Written Answers Nos. 172 - 190
172. Deputy Robert Dowds asked the Minister for Health his views on the way data protection affects the sharing of information between Tusla and the Health Service Executive; and if consent given to one entity is considered sufficient to cover interactions with both entities where a patient is shared. [27509/14]
View answerAccess to accurate and up to date patient information is critical to the provision of safe and efficient health services. The management of information of a personal and sensitive nature between service providers is one that I consider to be very important and should be done to ensure that the privacy and confidentiality of the information has the requisite protection whilst ensuring the highest quality of service at all times. All health sector staff who handle personal sensitive data should be clear in their responsibilities in how to deal with such information. This is clearly set out in the codes of conducts for medical professionals.
TUSLA and the HSE are statutory bodies and data controllers in their own right. The issue and the nature of the consent obtained in relation to sensitive personal data is dealt with under the Data Protection Acts 1988 and 2004. Where consent is used as the basis for processing of an individual’s personal information, he or she can give informed consent to the sharing of information between different data controllers. However, consent is only one of the grounds for the sharing of information between statutory bodies. They can, independently of consent, share information where it is necessary for the performance of their statutory functions. For completeness, it should be made clear that, in a legal sense, the Data Protection Acts do not refer to sharing per se but to the disclosure of information between data controllers which in an everyday sense is sharing of such information.
173. Deputy Heather Humphreys asked the Minister for Health if a medical card will be re-instated in respect of a child (details supplied) in County Monaghan with a serious medical condition; and if he will make a statement on the matter. [27510/14]
View answerThe Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible. The Health Service Executive operates the General Medical Services scheme, which includes medical cards and GP visit cards, under the Health Act 1970, as amended. It has established a dedicated contact service for members of the Oireachtas specifically for queries relating to medical cards and GP visit cards, which the Deputy may wish to use for an earlier response. Contact information has issued to Oireachtas members.
174. Deputy Bernard J. Durkan asked the Minister for Health the extent to which medical cards withdrawn under review are in the course of re-approval with particular reference to patients with special needs or specific health issues meriting discretionary consideration; and if he will make a statement on the matter. [27511/14]
View answerThe current eligibility system for health services, which has been in place since 1970, is based primarily on financial criteria. Therefore, the Government has decided to develop a policy framework for providing eligibility for health services to take account of medical conditions, including new legislation as appropriate and a HSE clinical expert group is to examine the range of conditions that should be considered as part of this process. The group has been asked to make an early report to the Minister for Health in the autumn.
The Government was very concerned about the potential impacts on the health of persons with serious illnesses whose discretionary medical cards and GP visit cards were refused renewals since the centralisation of medical card assessment in 2011. Therefore, in the context of the above eligibility policy development, the Government decided that medical cards and GP visit cards are to be issued to persons with a serious medical condition (or disability) who had the renewal of their discretionary card refused by the HSE, having completed an eligibility review during the period from 1 July 2011 to 31 May 2014.
This arrangement applies in the following circumstances:
- During the period, the person held a medical card or GP visit card issued on a discretionary basis, but the HSE made a decision to refuse its renewal on foot of a completed eligibility review.
- The person completed the review process during that period, i.e. provided the information and documentation required assessing their eligibility.
- The person has a serious medical condition, i.e., which required that their case was referred to a Medical Officer as a part of the review process.
It is anticipated that about 15,300 cards will be issued to people with serious medical conditions as part of this process. It is estimated that:
- 5,288 people will be issued with a discretionary medical card;
- 2,899 people will be issued with a discretionary GP visit card; and,
- 7,118 people will be moved from GP visit card to a discretionary medical card.
It is also recognised that a small number of individuals may not have been able to complete their review during the defined period due to circumstances relating to their medical condition, e.g., hospitalisation during treatment, change of residence during treatment. Therefore, the Director General of the HSE may act, on his own initiative, to take account of an ad misericordiam appeal on a case by case basis to issue a discretionary card to such a person that has a serious medical condition.
People do not need to make an application to receive a card as the HSE is working as quickly as possible through its database to contact the people concerned over the next few weeks to inform them that their card is being issued. If people do not hear from the HSE by mid-July, they should contact the HSE on its LoCall contact number.
175. Deputy Bernard J. Durkan asked the Minister for Health the degree to which he has had discussions with general practitioners in the context of resolving any outstanding issues of mutual concern; and if he will make a statement on the matter. [27512/14]
View answerThe Government is committed to introducing, on a phased basis, a universal GP service by 2016, as set out in the Programme for Government and the Future Health strategy framework. As announced in the Budget, it has been decided to commence the roll-out of a universal GP service by providing all children under 6 years with access to a GP service without fees. This will mean that almost half of the population will have access to GP services without fees. In line with this policy, the Health (General Practitioner Service) Bill was published on 23rd April 2014 and is currently progressing through the Oireachtas. The Bill was debated and approved at Committee Stage on 19 June 2014 and it is intended that the legislation will be passed by the Oireachtas before the summer break. This will provide for a GP service to be made available without fees to all children aged five years and younger.
The introduction of this service also requires a new contractual framework to be put in place between the HSE and individual general practitioners. A Framework Agreement with the Irish Medical Organisation (IMO) has recently been signed. This sets out a process for engagement concerning the GMS/GP contract and other publicly funded contracts involving General Practitioners (GPs), starting with the provision of GP care free at the point of access for children under 6 years. This will enable collaboration on the full implementation of a universal GP service and will allow progress on a new GMS GP contract. The HSE, Department and IMO are meeting today to commence discussions on a new GP contract for children under 6 years in accordance with the terms of the Framework Agreement.
176. Deputy Bernard J. Durkan asked the Minister for Health if he is satisfied that the budget in respect of his Department for the current year is likely to be adequate to meet in full the provision of the range of services as required; and if he will make a statement on the matter. [27513/14]
View answerThe total net budget for my Department (Vote 38) for 2014 is almost €202m comprising €186m Revenue and €16m Capital. This funding is for the salaries and expenses of the Office of the Minister for Health and certain other services administered by that Office, including grants to research, consultative and advisory bodies. The May Returns, produced five working days after month end, shows gross current expenditure for my Department at €3 million under profile. 2014 will be another challenging year for my Department; however, with astute financial planning and management I am satisfied that the budget will be adequate to meet in full the provision of the range of services as required.
177. Deputy Bernard J. Durkan asked the Minister for Health the degree to which staffing levels remain adequate throughout the public health service with particular reference to doctors, nurses and the various consultants; if an adequate deployment of staff has been made to ensure that waiting lists are not extended due to constraints arising from compliance with troika guidelines; and if he will make a statement on the matter. [27514/14]
View answer178. Deputy Bernard J. Durkan asked the Minister for Health the extent to which sufficient number of junior hospital doctors is likely to become available in the public sector in each of the next three years; and if he will make a statement on the matter. [27515/14]
View answer179. Deputy Bernard J. Durkan asked the Minister for Health the degree to which adequate numbers of nurses are likely to become available throughout the public health sector over the next three years; and if he will make a statement on the matter. [27516/14]
View answerI propose to take Questions Nos. 177 to 179, inclusive, together.
Though the HSE has the capacity to recruit where it is necessary to do so in order to ensure patient safety and to support service delivery, there is evidence that there are, at present, some difficulties in recruiting certain frontline staff including consultants, NCHDs and specialist nurses. I am currently progressing measures to ensure that we will have an adequate supply of highly skilled consultants, doctors and nurses.
There has been a significant increase in the number of consultants (Whole Time Equivalents) since the establishment of the HSE, the number increased by 723 from 1,947 in January 2005 to 2,670 in December 2013. However there are some specialties in which there are international shortages and which have been traditionally difficult to fill, regardless of the salary scale. There are also some hospitals to which it has historically been difficult to attract applicants, in particular smaller hospitals. The establishment of Hospital Groups will help to address this issue, as this will allow doctors to be appointed as group resources.
The ability of the public service to attract and retain high quality frontline staff shapes the extent to which the HSE can maintain and develop the range of health services required. I set up a group under the chairmanship of Professor Brian McCraith last July to carry out a strategic review of medical training and career structures. The Group will make recommendations aimed at improving the retention of medical graduates in the public health system, planning for future service needs and realising maximum benefit from investment in medical education and training. It provided an Interim Report in December 2013 focusing on training. In April 2014 the Group submitted its second report to me and this dealt with medical career structures and pathways following completion of specialist training. The final report of the Group will deal with a number of issues including workforce planning and this is due to be submitted to me by the end of this month. The work of the Group is key to ensuring that we have attractive propositions for consultants and doctors in training, NCHDs, in the years ahead.
Additional nursing support is being made available throughout the system. Measures include the increase in nursing hours available under the HRA and the appointment of nearly 500 nurses and midwives under the graduate scheme, with over 200 others currently going through the recruitment process. This innovative model combines a contract of employment (with clinical rotation) with a fully funded interdependent education programme. I have just approved the establishment of a taskforce to develop a framework that will determine the staffing and skill mix requirements for the nursing workforce in a range of major specialities. The focus will be on the development of staffing and skill mix ranges which take account of a number of influencing factors. The taskforce is being chaired by the Chief Nursing Officer.
Where frontline staffing shortages exist, the HSE makes alternative arrangements to ensure service provision, including recourse to agency and locum cover. However, it is preferable that sufficient numbers of doctors, nurses and NCHDs are recruited to permanent posts to support the most efficient and effective delivery of services. The details of availability and development of staff are a matter for the HSE and I have forwarded this aspect of the Deputy's questions to the HSE for direct reply.
180. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the working hours for junior hospital doctors are being brought into line with EU requirements; and if he will make a statement on the matter. [27517/14]
View answerThe provisions of the European Working Time Directive encompass a number of measures to protect workers' welfare and safety, including a maximum 48 hour working week - averaged over a reference period, the granting of breaks, minimum daily and weekly rest periods and the granting of compensatory rest where the working day exceeds 13 hours. The HSE is focused on advancing implementation of the Directive and progress has been made in respect of NCHDs. Data from the HSE shows that average working hours for NCHDs in 2009 was 60 hours a week, 54 hours per week in 2012 and just over 51 hours at the end of 2013. Intensive negotiations conducted at the Labour Relations Commission in September and October 2013 resulted in agreement on a joint approach, involving hospital management, the IMO and NCHDs to achieve EWTD compliance, with an immediate focus on eliminating shifts in excess of 24 hours. Data for March 2014 shows 93% compliance with this target, and 99.7% compliance in relation to elimination of working weeks in excess of 68 hours.
NCHD recruitment and retention is required in order to facilitate the achievement of EWTD compliance. Achievement of full compliance will also require reorganisation of the delivery of certain services within Hospital Groups. The number of NCHDs in the public health system has increased by over 200 in recent years and now exceeds 4,900. However, there are international shortages of NCHDs in certain categories and specialties. There are also some hospitals to which it has been difficult to attract NCHDS, for a range of reasons including training opportunities and rural location.
The next NCHD rotation occurs on 14th July. The HSE has advised that it is too early to be definitive on the level of vacancies that will arise, noting however that the number of posts that have not been filled is similar to previous years. Where posts are vacant and suitable candidates cannot be sourced, locums are retained or alternative arrangements are made to ensure the continued delivery of the service. However, the intention is to move to a position where reliance on agency to fill posts is minimised and permanent staff are appointed.
Last July I set up a group under the chairmanship of Professor Brian MacCraith to carry out a strategic review of medical training and career structures. Under its terms of reference the Group will make recommendations aimed at improving the retention of medical graduates in the public health system and planning for future service needs. It provided an Interim Report in December 2013 focusing on training. In April 2014 the Group submitted its second report to me and this dealt with medical career structures and pathways following completion of specialist training. The final report of the Group will deal with a number of issues including workforce planning and this is due to be submitted to me by the end of this month.
181. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the budget in respect of mental health services in the current year is deemed adequate to meet requirements; and if he will make a statement on the matter. [27518/14]
View answerThe Government is committed to the continued reform of the mental health services, notwithstanding the substantial overall reduction in resources available to the health service in recent years. The estimated provision for mental health in 2014 is €766 million. This figure includes the additional funding of €90 million that has been provided since 2012 for a range of new posts and other specific initiatives relating to mental health and suicide prevention. Areas being funded for development this year include specialised secondary care services for children and adolescents, adults, older persons, those with an intellectual disability and a mental illness, and forensic services. These service initiatives are in line with A Vision for Change.
In addition, about one in four people experience mental health problems in their lifetime, many of whom will be dealt with in primary care. It is estimated that approximately 90% of mental health problems are dealt with in primary care, and that some 30% of people who attend primary care have a mental health problem. Expenditure on these services is not captured in the health budget detailed above.
182. Deputy Bernard J. Durkan asked the Minister for Health the degree to which continuous monitoring takes place of the ambulance services with particular reference to the need to ensure compliance with appropriate call out times; and if he will make a statement on the matter. [27519/14]
View answerAs this is a service matter it has been referred to the HSE for direct reply.
183. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the remaining development stages in respect of Naas General Hospital, Naas, County Kildare, remain on course; the full extent of the enhanced scale of services envisaged; the extent to which this is in line with previous indications; and if he will make a statement on the matter. [27520/14]
View answerIn relation to the specific queries raised by the Deputy, as these are service matters they have been referred to the HSE for direct reply.
184. Deputy Finian McGrath asked the Minister for Health if he will provide a contact name or family liaison person or telephone contact for a centre (details supplied) in Dublin 3 to advise parents of adults with a disability; and if he will make a statement on the matter. [27537/14]
View answerAs the Deputy's question relates to service matters I have arranged for the question to be referred to the Health Service Executive for direct reply to the Deputy.
185. Deputy Michael Healy-Rae asked the Minister for Health the position regarding the embargo on the recruitment of psychiatric nurses and ongoing staffing shortages within the mental health services in County Kerry; and if he will make a statement on the matter. [27543/14]
View answerThe 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. It is in this context that the Government, and I as Minister, are continuing to progress as a priority the development of our mental health services, in line with implementing A Vision for Change. As part of this question relates to a specific service issue this matter has been referred to the HSE for direct reply.
186. Deputy John Browne asked the Minister for Health when he will approve extra nursing staff for Wexford Hospital; his views that with the opening of the new accident and emergency department that such extra staff are required as a matter of urgency; and if he will make a statement on the matter. [27550/14]
View answerAs this is a service matter, it has been referred to the HSE for direct reply.
187. Deputy James Bannon asked the Minister for Health the reason a person (details supplied) in County Longford had at least eight appointments for treatment cancelled and in view of the seriousness of the treatment required if the person will be provided with an early appointment. [27554/14]
View answerThe National Waiting List Management Policy, A standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the Health Service Executive, sets out the processes that hospitals are to implement to manage waiting lists. In relation to the particular query raised by the Deputy, I have asked the HSE to respond directly to the Deputy on this matter.
188. Deputy Regina Doherty asked the Minister for Health the reason a person (details supplied) in County Meath is to lose their home care package of three hours per week at the end of June; and if he will make a statement on the matter. [27556/14]
View answerAs this is a service matter it has been referred to the Health Service Executive for direct reply.
189. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the position regarding the PA Consulting Group's report of 30 August 2013 entitled Defining Financial Management: A Finance Operating Model for Health in Ireland; when this report was first presented to the Health Service Executive; when it was first published and with what public notice; where now stands the new operating model and the principles outlined in the conclusion and recommended way forward page; and if he will make a statement on the matter. [27557/14]
View answerFinancial Reform is a key element of Future Health - A Strategic Framework for Reform of the Health Service 2012 – 2015. The HSE commenced the Finance Reform Programme in Autumn 2012. Central to the establishment of this programme was the recognition that successful implementation of Future Health and the wider reform agenda will require fundamental changes in the way financial management is delivered across the health system in Ireland. The successful delivery of these reforms is dependent on having robust financial systems and reporting in place to meet future requirements, as current practices are not sustainable in the emerging landscape.
One of the main outputs of Phase 1 of the programme was the development of a new operating model for finance in health which was contained in the document entitled Defining Financial Management: A Finance Operating Model for Health in Ireland. This was endorsed in September 2013 by the Finance Reform Board which comprises senior management representation from HSE, Department of Health and Department of Public Expenditure & Reform. The new operating model was subsequently presented to the HSE Leadership Team and noted by the HSE Directorate. There was also a presentation to me as Minister for Health on key elements of the Finance Reform Programme including the content of the Finance Operating Model and the proposed next steps.
This report encompasses a roadmap for the finance function to facilitate delivery of an efficient and effective financial service to meet the emerging requirements of the changing organisational face of the Health System. A critical enabler for the transformation of financial management is the introduction of a single Integrated Financial Management System (IFMS) which is considered to be the single most important non-clinical priority for the HSE this year. A key element of developing the model was the active involvement of staff (financial and non-financial) across the health service including statutory and voluntary service providers. The document was published on the dedicated Finance Reform section of the HSE website www.hse.ie
The initial key element of Phase 2 of the Finance Reform Programme was the preparation of a detailed business case for a new operating model to meet the requirements of the Department of Health and the Department of Public Expenditure & Reform including the Office of the Government Chief Information Officer, DPER in relation to securing the necessary approval to procure a new Integrated Financial Management System (IFMS) for the health service.
The Business Case defines the case for change and scope as well as providing an estimate of the resources required to deliver the operating model and supporting technology. This Business Case completed in April 2014 is a major element of Phase 2 of the Programme. Following a feedback phase, the HSE submitted the Business Case to my Department on 30 May 2014 for endorsement and submission to DPER. The business case is under consideration within the Department and has been forwarded to the Department of Public Expenditure and Reform.
190. Deputy Michael Ring asked the Minister for Health the reason a decision has not issued from the Health Service Executive on an over 70s medical card application in respect of a person (details supplied) in County Mayo, in view of the fact that evidence has been submitted on two occasions to verify that the applicant's income is under the threshold. [27559/14]
View answerThe Health Service Executive has been asked to examine this matter and to reply to the Deputy as soon as possible. The Health Service Executive operates the General Medical Services scheme, which includes medical cards and GP visit cards, under the Health Act 1970, as amended. It has established a dedicated contact service for members of the Oireachtas specifically for queries relating to medical cards and GP visit cards, which the Deputy may wish to use for an earlier response. Contact information has issued to Oireachtas members.
