Written Answers Nos. 95-112
95. Deputy Liam Twomey asked the Minister for Health the alternatives to agency staff available to him in view of the significant cost increases in using agency staff in the Health Service Executive; and if he will make a statement on the matter. [36492/14]
View answerIn the Health Sector which provides 24/7 care 365 days of the year, flexibility is required that allows the use of overtime and agency staff to meet agreed and approved service levels. Recourse to overtime or agency is necessary for a variety of reasons including, for example, over-runs in operating theatres, sudden increases in service demand, to cover for sick leave, annual leave and maternity leave. However, the HSE is focused on reducing current levels of agency usage recognising that the increase in agency spending to date this year, up 42% to the end of July compared with 2013, is unsustainable.
In order to mitigate the impact on front-line services of the reduction in employment numbers that has been required, the priority is to reform how health services are delivered in order to ensure a more productive and cost effective health system. Agency staff cannot be used to substitute for staff losses as a result of the need to reduce health sector employment. The revised working arrangements provided for in the Haddington Road Agreement are a pivotal element in this regard. The Agreement has made a number of measures available to the HSE to reduce agency costs while maintaining existing service levels. These include the Graduate Nurse Initiative, the Support Staff Intern Scheme and the additional employee hours made available to the HSE due to increased working hours.
In addition, while it is necessary to continue to control public sector employment, 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. The scope for offering temporary contracts to fill posts on a temporary basis where it is established that there is a service need and that savings can be achieved by direct employment compared with agency usage is also under consideration.
96. Deputy Billy Kelleher asked the Minister for Health when the programme for Government commitment on the extension of BreastCheck will be honoured; and if he will make a statement on the matter. [36530/14]
View answerAs indicated in previous replies, I fully support the proposed extension of the Breastcheck screening programme to the 65-69 year age cohort. The timing of the implementation of this extension of the service will depend on the availability of resources and is being considered in the context of the Estimates process for 2015.
97. Deputy Thomas P. Broughan asked the Minister for Health if he is satisfied with the level of resources allocated to Beaumont Hospital, Dublin 9, in particular to its emergency department to meet demand for services; and if he will indicate how very severe incidents of overcrowding in recent weeks can be adequately addressed so as to guarantee patient safety at the hospital. [36463/14]
View answerBeaumont Hospital continuously monitors staffing levels in the Emergency Department (ED) to meet service demands. In times of severe pressure, additional staff are allocated to the department. The challenges in the ED reflect both increased demand for emergency care and a slowing down of patient flow within the hospital. A number of factors have impacted on the hospital's ability to maintain the progress which had been evident in its ED activity up to July, including:
- An increase in patients presenting, up to 26% of whom require admission;
- Reduced medical discharges due to age and acuity of patients presenting;
- Delayed discharges (in excess of 80 patients), with reduced access to private nursing homes for transitional care due to lack of bed capacity;
- Increased bed requirements for patients receiving radiation oncology services;
- Cleaning and infection control measures leading to temporary closure of 14 beds.
In addition to the general measures employed to promote patient flow, such as frequent ward rounds, increased access to diagnostics and fast-tracking referrals to other teams in order to expedite discharges, a number of initiatives are being pursued to accelerate patient flow through the hospital:
- 'Care of the Elderly' physicians have extended clinical cover to 32 existing step-down beds at Clontarf and 50 existing beds at Lusk to enable discharge and prevention of re-admission;
- A review of processes is being undertaken in the Acute Medical Assessment Unit, in conjunction with the SDU, to enable more effective functioning of the ED and patient flow;
- Continued focus on length of stay has enabled reduction of 2 days on average length of stay;
- Focus on discharge is being enabled through the use of a simple visual operational tool in every ward for management of patient care from admission to medical discharge or transfer.
All of the measures described are focussed on improving patient experiences at Beaumont hospital. Significant work is also ongoing with the primary care and community care sectors to promote access to appropriate care at an appropriate location, whether that is in a primary care centre, the hospital or a therapeutic or long-term nursing care setting.
98. Deputy Seán Ó Fearghaíl asked the Minister for Health the measures that will be put in place to tackle the difficulties in the provision of child and adolescent mental health services; and if he will make a statement on the matter. [36538/14]
View answerThe Mental Health Division of the HSE is committed to ensuring that all aspects of Child and Adolescent Mental Health services (CAMHS) are delivered nationally in a consistent and timely fashion. A Vision for Change describes how services should be coordinated and integrated to meet the full range of social, psychological and physical care needs of children with mental health problems.
The Child and Adolescent Mental Health Service is a key Service Improvement Project for the HSE. The project aims to improve access to and use of CAMHS In-patient, Day Hospital and Community based services, particularly in the context of agreed protocols governing the area of 16-17 year olds. The first meeting of a multi-disciplinary Group established to progress this project took place this month, and it is intended that meetings will be held on a monthly basis. The Group has also met with the Management Teams of all four CAMHS In-Patient units, to review various operational issues including eliminating any restrictions inhibiting full operational bed usage in certain circumstances.
In June of this year, the operational capacity of the Child and Adolescent Acute Inpatient Units was 56 beds. However, due to building works and temporary difficulties arising from loss of certain staff in three of the CAMHS Units, capacity nationally has reduced to 46. It is planned that these issues will be resolved as quickly as possible, and that capacity will increase to 58 by year-end. In addition, construction work is continuing on a new 22 Bed unit at the Cherry Orchard Hospital site in Dublin, which will be completed in September 2015. Where required, and if no public bed is available, in-patient beds are utilised in private hospitals. There are also a small number of children that may require placement outside of the State, where this is deemed to be the best service option in such cases.
It should be noted also that the HSE Mental Health Division is placing particular focus at the moment on overcoming certain issues to improve recruitment and retention rates for Consultant Psychiatrists.
As part of development funding prioritised by this Government since 2012 for mental health overall, upwards of 230 new posts have been allocated to Child and Adolescent Community Mental Health Teams. This additional investment is intended to enable CAMHS teams to cater for all age ranges up to 18 years. Area Mental Health Management Teams are now also in place across the country, to ensure a more seamless service between CAMHS and Adult Mental Health services.
99. Deputy Charlie McConalogue asked the Minister for Health the total number of consultant posts being filled by agency staff in Letterkenny General Hospital; the total cost in 2014 to Letterkenny General Hospital of the agency paid consultants; if an allowance will be made in the Letterkenny General Hospital budget to reflect this situation; his plans to attract consultants to Letterkenny General Hospital; and if he will make a statement on the matter. [36493/14]
View answerTo date, there have been significant challenges in filling medical posts including Consultant posts at Letterkenny General Hospital. At present there are 7.5 WTE posts currently being filled by Agency Consultant Staff. Two of these posts commenced in August 2014. The cost of the remaining 5.5 WTE agency paid Consultants to Letterkenny General Hospital as at 31st July 2014 is €933k (January to July), inclusive of agency fees and VAT at 23%.
Consultants are only employed via agency when all other opportunities to recruit on payroll have been exhausted. As with all recruitment, all efforts to source suitable personnel on payroll continue to be exercised. The determination of the allocation of Budget for Letterkenny General Hospital will be a matter for HSE management to determine, taking account of all relevant factors including service delivery and staffing issues.
100. Deputy Emmet Stagg asked the Minister for Health if his Department has received requests for information from the Ombudsman, concerning the special housing needs of a person (details supplied) in County Kildare, with a deadline for reply of 9 August 2014; and if a reply has issued to the Ombudsman. [36438/14]
View answerMy Department has received a query from the Ombudsman and is currently investigating the matters raised. A reply to the Ombudsman will issue shortly.
101. Deputy Paul J. Connaughton asked the Minister for Health the progress that has been made on extending the free national breast cancer screening programme, BreastCheck, to women aged 65 to 69 years; and if he will make a statement on the matter. [36546/14]
View answerAs indicated in previous replies, I fully support the proposed extension of the Breastcheck screening programme to the 65-69 year age cohort. The timing of the implementation of this extension of the service will depend on the availability of resources and is being considered in the context of the Estimates process for 2015.
102. Deputy Martin Heydon asked the Minister for Health if he will provide an update on the progress of the Healthy Ireland project; his priorities in this area; and if he will make a statement on the matter. [36495/14]
View answerHealthy Ireland, A Framework for Improved Health and Wellbeing 2013-2025, was launched in March 2013. It is the national framework for action to improve the health and well-being of the country over the coming generation.
The Framework has four goals:
- Increase the proportion of people who are healthy at all stages of life;
- Reduce health inequalities;
- Protect the public from threats to health and well-being; and
- Create an environment where every individual and sector of society can play their part in achieving a healthy Ireland.
The priorities for Healthy Ireland address these four overarching goals.
The initial priority for Healthy Ireland has been to put in place the underpinning architecture to establish clear structures and accountability mechanisms for implementation on which current and future progress can be measured, evaluated and reported on. There has also been a strong focus on the development of the wider enablers of implementation such as stakeholder consultation, building a supportive culture, communication and leadership. This includes discussions with a range of different organisations and bodies to create awareness and deliver information about Healthy Ireland, to build new relationships, and to commence exploratory discussions about potential collaborations or initiatives that could be aligned with the Healthy Ireland goals and vision.
A number of key projects have been initiated since the publication of the Framework. Priorities are:
- A National Physical Activity Plan, being developed in collaboration with the Department of Transport, Tourism and Sport and other stakeholders, to encourage greater participation in, and greater recognition of, the importance of physical activity. This Plan will be an exemplar of Healthy Ireland in action and will be a significant opportunity to build a new cross-sectoral approach to meeting the goals and vision of Healthy Ireland;
- An annual Healthy Ireland Survey which will gather information to inform the development of robust baseline data, at a national level, on a range of health and well-being indicators, e.g. tobacco use, alcohol consumption, physical activity, diet, sexual health and well-being etc. Ethical approval has been received and preparatory work including cognitive testing of questions is nearing completion. It is expected that the first wave of the survey will happen in Q4 2014. This will be the first new data of this type since the SLAN survey of 2007;
- A Research, Data and Innovation Plan which will provide a coordinated strategic approach to improve the generation and use of knowledge in areas relevant to Healthy Ireland is in development. A prioritised research programme for Healthy Ireland will be agreed, on a cross sectoral basis, which will facilitate the incorporation of research into practice, programme and policy decisions. It is anticipated that the plan will be completed in Q4 2014;
- An Outcomes Framework is being developed to provide a coherent approach to monitoring, evaluating and reporting on the implementation of the Healthy Ireland framework;
- Key policies and strategies being implemented under the Healthy Ireland umbrella include: Tobacco Free Ireland, Obesity Policy, a new National Sexual Health Strategy, the National Positive Ageing Strategy, Suicide Prevention Strategic Framework, Public Health approach to Alcohol;
- Co-operating with and supporting the Department of Children and Youth Affairs in the implementation of Better Outcomes, Brighter Futures, The National Policy Framework for Children and Young People;
- Developing a national ‘Healthy Workplace’ framework across both the public and private sector on a collaborative basis;
- A Healthy Ireland Council, chaired by Mr Keith Wood, has been appointed and the Council held its inaugural meeting on 26 June 2014. It was addressed by Dr Margaret Chan, Director General of the World Health Organisation. It is scheduled to meet again on 23 October 2014. The Council is a key initiative to leverage engagement with whole-of-society and to connect and mobilise communities, families and individuals into a national movement with the aim of supporting everyone to enjoy the best possible health and well-being; and
- A number of Healthy Ireland co-branded initiatives, including across private sector partnerships will roll out in the next 6 to 18 months, supporting the ongoing communication and stakeholder engagement strategy to build a supportive culture and environment as envisaged in the vision and goals of Healthy Ireland.
I am satisfied with the progress being made by Healthy Ireland. Healthy Ireland is one the four pillars of Future Health, the Strategic Framework for Reform of the Health Service 2015-2015. It emphasises the need to move from simply treating ill people to a new concentration on keeping people healthy. I believe that we must prioritise the health and well-being of the population and this means that all sectors of society and government must play their part in achieving the goals of Healthy Ireland. I am conscious that more effort needs to be invested in health and well-being in order to overcome the health inequalities that some communities face and to combat the effects of modern diet and lifestyle on health. It will be necessary to substantially develop the concept and practice of cross departmental, cross sectoral working in order to embed the concept of 'Health in all Policies' across government. This is a key objective of the World Health Organisation's Health 2020 policy on which Healthy Ireland is modelled.
103. Deputy Jerry Buttimer asked the Minister for Health his priorities for implementing the Healthy Ireland project; and if he will make a statement on the matter. [36503/14]
View answerHealthy Ireland, A Framework for Improved Health and Wellbeing 2013-2025, was launched in March 2013. It is the national framework for action to improve the health and well-being of the country over the coming generation.
The Framework has four goals:
- Increase the proportion of people who are healthy at all stages of life;
- Reduce health inequalities;
- Protect the public from threats to health and well-being; and
- Create an environment where every individual and sector of society can play their part in achieving a healthy Ireland.
The priorities for Healthy Ireland address these four overarching goals.
The initial priority for Healthy Ireland has been to put in place the underpinning architecture to establish clear structures and accountability mechanisms for implementation on which current and future progress can be measured, evaluated and reported on. There has also been a strong focus on the development of the wider enablers of implementation such as stakeholder consultation, building a supportive culture, communication and leadership. This includes discussions with a range of different organisations and bodies to create awareness and deliver information about Healthy Ireland, to build new relationships, and to commence exploratory discussions about potential collaborations or initiatives that could be aligned with the Healthy Ireland goals and vision.
A number of key projects have been initiated since the publication of the Framework. Priorities are:
- A National Physical Activity Plan, being developed in collaboration with the Department of Transport, Tourism and Sport and other stakeholders, to encourage greater participation in, and greater recognition of, the importance of physical activity. This Plan will be an exemplar of Healthy Ireland in action and will be a significant opportunity to build a new cross-sectoral approach to meeting the goals and vision of Healthy Ireland;
- An annual Healthy Ireland Survey which will gather information to inform the development of robust baseline data, at a national level, on a range of health and well-being indicators, e.g. tobacco use, alcohol consumption, physical activity, diet, sexual health and well-being etc. Ethical approval has been received and preparatory work including cognitive testing of questions is nearing completion. It is expected that the first wave of the survey will happen in Q4 2014. This will be the first new data of this type since the SLAN survey of 2007;
- A Research, Data and Innovation Plan which will provide a coordinated strategic approach to improve the generation and use of knowledge in areas relevant to Healthy Ireland is in development. A prioritised research programme for Healthy Ireland will be agreed, on a cross sectoral basis, which will facilitate the incorporation of research into practice, programme and policy decisions. It is anticipated that the plan will be completed in Q4 2014;
- An Outcomes Framework is being developed to provide a coherent approach to monitoring, evaluating and reporting on the implementation of the Healthy Ireland framework;
- Key policies and strategies being implemented under the Healthy Ireland umbrella include: Tobacco Free Ireland, Obesity Policy, a new National Sexual Health Strategy, the National Positive Ageing Strategy, Suicide Prevention Strategic Framework, Public Health approach to Alcohol;
- Co-operating with and supporting the Department of Children and Youth Affairs in the implementation of Better Outcomes, Brighter Futures, The National Policy Framework for Children and Young People;
- Developing a national ‘Healthy Workplace’ framework across both the public and private sector on a collaborative basis;
- A Healthy Ireland Council, chaired by Mr Keith Wood, has been appointed and the Council held its inaugural meeting on 26 June 2014. It was addressed by Dr Margaret Chan, Director General of the World Health Organisation. It is scheduled to meet again on 23 October 2014. The Council is a key initiative to leverage engagement with whole-of-society and to connect and mobilise communities, families and individuals into a national movement with the aim of supporting everyone to enjoy the best possible health and well-being; and
- A number of Healthy Ireland co-branded initiatives, including across private sector partnerships will roll out in the next 6 to 18 months, supporting the ongoing communication and stakeholder engagement strategy to build a supportive culture and environment as envisaged in the vision and goals of Healthy Ireland.
I am satisfied with the progress being made by Healthy Ireland. Healthy Ireland is one the four pillars of Future Health, the Strategic Framework for Reform of the Health Service 2015-2015. It emphasises the need to move from simply treating ill people to a new concentration on keeping people healthy. I believe that we must prioritise the health and well-being of the population and this means that all sectors of society and government must play their part in achieving the goals of Healthy Ireland. I am conscious that more effort needs to be invested in health and well-being in order to overcome the health inequalities that some communities face and to combat the effects of modern diet and lifestyle on health. It will be necessary to substantially develop the concept and practice of cross departmental, cross sectoral working in order to embed the concept of 'Health in all Policies' across government. This is a key objective of the World Health Organisation's Health 2020 policy on which Healthy Ireland is modelled.
104. Deputy Tom Fleming asked the Minister for Health if he will co-ordinate a strategy between the Health Service Executive and the Department of Transport, Tourism and Sport to promote a healthy lifestyle programme for Irish youths; and if he will make a statement on the matter. [35762/14]
View answerHealthy Ireland, A Framework for Improved Health and Wellbeing 2013-2025, was launched in March 2013. It is the national framework for action to improve the health and well-being of the country over the coming generation. One of the priority actions being undertaken under Healthy Ireland is the development of a National Physical Activity Plan. My Department and the Department of Transport, Tourism and Sport are currently co-chairing a working group developing this Plan. The group, which comprises key stakeholders with an interest and an expertise in physical activity, is focusing attention on operational issues to encourage greater participation in, and greater recognition of, the importance of physical activity. A draft plan will be circulated for consultation shortly and it is anticipated that the plan will be launched early in 2015.
In addition to the development of the physical activity plan, a range of other initiatives which support, encourage and promote healthy lifestyles are already in existence, details of some of which are available on the HSE's website at www.hse.ie and on www.healthpromotion.ie. My Department is also working with the Department of Children and Youth Affairs in the implementation of Better Outcomes, Brighter Futures, The National Policy Framework for Children and Young People and with the HSE, the Department of Education and Skills and the Professional Development Service for Teachers (PDST) to strengthen collaboration, streamlining and simplifying current oversight structures for SPHE in schools. Many other initiatives which promote healthy lifestyles are also delivered by a range of community and voluntary organisations all around Ireland.
105. Deputy Martin Heydon asked the Minister for Health if he will provide an update on the measures the State has in place to deal with potential epidemics, particularly in view of the ongoing ebola crisis; and if he will make a statement on the matter. [36494/14]
View answerEmergency Planning in Ireland is structured around the "Lead Government Department" principle. There are currently 41 emergency types, each with a Lead Government Department (LGD) set out in Annex 'A' to Strategic Emergency Planning Guidance. The Government Department that is responsible for an activity in normal conditions retains that responsibility during a major emergency. When an emergency occurs it is the responsibility of the relevant lead Government Department to chair the National Co-ordination Group (NCG) which deals with the relevant emergency.
The Department of Health is currently the LGD for two emergency types:
- Pandemic influenza and other public health emergencies
- Biological incidents (where incident is primarily a public health incident).
Consequently my Department would be responsible for calling and chairing a meeting of the National Co-ordination Group should this be necessary for dealing with issues arising from any outbreak of pandemic influenza or other public health emergencies.
EU Decision No 1082/2013/EU of the European Parliament on serious cross-border threats to health agreed under the Irish Presidency came into force in November, 2013. The Decision provides a coherent framework for tackling all serious cross-border public health threats by addressing three main areas: preparedness and response planning; risk monitoring and assessment; risk management and crisis communication.
The Health Service Executive Emerging Viral Threats Group and the Ebola Scientific Advisory Group have met recently to review the situation and approve national guidance for Ebola and other emerging viral threats to health. The Health Protection Surveillance Centre has issued this guidance to hospitals and GPs, including an algorithm for the assessment of viral haemorrhagic fevers (VHFs), clinical assessment forms and advice for health care workers, including humanitarian aid workers, returning to or coming to Ireland following travel from an area affected by the Ebola Virus Disease. The situation continues to be monitored.
In conclusion, considerable public health planning is under way with a range of bodies and professionals in relation to the implications of the Ebola emergency in West Africa.
106. Deputy Jerry Buttimer asked the Minister for Health if he will provide an update on the next steps towards universal health insurance; and if he will make a statement on the matter. [36502/14]
View answerI am committed to a major agenda of health reform, in line with the commitments contained in the Programme for Government and our policy statement, Future Health. I want to push ahead as soon as possible with key reforms in areas such as extending free GP care on a phased basis, improving the management of chronic diseases, implementing key financial reforms including Money Follows the Patient, and establishing hospital groups as a critical enabler of improving patient quality and efficiency.
When I became Minister for Health I reviewed our progress to date and the timescales for implementing very important reforms, including Universal Health Insurance, based on universal entitlement to a single-tier health service, that is based on need, not income.
I remain committed to implementing the important improvements that a UHI system is intended to bring. While I believe that it will not be possible to introduce a full UHI system by 2019, as envisaged in the White Paper on Universal Health Insurance, I want to emphasise my commitment to implementing reforms based on UHI and the White Paper. In order to do this I want to examine some key elements further and then to decide on the best way forward.
The Government published the White Paper on Universal Health Insurance in April of this year and my Department initiated a consultation process on it. An independent analysis of the submissions is under way and I expect to receive this report in the next week.
My Department has also initiated a major costing exercise to estimate the cost of UHI for households and the Exchequer and is working closely with the ESRI and the Health Insurance Authority and initial costings should be available by the end of quarter one in 2015.
The independent thematic analysis of submissions from the consultation process on the White Paper and the results of the major costing exercise on UHI will assist in charting a clear course towards the objective of a universal, single-tier health service.
107. Deputy Liam Twomey asked the Minister for Health the measures being taken by his Department to control the cost of private health insurance; and if he will make a statement on the matter. [36491/14]
View answerMy Department and the Health Insurance Authority (HIA) monitor the factors that contribute to costs on an ongoing basis. The cost of private health insurance is influenced by issues such as the number of persons and the age profile of those holding private health insurance, ongoing medical innovations which can have an impact on the cost of care and the cost of claims.
I am determined to address the issues contributing to increased costs in the sector. Health insurers also have an important role to play in keeping health insurance affordable. I welcome the 2% reduction in claims costs across the market for 2013 reported by the HIA and urge the sector to further build on this positive achievement. As part of the Consultative Forum on Health Insurance, Mr. Pat McLoughlin was appointed as Independent Chair to work with insurance companies, my Department and the HIA to identify effective cost management strategies for the industry. Mr. McLoughlin's final report is expected shortly and I will consider how the recommendations can best be implemented.
I am also keen to create the best possible environment within which more people, particularly young people, will want to obtain and retain private health insurance. Under Lifetime Community Rating, from 1 May 2015 loadings will be incurred by anyone aged 35 or over taking out private health insurance for the first time. Loadings can be avoided by taking out health insurance before this date. I am also going to address the sharp price increase that younger people currently experience when they can no longer avail of student discounts. This has led to a substantial reduction in penetration rates in the 20-25 age group, which I will address by making legislative provision for the introduction of Young Adult rates in 2015.
These measures are designed to encourage more people to join the market at younger ages, which is critical to the sustainability of our system of community-rated health insurance.
108. Deputy Charlie McConalogue asked the Minister for Health the position regarding the consultant posts which are being filled by agency staff in Letterkenny General Hospital; the length of time that these posts have been filled by agency staff; the total cost to Letterkenny General Hospital in 2014 of the agency consultants; the efforts his Department is making to ensure that these consultant posts are filled by permanent staff; when he expects the posts to be filled; and if he will make a statement on the matter. [36540/14]
View answerThe HSE have advised that there are currently 7.5 WTE consultant posts in Letterkenny being filled by agency (hourly rate of pay) consultants as follows:
WTE's
|
No. of posts |
Posts filled |
Department |
|
2 |
Have been filled by Agency Staff since August 2014 |
Paeds and MAU |
|
0.5 |
Has been filled since June 2009 |
Radiology |
|
1 |
Has been filled since April 2011 |
Radiology |
|
1 |
Has been filled since July 2013 |
Medicine |
|
1 |
Has been filled since 2008 |
ED |
|
1 |
Has been filled since October 2013 |
Oncology |
|
1 |
has been filled since September 2014 |
Surgery |
The cost of WTE agency paid consultants to LGH in 2014 as at the 31st July 2014 is €933K (January to July) inclusive of agency fees and VAT at 23%. The HSE has advised that every attempt has been made to fill these posts on a permanent basis and that consultants are only employed via agency when all other opportunities to recruit on payroll have been exhausted. Posts have been advertised nationally on a number of occasions for the Department of Radiology and Emergency Medicine, however, no suitable candidates were identified. Of the 7.5 WTE consultants employed through agency, two of these posts have only recently become vacant, while one of the posts is a new consultant post. It is envisaged that all of the posts will be advertised for filling on a permanent basis in the foreseeable future and they are currently with the HSE’s National Recruitment Service.
Measures are in train to support consultant recruitment and retention. In July 2013 Minister Reilly established a Working Group, chaired by Professor Brian MacCraith, to carry out a strategic review of medical training and career structures. One of the recommendations from the MacCraith report is that the relevant parties commence a timetabled IR engagement of short duration to address the barrier caused by the variation in rates of remuneration that have emerged since 2012 between new entrant consultants and their established peers. A number of meetings between the management (HSE, Departments of Health and Public Expenditure and Reform) and the IMO on this recommendation were facilitated by the LRC. Management presented a paper setting out a new career and pay structure for consultants. The LRC has made related recommendations, involving enhanced pay scales for new entrant consultants, and these are currently being considered by the IMO.
109. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he will report on developments in Cappagh hospital, Dublin; if he will provide an update on the number of operating theatres being used in comparison to full availability; his views on reports of work activity being severely reduced due to budget restraints (details supplied); and if he will make a statement on the matter. [36541/14]
View answerCappagh National Orthopaedic Hospital is a tertiary referral centre and receives referrals from all counties in Ireland for complex orthopaedic care, in addition to the provision of the national surgical bone tumour service. The Hospital has advised that it has experienced an unprecedented increase in demand for in-patient treatment throughout 2014. This is consistent with trends in other jurisdictions with similar demographic profiles.
The cumulative effect of a reducing allocation, cessation of NTPF funding and reduction in income has limited surgical capability. Cappagh Hospital has a total of 7 operating theatres. However, not all theatres have been in use in 2014, which is as a result of both constrained financial capability and availability of suitably qualified nursing staff for theatre.
In terms of access, urgent patients continue to be prioritised and Cappagh Hospital has advised that due to strict chronological booking policies, all patients attending the hospital are being offered dates for surgery based on their waiting time to surgery, with due regard to clinical categorisation. It has also advised that day case and outpatient activity targets will be achieved this year.
I understand that the HSE is in active engagement with Cappagh Hospital to examine and agree options for optimising the available theatre resources and to ensure patients have timely access. It is expected that the Hospital will be in a position to carry out additional activity before year end.
110. Deputy Colm Keaveney asked the Minister for Health if his attention has been drawn to issues with regard to the recruitment of psychologists by the Health Service Executive; and if he will make a statement on the matter. [36533/14]
View answerProfessionally trained psychologists employed by the health service play an integral role in the delivery of a wide range of psychological services. These include:
- working with children and their families who present with developmental, emotional or behavioural difficulties and others who have intellectual and physical disabilities;
- working with adolescents with a wide range of difficulties from adjustment problems to serious mental health issues;
- working with adults who present with mental health problems including anxiety, depression and mental disorders.
Psychologists deliver services in a number of ways: as part of a multidisciplinary team of health professionals; as part of a network of health professionals; or as a sole health professional providing a service to a client. They deliver their services in a range of settings including community-based health centres, residential centres, nursing homes and hospitals.
Under Section 22 of the Health Act 2004, the HSE has the authority to appoint persons to be its employees and may determine their duties. This includes the appointment of persons to posts within the psychology service. With regard to the recruitment of psychologists, in the context of significant organisational change and re-alignment, it is the Executive's intention to review the selection criteria for posts within the psychology service. The review will commence in November and, as part of this process, the views of stakeholders will be invited and consideration will be given to developments within the profession.
This review is timely in order to ensure that the recruitment of professionally trained psychologists continues to meet the needs of our evolving health services. I welcome the review and look forward to receiving the report once completed.
111. Deputy Richard Boyd Barrett asked the Minister for Health if he considers the welfare of children with mental health issues is adequately protected considering the chronic shortage of inpatient beds throughout the country; and if he will make a statement on the matter. [35734/14]
View answerThe Mental Health Division of the HSE is committed to ensuring that all aspects of Child and Adolescent Mental Health services (CAMHS) are delivered nationally in a consistent and timely fashion. A Vision for Change describes how services should be coordinated and integrated to meet the full range of social, psychological and physical care needs of children with mental health problems.
The Child and Adolescent Mental Health Service is a key Service Improvement Project for the HSE. The project aims to improve access to and use of CAMHS In-patient, Day Hospital and Community based services, particularly in the context of agreed protocols governing the area of 16-17 year olds. The first meeting of a multi-disciplinary Group established to progress this project took place this month, and it is intended that meetings will be held on a monthly basis. The Group has also met with the Management Teams of all four CAMHS In-Patient units, to review various operational issues including eliminating any restrictions inhibiting full operational bed usage in certain circumstances.
In June of this year, the operational capacity of the Child and Adolescent Acute Inpatient Units was 56 beds. However, due to building works and temporary difficulties arising from loss of certain staff in three of the CAMHS Units, capacity nationally has reduced to 46. It is planned that these issues will be resolved as quickly as possible, and that capacity will increase to 58 by year-end. In addition, construction work is continuing on a new 22 Bed unit at the Cherry Orchard Hospital site in Dublin, which will be completed in September 2015. Where required, and if no public bed is available, in-patient beds are utilised in private hospitals. There are also a small number of children that may require placement outside of the State, where this is deemed to be the best service option in such cases.
It should be noted also that the HSE Mental Health Division is placing particular focus at the moment on overcoming certain issues to improve recruitment and retention rates for Consultant Psychiatrists.
112. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the steps he plans to take to ensure that all hospital consultants are compliant with the terms of their public contract; the extent of serial breaches that he and his Department are aware of by hospital site; and if he will make a statement on the matter. [36544/14]
View answerThe current consultant contract which was negotiated in 2008 provides for the regulation of private practice and includes mechanisms for ensuring compliance by consultants with the permitted ratio of public to private practice.
The HSE has advised that appropriate application of the mechanism for monitoring of public:private mix levels by individual consultants takes place at local hospital level. Clinical Directors across all hospitals review the public:private mix ratios of individual consultants and where required appropriate meetings and communications with consultants about necessary corrective actions are issued. As part of the process, following appropriate timeframes for corrective actions, the HSE will initiate formal procedures with consultants (in line with the procedure set out in the Consultants Contract). Every month hospital CEOs and Hospital Clinical Directors receive a specific report on each consultants public:private mix ratios for the preceding period.
In parallel to hospital monitoring, the HSE receives a national report detailing the total number of consultants compliant/non-compliant across each individual hospital. This allows the HSE to review with hospitals the requirement for corrective action where necessary. Discussions about public:private mix levels form part of the performance management agenda with hospitals on a periodic basis.
It should be emphasised that the Consultant Contract specifies a series of steps and timelines that allows a non-compliant consultant to become compliant again. Thus, whilst a number of consultants may, according to the monitoring reports be non-compliant, they may also be actively undertaking steps to become compliant.
Implementation of Consultant Contract 2008 is primarily a matter for the HSE and the Voluntary Hospitals and agencies that employ consultants. My Department has written to the HSE concerning the need to ensure that consultants' private work is in accordance with the provisions of the contract and I am aware that the HSE has made contact with all hospitals in relation to the matter. As I have no role in compiling data relating to private practice I have directed your enquiry concerning breaches by site to the HSE for reply.
