by the Ombudsman for Children entitled A Meta-analysis of Repetitive Root Cause Issues regarding the Provision of Services for Children in Care; and if he will make a statement on the matter. [14883/14]

View answer

Written answers (Question to Health)

I note the report referred to by the Deputy which was published recently by the Office of the Ombudsman for Children. A significant part of the report refers to services provided by the Child and Family Agency, and my colleague the Minister for Children and Youth Affairs has recently responded to the issues raised in the report. As a number of the report's recommendations relate to the HSE Child and Adolescent Mental Health Services, and the need for improved inter-agency co-operation with the Child and Family Agency, I have asked the Executive to consider these and determined the steps necessary to address the issues identified.

The HSE Child and Adolescent Mental Health Services are benefitting significantly from the funding provided by the Government for mental health services, which amounts to €766 million in 2014, including additional funding of €20 million this year, as part of total additional funding of €90 million over the period 2012 to 2014 inclusive. By the end of 2014, upwards of 1,100 new posts will be put in place, to strengthen Community Mental Health Teams for both adults and children, and develop other specialist mental health services.

A Vision for Change recommended the establishment of 99 multi-disciplinary Child and Adolescent Mental Health teams to provide acute secondary mental health care in the community. There are now 61 CAMHS teams in place, compared to 54 in 2008. The additional funding in 2012-14 is being used, in part to expand and enhance the skill mix of these teams. Around 230 new posts were allocated to CAMHS over 2012-13 and recruitment is well advanced. The increasing demands being placed on our Child Mental Health Services were reflected in the 14,000 or so referrals received by CAMHS teams in 2013. This was nearly 1,000 or 8% more, than projected in the HSE National Service Plan last year. However, the target of 70% of referrals being seen within 3 months was maintained.

I accept that there are specific additional risks of developing mental illness associated with children who are within the care system and that a proportion of the children attending CAMHS services are in contact with, or in the care of, the social services. A comprehensive protocol is in place between the HSE and the Child and Family Agency to ensure that the needs of children in the care of the State have access to CAMHS services in the same way as any other child with a mental illness, prioritised on need.

Question No. 113 answered with Question No. 107.

Chronic Disease Management Programme

Questions (114)

Patrick O'Donovan

Question:

114. Deputy Patrick O'Donovan asked the Minister for Health the progress being made on implementation of the national clinical programme for asthma; and if he will make a statement on the matter. [14701/14]

View answer

Written answers (Question to Health)

The 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. Asthma is the most common chronic respiratory disease in Ireland, affecting people of all ages and all socio-economic groups. Ireland has the fourth highest prevalence of asthma worldwide and current estimates suggest that there are approximately 450,000 people with doctor-diagnosed asthma in Ireland (approximately 1 in 10 of the population). The prevalence is even higher in children, with about 21% of children affected. Asthma is often under-diagnosed and uncontrolled, creating a substantial burden of ill-health to individuals. Between 35% and 50% of medical expenditure on asthma is a consequence of exacerbations, an asthma outcome most view as representing treatment failure. Hospitalisation, emergency department and unscheduled hospital visits, and use of rescue medications comprise the majority of exacerbation-related treatment costs.

The overarching aim of the NCPA 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 out-of-hours services, emergency departments and in-patient services. The development of the Programme has been influenced by international evidence of the effectiveness of asthma management, with significantly improved outcomes focusing on improving asthma control in the community. The initial focus of the work of the NCPA has been on the development of national asthma guidelines based on international best practice, early asthma diagnosis, active asthma treatment, guided self-management and patient education.

The Programme has also developed a National Model of Care for Asthma, which details how physicians, nurses and other health 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. A number of elements of the NCPA have already been implemented, including development of guidelines, an asthma education programme and patient education materials. The NCPA is listed in the HSE's Primary Care Divisional Operational Plan for 2014 and work is underway on an implementation plan for the Model of Care. The work of the Programme will ensure that patients with asthma will benefit from being part of a well-managed integrated system of care, coordinated at primary care level.

Energy Conservation

Questions (115, 135, 494)

David Stanton

Question:

115. Deputy David Stanton asked the Minister for Health the strategies being developed by his Department to encourage and promote energy saving in premises owned or operated by his Department and the Health Service Executive; the targets in place to gauge the success of such strategies; and if he will make a statement on the matter. [14902/14]

View answer

David Stanton

Question:

135. Deputy David Stanton asked the Minister for Health the policy and practice of his Department regarding energy saving and efficiency in premises owned or operated by his Department and the Health Service Executive; and if he will make a statement on the matter. [14901/14]

View answer

Terence Flanagan

Question:

494. Deputy Terence Flanagan asked the Minister for Health the progress to date that has been made by the Health Service Executive in carrying out an audit of energy usage in its buildings; and if he will make a statement on the matter. [14693/14]

View answer

Written answers (Question to Health)

I propose to take Questions Nos. 115, 135 and 494 together.

My Department is participating in the Office of Public Works (OPW) "Optimising Power @ Work" Scheme. The main focus of the scheme is to improve energy efficiency and reduce CO2 emissions through improved heating, ventilation and air conditioning systems and a staff awareness campaign to reduce energy consumption where possible. In the last two years, the main heating system was upgraded as was the Building Management System which provided more efficient generation and distribution of the heating. As a result, savings have been achieved in the heating and electricity consumption at my Department's offices in Hawkins House, notwithstanding the age of the building and the limitations arising from single glazed metal windows. The overall energy consumption has been reduced by 9% since the Scheme was introduced in 2007.

In regard to the Health Service Executive (HSE) I have been informed that in early 2013 the National Health Sustainability Office (NHSO) was established within the Estates Function of the HSE. All Sustainability related, including all energy, waste and water related projects, will now be channelled through the NHSO. The following strategies, which will include clearly identified targets and objectives, are currently being developed by the office:

- Health Energy Strategy: Currently being finalised

- National strategies for Clinical and Hazardous Waste, Domestic Waste, Water and Wastewater: To be developed in 2014

- National Health Sustainability Strategy: To be developed in 2014.

Since the NHSO's establishment a number of steps have been undertaken by the office to encourage and promote energy savings in premises. These include:

- Energy MAP Training: National training programme on energy management and capacity building run in conjunction with the Sustainable Energy Authority of Ireland (SEAI). The attendance over the three-day programme equated to approximately 400 person days and included representation from the Voluntary Hospitals

- Geographical Survey: A survey involving 2,443 sites was carried out in 2013 to obtain key information necessary for national sustainability programmes- Statutory Obligation of S.I. 542: The geographic survey included the recording of MPRN electricity meters and GPRN gas meters numbers at each site which were reported and verified on the SEAI database. The HSE is now fully compliant with this Statutory obligation

- Energy Service Company (ESCo) Proposals: Phase 1 Exemplar Projects - The HSE is at the pre-qualification questionnaire (PQQ) stage with three ESCo proposals - installation of wood fuelled boilers to Roscommon General Hospital, Sacred Heart Hospital and Aras Attracta in Swinford, including a deep retrofit of Aras Attracta

- Office of Public Works (OPW) energy management programme: The HSE has piloted three sites; Oak House, Dr Steevens Hospital and Sir Patrick Duns. Tallaght Hospital and Galway University Hospital are also under consideration

- District Heating Proposal: There are two systems under review, Letterkenny and Kerry General Hospitals

- Energy Efficient Design Reviews: One project is now complete under this process and using the lessons learnt five more projects are in the programme.

The success of such strategies will be gauged in a number of ways including:

- Statutory and Regulatory compliance: Inform, monitor and audit with regard to the various Statutory and Regulatory compliance requirements

- ESCo Utilisation: Deliver the strategic programme of energy reduction through ESCo utilisation; with phase one being the Exemplar Projects programme and Phase 2 the introduction of the Sustainability Concession Programme

- Continuous Measurement Tool: Develop a continuous measurement tool for HSE implementation of sustainability measures in relation to: procurement, travel, facilities management, workforce, community engagement and buildings

- Contract Management: Manage energy, water and waste contracts corporately through a standard methodology and approach and introduce relevant energy, water and waste management related software and systems to ensure a standard and efficient approach

- Sustainability Management Concession Contract and the Corporate Sustainability Management Services: These key programmes of work, which have been identified as the main vehicles for developing and implementing the National Health Sustainability Strategy, will be progressed in 2014 and include the development of a fully integrated Sustainability Reporting System and Centralised Payment System (SRCPS) in anticipation of Directive 2012/27/EU of the European Parliament being transposed by June 2014 with mandatory compliance by December 2015.

Departmental Agencies Staff Remuneration

Questions (116)

Seán Fleming

Question:

116. Deputy Sean Fleming asked the Minister for Health the implications for State-funded agencies that fail to comply with consolidated public sector pay scales by continuing to make top-up payments to staff; when he expects this issue to be definitively resolved; and if he will make a statement on the matter. [9707/14]

View answer

Written answers (Question to Health)

At my request, the HSE has taken urgent action to ensure Section 38 agencies which have been found to be in breach of health sector pay policy are brought into compliance. The process which has been ongoing with the Section 38 Agencies to reach compliance with government pay policy is nearing completion. Since the beginning of the year the Regional Directors of Performance and Integration (RDPI's), with support from Regional HR, have been working with each Agency to verify where there are deviations from pay policy and to assist the Agencies to become compliant with health sector pay policy.

In line with the pay policy, organisations which wished to continue payment of an unapproved allowance were invited to submit their business cases for consideration by the HSE. Business cases were also required for the continued payment of allowances which are not encompassed by or in line with the Department of Health Consolidated Salary Scales but may have been sanctioned in the past. A total of 202 business cases have now been received. Where the HSE is satisfied that there are legitimate reasons for the continuation of an allowance, these will be submitted to the Department of Health for sanction. The Department of Health will liaise as appropriate with the Department of Public Expenditure and Reform.

An Internal Review Panel, made up of members of the HSE Leadership Team, have reviewed each business case in detail and a report on their deliberations is expected shortly. 143 business cases were received in respect of Senior Managers, i.e. those at a salary level of Grade VIII and above, for consideration by the Internal Review Panel. In addition, 59 business cases in respect of employees on a salary level below Grade VIII have been reviewed by the Regional Directors of Performance and Integration with support from Regional HR. As indicated above the Internal Review Panel process in the HSE is nearing completion. The Department expects to receive a report on the outcome of the Review Panel's conclusions shortly and will then consider any business cases that the Review Panel consider may be justified, in consultation with the Department of Public Expenditure and Reform.

Due to the complexity of the issues involved, it is difficult to give a precise timescale as to when this issue will be brought to a satisfactory conclusion. However, I am determined that the payment of unapproved allowances to senior executives will be eliminated in an expeditious manner.

Ambulance Service Provision

Questions (117)

Maureen O'Sullivan

Question:

117. Deputy Maureen O'Sullivan asked the Minister for Health the Health Service Executive's plans to remove the Dublin Fire Brigade ambulance service; the reasons for possible removal of the service; if the reasons involve the issue of cost and Health Information and Quality Authority oversight; if his attention has been drawn to the vital work that the 800 highly skilled and committed firefighter-paramedics and advanced paramedics currently do in protecting over 1 million civilians in Dublin; and if he will make a statement on the matter. [14696/14]

View answer

Written answers (Question to Health)

Dublin Fire Brigade (DFB) provides emergency ambulance services in Dublin city and county, by arrangement between Dublin City Council and the HSE. The HSE National Ambulance Service (NAS) provides some emergency capacity in the greater Dublin area, as well as non-emergency patient transport. The ongoing development of pre-hospital emergency care involves a range of initiatives, including the development of a single national control and dispatch system for the State. This new system, expected to be completed in 2015, will deploy all emergency ambulance resources in the State, including emergency ambulances, rapid response and intermediate care vehicles, first responders, aeromedical services and ambulances in Dublin.

In the context of the development of the national control system, the Dublin City Manager and the HSE's Chief Operating Officer have commissioned a joint review of DFB ambulance services in Dublin City and County. The review will consider all aspects of ambulance operations provided by DFB within the Dublin area, including the capacity and capability of ambulance services. The review will inform consideration of the best model for provision of emergency medical services in the greater Dublin area. It is part of the process of ensuring a clinically driven, nationally co-ordinated system, supported by improved technology, so that emergency pre-hospital care can continue to modernise and services can be delivered in an appropriate and timely manner, to the benefit of patients.

There has been speculation about this review and I am aware of the concerns expressed by some about the future of the service. I want to assure those concerned that I fully appreciate the service the Fire Brigade provides. This review is not a negative reflection on that service. It is being conducted in parallel with the HIQA review of the National Ambulance Service and the NAS capacity review. The intention behind all of these reviews is to examine our pre-hospital emergency care services throughout the country, with a view to identifying the best way to enable them to meet the challenges of the future. I look forward to the recommendations of all three reviews, which I am certain will enable us to ensure that we provide a service capable of delivering the best possible outcomes for the public.

Medical Card Reviews

Questions (118)

Catherine Murphy

Question:

118. Deputy Catherine Murphy asked the Minister for Health the reason he stated in Dáil Éireann on 27 February 2014 that the Health Service Executive guaranteed to him that persons who have been selected for review of their medical card will be approached at least three months in advance of a review when in fact this is not the case in practice (details supplied); if he is satisfied that he is supplied with the most accurate information by the HSE in this regard; the way it is expected to ensure that this guarantee is followed in every case; and if he will make a statement on the matter. [14899/14]

View answer

Written answers (Question to Health)

All medical card and GP visit card holders are subject to a periodic review of eligibility to determine continuing eligibility. Ordinarily, three months before an individual's existing medical card/GP visit card eligibility expiry date, a review notification issues to the individual (or their parents, in the case of a child).

I am advised by the HSE that it has not been able to investigate this case with the individual details provided by the Deputy. If the Deputy will provide further information on the individual, I will arrange for the HSE to respond directly on this matter.

Maternity Services Provision

Questions (119)

Caoimhghín Ó Caoláin

Question:

119. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the actions that have followed the Health Service Executive report into maternity services at the Midlands Regional Hospital, Portlaoise; the further measures that will be put in place there and in other maternity units; and if he will make a statement on the matter. [14907/14]

View answer

Written answers (Question to Health)

The Chief Medical Officer's Report into Perinatal Deaths at Midland Regional Hospital Portlaoise 2006 to date makes 42 recommendations, all of which I have accepted. The HSE has now established an implementation group to oversee and ensure that the Report's recommendations are progressed in a timely and effective manner. The group has representation from Acute Hospitals Division, Clinical Strategy and Programmes, Quality and Patient Safety and is chaired by the National Director of Acute Hospitals Division. The HSE has forwarded the first Progress Report from the implementation group to me. Progress on implementation of the recommendations will be reviewed by the HSE Leadership Team and a monthly report will be provided to the Chief Medical Officer.

The Deputy may also wish to note that pending implementation of the recommendation that Portlaoise Hospital Maternity Services become part of a managed clinical network under a singular governance model with the Coombe Women & Infant University Hospital, a team was put in place on 28th February to run the Maternity Service. With regard to the Report's recommendation that other small maternity services around the country should be incorporated into managed clinical networks within the relevant hospital group, I am advised that discussions have commenced with the relevant Hospital Groups in relation to progressing this recommendation.

Services for People with Disabilities

Questions (120)

Caoimhghín Ó Caoláin

Question:

120. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he will review the supports in place for persons (details provided) in County Wexford; and if he will make a statement on the matter. [14909/14]

View answer

Written answers (Question to Health)

As specialist disability services are provided by the Health Service Executive or through a range of voluntary service providers the Department sought and received details of the specialist disability services provided to the family named by the Deputy in County Wexford. The HSE has informed the Department that the family and their children are currently allocated 10 Home Support hours (for domestic duties) on an ongoing basis. Each of the children receives both day services and respite services.

The HSE has also stated that it has reviewed the supports in place for the family in relation to their existing day and respite services. The HSE is now developing a further package of care for the family. In addition to existing service provision, it is proposed to extend day service from 3 to 5 days per week and respite service provision to a proposed monthly weekend respite. It is the Department's understanding that these proposals will be completed in consultation with the family.

Orthodontic Services Provision

Questions (121)

Heather Humphreys

Question:

121. Deputy Heather Humphreys asked the Minister for Health if he will consider lifting the moratorium on recruitment within the Health Service Executive in order to address the severe waiting times for orthodontic treatment; if his attention has been drawn to the fact that young children classed as high priority are having to wait three to four years for treatment; the findings of the independent review of orthodontic services; the number of children currently on a waiting list for orthodontic treatment in each region; his views on whether urgent action is required to address this problem; and if he will make a statement on the matter. [14699/14]

View answer

Written answers (Question to Health)

The Government has decided that the numbers employed across the public service must be reduced in order to meet fiscal and budgetary targets. In order to mitigate the impact on frontline services of the reduction in employment numbers, the priority is to reform how health services are delivered in order to ensure a more productive and cost effective health system. The revised working arrangements provided for in the Haddington Road Agreement are a pivotal element in this regard. Subject to approval by senior managers, arrangements are in place in the HSE to allow the recruitment of staff where it has been established that there is an urgent service requirement. In addition, the HSE continues to fill a significant number of development posts in line with service priorities identified by Government.

The HSE is aware of the need to address orthodontic waiting times and commissioned an independent national review of orthodontic services to give guidance as to what changes will be desirable. The review has now been completed. The key issue highlighted by the review, which has assessed services nationally, is that the Orthodontic Service should be fully integrated within the Primary Care Service. This is under consideration by the HSE to be implemented as part of the HSE's Transformation Programme. Pilot schemes, which will involve the use of orthodontic therapists, are currently being introduced. It is expected that these changes will have a positive impact on waiting times.

The HSE provides orthodontic treatment to those who have been assessed and referred for treatment before their 16th birthday. It should be noted that the nature of orthodontic care means that immediate treatment is not always desirable. It is estimated that in up to 5% of cases it is necessary to wait for further growth to take place before treatment commences. Information on waiting times is collated by the HSE by region and for the intervals is shown as follows. The most recent information relates to the last quarter of 2013.

Waiting time from assessment to commencement of treatment

1 - 6 months

7 - 12 months

13 - 24 months

2 - 3 years

Over 4 years

TOTAL

HSE Dublin Mid-Leinster

823

723

1,056

973

178

3,753

HSE West

1,337

936

1,658

924

122

4,977

HSE South

620

516

829

1,056

373

3,394

HSE Dublin North East

440

783

855

842

496

3,416

Universal Health Insurance White Paper

Questions (122, 551)

Timmy Dooley

Question:

122. Deputy Timmy Dooley asked the Minister for Health the date on which he will be publishing the White Paper on universal health insurance; and if he will make a statement on the matter. [14854/14]

View answer

Micheál Martin

Question:

551. Deputy Micheál Martin asked the Minister for Health the position regarding the commitment in the programme for Government on universal health insurance; and if he will make a statement on the matter. [11534/14]

View answer

Written answers (Question to Health)

I propose to take Questions Nos. 122 and 551 together.

The Government has embarked on a major reform programme for the health system, the aim of which is to deliver a single-tier health service, supported by universal health insurance (UHI), where there is fair access to services based on need, not on ability to pay. Under UHI, everyone will have a choice of health insurer and access to a standard package of health services. In addition, a system of financial protection will ensure affordability by paying or subsidising UHI premiums for those who qualify.

The White Paper on Universal Health Insurance, currently at an advanced stage of drafting, will provide more detail on the UHI model for Ireland, the process for determining the future health basket, including the standard package of services covered under UHI, funding mechanisms and the key stages of the journey to UHI. Following an initial discussion on the White Paper in early March, the issue will return to Government in the near future with a view to publication thereafter. This will be followed by consultation on the general approach set out in the White Paper and a separate consultation on the future health basket.

My intention is to have all the necessary groundwork in place in early 2016 to enable us to phase in implementation of UHI between 2016 and 2019.

Graduate Nursing Scheme

Question No. 124 answered with Question No. 111.

Questions (123)

Mick Wallace

Question:

123. Deputy Mick Wallace asked the Minister for Health his views on whether it is acceptable for graduate nurses and midwives participating in the graduate nurse-midwifery programme to be paid only 85% of the first point of the new entrant scale; and if he will make a statement on the matter. [14904/14]

View answer

Written answers (Question to Health)

In a time of very limited recruitment opportunities in the public service, I am very pleased that up to 1,000 two-year contracts are being made available to graduate nurses and midwives in our health services under the Graduate Nurse/Midwifery Programme. In addition to giving employment opportunities, a major objective of the Nurse Graduate scheme is to put in place more cost-effective service delivery arrangements, having regard to the high rates of expenditure on agency staffing and overtime. The Minister for Public Expenditure and Reform agreed to the initiative on the basis that it would be outside the Employment Control Framework and deliver significant savings.

Under the Haddington Road Agreement it was agreed that participants will be paid 85% of the first point of the new entrant scale in the first year and 90% in the second. Alongside these valuable employment opportunities, those who take up offers will also be able to avail of supported further professional development. The scheme will support the retention of graduate nurses and midwives within the Irish health system and enable them to gain valuable work experience and development opportunities post-graduation. Participants will have access to a variety of care settings while gaining clinical experience.

The educational component of the graduate nurse and midwife programme comprises a 2 year part-time 3 module Certificate Graduate Education Programme that will be Nursing and Midwifery Board of Ireland approved and academically accredited. This formally accredited programme will have currency for accreditation for prior learning by Higher Education Institutes when graduates wish to undertake further study and progress towards a Masters Level Award at a later stage in their careers.

Under the Programme, by the end of January 2014 the recruitment of over 600 graduate nurses was completed or in train, over 1,000 applications having been received.

Question No. 124 answered with Question No. 111.

Hospital Mortality Rates

Questions (125)

Denis Naughten

Question:

125. Deputy Denis Naughten asked the Minister for Health the steps that are being taken to examine the reasons behind the significant variation in mortality rates at each acute hospital as highlighted in the health care quality indicators in the Irish Health System: Examining the Potential of Hospital Discharge Data report; and if he will make a statement on the matter. [14708/14]

View answer

Written answers (Question to Health)

My Department published the report “Health Care Quality Indicators in the Irish Health System: Examining the Potential of Hospital Discharge Data using the Hospital Inpatient Enquiry System” on the 17th February 2014. The purpose of the report was to assess the feasibility of using HIPE data to derive healthcare quality indicators that could in the future be used to measure the quality of care provided by our hospitals. The analysis undertaken used HIPE data from 2006 to 2010. The analysis highlighted variations in findings with a small number of hospitals being identified as outliers for certain quality indicators. There are many possible reasons for these variations including quality of data, for example coding issues and quality of care issues.

This information was communicated to the hospitals through the Quality and Patient Safety Directorate of the HSE in order for the hospitals to determine the reasons for the variation. My Department has been assured by the HSE that the hospitals have had the opportunity both to correct their data and address any quality of care issues. As already stated the primary focus of this report was to look at the feasibility of these indicators and to progress to robust indicators for the future rather than carrying out a review of historical data. Measuring the quality of healthcare in Ireland and publicly reporting how our services are performing is part of my Government's commitment to improved accountability and continued improvement in our health services. Therefore it is the intention of my Department to develop a National Healthcare Quality Reporting System which will regularly publicly report quality indicators. The first report on quality healthcare indicators derived from HIPE for the years 2011- 2013, at national, regional and identified hospital level will be published later this year.

Ambulance Service Response Times

Questions (126)

Caoimhghín Ó Caoláin

Question:

126. Deputy Caoimhghín Ó Caoláin asked the Minister for Health his views on whether target ambulance response times are not being met and a full and proper service cannot be provided due to shortage of personnel, shortage of infrastructure and shortage of funding; and if he will make a statement on the matter. [14908/14]

View answer

Written answers (Question to Health)

The National Ambulance Service (NAS) is continuing to modernise and reconfigure its services to ensure emergency pre-hospital care is delivered in an appropriate and timely manner. A significant reform programme is currently underway which will provide a clinically driven, nationally co-ordinated system, supported by improved technology. In that regard, additional funding of €3.6 million and 43 staff have been provided in the National Service Plan 2014.

For ECHO calls, which are life threatening cardiac or respiratory calls, the HSE set a target in 2013 for 70% of vehicles to meet this response time. For DELTA calls, for life-threatening conditions other than cardiac or respiratory, the target was 68%. Nationally in 2013, emergency ambulances responded within 19 minutes for 69.4% of ECHO calls and 63.7% of DELTA calls. Some individual regions performed as high as 79% for ECHO calls. I would also point out that over 2,100 more emergency calls were reached within 19 minutes in 2013 than in 2012.

In order to drive improvement in response times, the 2014 National Service Plan sets a target that 80% of life threatening calls should be responded to in less than 19 minutes. Ongoing performance improvement projects include:

- the single national control system, to be completed in 2015

- the Intermediate Care Service, for routine and non-emergency transfers, allowing emergency vehicles to focus on emergency situations

- the move to on-duty rostering and the development of a national rostering system

- the Emergency Aeromedical Support Service - 368 missions were completed in 2013, one third of which involved time critical transfers of STEMI heart attack patients to primary PCI units.

I would also like to draw the Deputy's attention to three separate reviews of ambulance services currently underway. HIQA is examining the governance arrangements for pre-hospital emergency services; the HSE and Dublin City Council have commissioned a joint review of Dublin ambulance services to determine the optimal and most cost-effective model of ambulance services delivery for the city; and the UK Association of Ambulance Chief Executives is undertaking a comprehensive capacity review of the NAS, to determine what level of resourcing, in terms of staff, vehicles, skills and distribution, is required to deliver a safe and effective service now and into the future. I am confident that these reviews will inform the development of a modern, clinically driven system, properly resourced, for appropriate and timely services to the benefit of patients.

Suicide Prevention

Questions (127)

Maureen O'Sullivan

Question:

127. Deputy Maureen O'Sullivan asked the Minister for Health his plans for the €6 million that has been allocated to promote positive mental health; the organisations that will be receiving this money; if he will consider allocating some of the funds to the young people's facilities and services fund; and if he will make a statement on the matter. [13997/14]

View answer

Written answers (Question to Health)

The budget for the National Office for Suicide Prevention (NOSP) in 2014 is €8.8 million, an increase of 8% on the funding available in 2013. The NOSP is planning to provide funding in the region of €6 million to statutory services and over 30 non-governmental organisations to carry out a wide array of work in communities across the country, focusing on promoting positive mental health and reducing suicide and self harm.

As the responsibility for allocating this funding rests with the NOSP, I have referred the question to that Office for attention for direct reply to the Deputy.

Ambulance Service Provision

Questions (128)

Richard Boyd Barrett

Question:

128. Deputy Richard Boyd Barrett asked the Minister for Health if he will confirm that there will be no job losses or reductions in service in the plans for the reconfiguration of ambulance services; and if he will make a statement on the matter. [14905/14]

View answer

Written answers (Question to Health)

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

Medical Card Reviews

Questions (129)

Catherine Murphy

Question:

129. Deputy Catherine Murphy asked the Minister for Health if he will describe the precise, detailed process by which discretionary medical cards are selected for review; if the process is entirely randomised or if it is systematic; if the latter, if he will fully describe the way this system is followed and the way medical card holders are protected from undue audit and examination that may exacerbate an existing condition and is not likely to result in a change of circumstances; and if he will make a statement on the matter. [14900/14]

View answer

Written answers (Question to Health)

All medical cards, including those granted on a discretionary basis, are subject to a periodic review of eligibility to determine continuing eligibility. Cards are selected for review in advance of the expiration of their eligibility period, i.e. when the "valid to" date on the card is approaching. In addition, cards are selected on a random basis, where the HSE carries out, on an on-going basis, audits of eligibility to ensure that the medical card register is as accurate as possible and that its voted budget is being spent appropriately in the medical card scheme.

Hospital Waiting Lists

Questions (130)

Bernard Durkan

Question:

130. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the waiting time for various surgical procedures has been addressed in each of the past five years to date with particular reference to the number of patients awaiting procedures under various headings throughout the public health sector; the extent to which the situation has been addressed or requires further attention; and if he will make a statement on the matter. [14827/14]

View answer

Written answers (Question to Health)

In relation to the detailed information requested by the Deputy, as these are service matters, I have asked the Health Service Executive to respond to him directly.