Written Answers Nos. 424-438
424. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he remains satisfied regarding this country's ability to contain an outbreak of Ebola; and if he will make a statement on the matter. [43253/14]
View answerAs of 5 November 2014, the cumulative number of cases attributed to Ebola stands at 13,042, including 4,818 deaths. The European Centres for Disease Prevention and Control (ECDC), in its latest risk assessment has concluded that the risk of a case in the EU is considered to be low; however the increase in cases in the affected countries means that the risk of a case being imported into Europe has increased. Environmental conditions in Ireland however do not support the natural reservoirs or vectors of any of the viruses that cause VHF. Consequently, the risk of transmission of Ebola in Ireland is considered very low. The HSE has confirmed that there have been no confirmed cases of Ebola in Ireland.
The National Public Health Emergency Team (NPHET) is the forum for managing the interface between the Department of Health and the Health Service Executive during the planning and response phases of a public health emergency. NPHET has met five times since 10 October to coordinate health services response. It now intends to meet every two weeks reflecting the greater level of preparedness that has been put in place in recent weeks.
The EVD Coordination group meets to coordinate preparedness on cross-sectoral issues. It includes representatives from a number of Government Departments and State agencies. It has met eleven times since 15 August. The EVD Transport Sub-group, which coordinates preparedness in the transport sector, is meeting regularly to resolve issues at ports and airports.
The HSE has developed a communications strategy for dealing with Ebola. It was developed in the context of the media protocol developed in conjunction with the Government Information Service. It will be regularly updated as the situation evolves and lessons learned.
The HSE has established a cross directorate group to fast track the training of front line health care staff. Additionally the Acute Hospitals Directorate has established an Ebola response management group to increase preparedness across all Hospitals
All hospitals have been instructed to have on-going training in PPE, targeting specific groups. An assessment on training and deadlines for training completion was completed by all hospitals and is being analysed to guide the development of training.
Extensive information has been provided for hospital clinicians, general practitioners and other healthcare workers, to enable rapid identification of suspected Ebola patients, in other settings, and their urgent management by the Health Protection and Surveillance Centre (HPSC).
A number of hospitals have or are planning shortly to undertake simulation exercises, building on the recent exercise held by the National Isolation Unit in the Mater Misericordiae Hospital.
An interagency exercise is being planned based on exercises undertaken in other EU countries. This will be tailored to improving preparedness in the Irish context.
The HSE has distributed has Emerging Viral Threats pack sent to all GPs, Co-ops and Balseskin refugee centre GPs. The PPE contained in the distributed packs continues to be fit for purpose.
The HSE is liaising with the airports and ports to provide information for staff, including holding information sessions. The HPSC has published guidance for Airport Managers and Airlines, Port Managers and for educational settings. It is also liaising with the Revenue Commissioners concerning guidance for customs officers. The HPSC have produced specific information for travellers and people who have returned recently form affected areas. Advices have also been produced for people intending to work with aid agencies in the affected countries. Information posters have also been produced, and are on display in airports. Advices have also been produced for airports and ports and for educational settings.
The National Isolation Unit (NIU) located at the Mater Misericordiae Hospital, Dublin, is the national referral centre for high risk suspected and confirmed cases of Ebola. The self-contained unit has 12 beds and is designed to admit, isolate and treat patients suspected or diagnosed with highly infectious diseases that are referred from all over Ireland who have both hazardous and highly infectious diseases. There are no plans to treat Ebola cases in other acute hospitals.
In Ireland, all VHF diagnostic tests will be carried out in the BioSafety Level 3 facility at the National Virus Reference Laboratory (NVRL), Dublin.
All elements of the Irish response to date are based on best practice and take account of national and international best practice, and will be reviewed when new information becomes available as the situation evolves. My Department continues to work closely with the HSE, other government departments, the WHO, the ECDC, the EU Commission, Member States and other partners to coordinate measures to tackle the Ebola epidemic and to protect Irish citizens.
425. Deputy Bernard J. Durkan asked the Minister for Health the steps he proposes to take to address any ongoing issues in regard to hospital waiting lists; and if he will make a statement on the matter. [43254/14]
View answerAccording to the HSE's most recently published data, the total number of patients on in-patient and day case waiting lists at the end of August 2014 was 53,431. This is an increase of 3,736 or 7.5% on August 2013.
In August 2014 the number of patients waiting in excess of 12 months for an outpatient appointment has decreased from 84,167 to 41,604; a reduction of 51% when comparing the same periods in 2013 and 2014. Furthermore, the percentage of patients waiting more than 12 months has decreased from 22% in August 2013 to 11% in August 2014. Up to the end of August there has been a 3% increase in outpatient attendances compared to 2013; this equates to 64,289 additional patients seen. Although the increased provision and uptake of outpatient appointments is positive, it is likely to result in some additional demand for in-patient and day cases.
The trends indicate that waiting lists are likely to continue to increase in to next year. The capacity to provide services for these patients has been curtailed by increased emergency admissions and delayed discharges. The HSE continues to seek improvements in the provision of elective surgery, medical and outpatient services through reform, facilitation of local level initiatives, strict adherence to the National Waiting List Protocol and relevant HSE Clinical Programme guidelines and networking of services between hospitals in the new Hospital Groups. The Government has provided additional funding of €25 million in 2015 to address delayed discharges and thereby improve timeliness for admissions from Emergency Departments and waiting lists. The plans to address in-patient and day-case waiting lists are being considered in the 2015 Service Planning process which is currently underway and progress in this area will be a priority for hospital groups throughout next year.
426. Deputy Bernard J. Durkan asked the Minister for Health if he is satisfied that adequate staffing levels are being maintained at all levels throughout the public health sector, with particular reference to employment at consultant, medical and nursing levels; and if he will make a statement on the matter. [43255/14]
View answer428. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he remains satisfied that adequate staffing levels are maintained to meet requirements in public hospitals throughout all disciplines; and if he will make a statement on the matter. [43257/14]
View answerI propose to take Questions Nos. 426 and 428 together.
Given the budgetary position it was essential that the numbers employed across the public service be reduced in recent years in order to meet fiscal and budgetary targets. However, given the need to ensure delivery of essential services, arrangements have been 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 moratorium did not extend to consultant recruitment and more recently NCHD recruitment was facilitated given the need to progress EWTD compliance. This policy has resulted in overall medical/dental numbers increasing by 700 since the end of 2007. In the current calendar year the fall in nursing numbers has been reversed with an increase of about 150 nurses in the period to from January to the end of September.
In order to mitigate the impact on frontline services of the overall reduction in employment numbers, the priority was and is reform of 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. In addition, while it is necessary to continue to control public sector employment, the focus in 2015 will be on budgetary control, enabling the health services to appoint staff where more efficient and economical delivery of services can be achieved.
427. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he remains satisfied regarding the availability of adequate staffing at primary care level throughout the country; and if he will make a statement on the matter. [43256/14]
View answerAt the end of June 2014, 4,362 staff were assigned to Primary Care Teams and Health and Social Care Networks. In line with the commitment in the Programme for Government to a significant strengthening of primary care services, the HSE's National Service Plan 2013 provided for additional funding of €20m to support the recruitment of prioritised front-line primary care team posts and enhance the capacity of the primary care sector (€18.525m for 264.5 front-line Primary Care posts and €1.475m to support Community Intervention Team development).
The breakdown of the 264.5 posts by Region is as follows:
|
HSE REGION |
Public Health Nurses |
Registered General Nurses |
Physiotherapists |
Occupational Therapists |
Speech and Language Therapists |
TOTAL |
|
Dublin Mid-Leinster |
38.5 |
8.5 |
24 |
12.5 |
23 |
106.5 |
|
Dublin North East |
12 |
9.5 |
14.5 |
9 |
14.5 |
59.5 |
|
South |
12 |
8.5 |
7 |
18 |
6.5 |
52 |
|
West |
9.5 |
14 |
2 |
13 |
8 |
46.5 |
|
TOTAL |
72 |
40.5 |
47.5 |
52.5 |
52 |
264.5 |
At the end of October 2014, a total of 232.5 posts (88%) have been filled. A further 4 posts have start dates agreed and the remaining 28 posts are still going through the recruitment process. In addition, 17 WTE Primary Care based Clinical Diabetes Nurse Specialists posts have been recruited, enabling better support and integration of diabetic patients in the community and supporting General Practitioners in the delivery of diabetic care. In 2014, more than half of the total health expenditure on operational services is in the community healthcare sector. The 2014 gross current Budget Day Estimate for the Health Service (including Children and Families) is €13.120bn. Based on the above, the proportion of the health budget aligned to primary care in 2014 is approximately 25%.
The HSE recently published the report, ‘Community Healthcare Organisations – Report and Recommendations of the Integrated Service Area Review Group’ , which sets out how health services, outside of acute hospitals, will be organised and managed. Community healthcare services include primary care, social care (involving services for older persons and for persons with a disability), mental health and health & well-being. The establishment of nine Community Healthcare Organisations (CHOs) and 90 Primary Care Networks will see the further reconfiguration of staff to front line integrated services.
I am confident that the resources outlined above along with the implementation of the CHO Report will facilitate the delivery of the Government's commitment to refocus health care away from the hospital setting and into the community, which is an essential component of the health service reform process.
429. Deputy Bernard J. Durkan asked the Minister for Health the total number of hospital beds available throughout the public health sector at present; if such numbers have fluctuated in the past five years and, if so, to what extent; if augmentation is required and-or proposed in this regard; and if he will make a statement on the matter. [43258/14]
View answerAs this is a service matter, I have asked the HSE to respond to you directly. If you have not received a reply from the HSE within 15 working days please contact my Private Office and they will follow up the matter with them.
430. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he has identified the most pressurised areas of the delivery of health services at present; if he expects to be in a position to address these issues in the short and medium term; and if he will make a statement on the matter. [43259/14]
View answerSince my appointment as Minister for Health I have said, on more than one occasion that my first priority was to achieve a realistic budget for the health service. I believe that was achieved in Budget 2015, with an increase in the exchequer allocation of €305 million. When taken together with once-off increased projected revenues of some €330 million and savings and efficiencies of €130 million ,the HSE will have over €750 million more to fund services in 2015 that it did when preparing its Service Plan in 2014.
This does not mean that all areas of concern across the health service can be addressed immediately but it does make the funding situation more manageable.
Despite this additional spending power, next year remains a real challenge: our rising and aging population, the increase in chronic conditions with our progress in screening for cancers and chronic diseases means more people requiring treatment driving up demand and costs.
I aim to ensure that the existing level of services is maintained in 2015 and that some targeted enhancements are introduced.
I have already signalled that Programme for Government commitments on the extension of BreastCheck and investment in mental health will be honoured. Extra funding of €25 million will be provided to tackle the issue of delayed discharges, which is having a detrimental knock on effect on waiting times and emergency department overcrowding. In 2015, we will deliver on the first phase of Universal Health Care and some 240,000 children under 6 years and approximately 10,000 seniors over 70 years, who currently neither have a medical card nor a GP visit card will be provided with a GP service without fees.
I want to continue the work of my predecessor Minister Reilly in further developing and building the Hospital Groups by putting in place Boards, CEOs and senior management teams and strategic plans.
I also want to take an active role in promoting healthy living. Changes in lifestyle can prevent many diseases such as diabetes, heart disease and lung disease. Other priorities for the remainder of the Government term include the following:
1 Stabilise cost of health insurance
2 Reduce cost of medicines
3 Retaining doctors and nurses
4 Five Major Capital Projects
5 Universal Patient Registration.
It is of course of the utmost importance that patient safety remains an overriding priority across the health service and this will be reflected in the 2015 service plan.
432. Deputy Bernard J. Durkan asked the Minister for Health the extent to which issues in relation to medical cards have been resolved or streamlined; and if he will make a statement on the matter. [43261/14]
View answerI understand the Deputy is referring to the Keane report - The Report of the Expert Panel on Medical Need for Medical Card Eligibility. Eligibility for health services in Ireland, as set out in the Health Act 1970 as amended, is based primarily on ordinary residence and means. All people ordinarily resident in the State are eligible for publicly-funded hospital services. In addition, about two-fifths of the population are eligible for publicly-funded primary care services.
The Deputy will be aware that the Director-General of the HSE established an Expert Panel to examine and recommend the range of medical conditions that would be considered as a basis of eligibility for health services. The Expert Panel was chaired by Prof Frank Keane, Past President of the Royal College of Surgeons Ireland and Clinical Lead, National Clinical Programme for Surgery. The panel included a range of 23 clinical experts from primary care, specialist services and therapies. It also included a patient representative. The work of the Expert Panel was also informed by on-line public consultation and the convening of a patient representative forum to consider the issues.
The Keane report was received by my Department last month and I am considering its findings. The Keane report acknowledged that eligibility is a complex and challenging issue. It is widely known that the report concluded that it is neither feasible nor desirable to list conditions for medical card eligibility.
This is a very detailed report and when I have finished considering its conclusions, discussed them with the HSE and consulted as necessary with the Minister for Public Expenditure and the Attorney General, I will be reporting to Government on the matter.
433. Deputy Bernard J. Durkan asked the Minister for Health the extent to which central procurement and generic prescribing have been each identified and assessed for potential to reduce health service costs without in any way affecting the quality and efficacy of the service; and if he will make a statement on the matter. [43262/14]
View answerMost drugs and medicines which are paid for by the HSE are supplied to patients through over 1,800 community pharmacies who, in turn, purchase them from wholesalers or, to a lesser extent, directly from drug manufacturers. The current pharmacy based model results in over 70 million items being dispensed annually through local pharmacies across the State, including low population centres in rural areas. It enables pharmacies to receive deliveries each day from multiple wholesalers ensuring that all patients have continued access to essential medicines without delay. Under this model, as the drugs are purchased by individual pharmacies with no direct input by the HSE, there is no scope for the type of central procurement arrangement envisaged by the Deputy.
Establishing an alternative centralised distribution centre capable of distributing 70 million items across the State would be extremely difficult to achieve and would absorb any potential savings available to the HSE from directly purchasing medicines.
Under the Memorandum of Understanding with the Troika, Ireland committed to increasing the share of generic drug usage in the medium-term. In Quarter 2 2014 generic products accounted for 64% of the total off-patent market by volume. My Department has set a target of achieving 70% generic penetration of the off-patent market by volume by 2016.
A number of enabling measures are being implemented to achieve this target, in particular, the introduction of generic substitution and reference pricing under the Health (Pricing and Supply of Medical Goods) Act 2013.
In October 2012 a new agreement on the pricing and supply of generic drugs was reached with the Association of Pharmaceutical Manufacturers in Ireland (APMI), which represents the generic drugs industry. Under this Agreement the maximum price the HSE pays for generic products was 50% of the initial price of an originator medicine, this was further reduced to 40% from 1 May 2014. This has resulted in the price differential between off-patent drugs and most generic equivalents increasing from 5% to approximately 20%.
The Medicines Management Programme within the HSE has introduced the preferred drugs initiative which facilitates more cost-effective prescribing particularly in relation to high-cost medicines. It continues to engage with general practitioners to reinforce the message around safe, effective and cost-effective prescribing including generic prescribing.
434. Deputy Bernard J. Durkan asked the Minister for Health the extent to which orthodontic services continue to be made available to children and teenagers with particular reference to follow-up on school medical examinations; and if he will make a statement on the matter. [43263/14]
View answerThe HSE provides orthodontic treatment to those who have been assessed and referred for treatment before their 16th birthday. Where a course of orthodontic treatment commences while a child is in primary school the necessary treatment will continue after the child enters secondary school. Orthodontic referrals are generally received via the Public Dental Service primary school screening programme. Those who attend private schools or are home schooled are also included. An individual's access to orthodontic treatment is determined against a set of clinical guidelines called the Modified Index of Treatment Need. Patients with the greatest level of need, i.e. Grade 5 or Grade 4 are provided with treatment by the HSE.
435. Deputy Bernard J. Durkan asked the Minister for Health the total number of identified sufferers of narcolepsy; the extent to which supportive arrangements are in place or remain to be put in place in respect of such persons; and if he will make a statement on the matter. [43264/14]
View answerThe HSE and the Department of Education and Skills continue to provide a range of services and supports to individuals diagnosed with narcolepsy following pandemic vaccination regardless of age, on an ex-gratia basis. These services and supports which are co-ordinated by the HSE National Advocacy Unit are intended to provide that individuals receive tailored assistance to address their specific requirements, where appropriate. It is acknowledged that treatment and individual medical needs may need to be reassessed over time to take account of changes in their condition or circumstances.
The ex-gratia health supports include clinical care pathways to ensure access to rapid diagnosis and treatment, multidisciplinary assessments led by clinical experts, counselling services for both the individuals and their families, discretionary medical cards for those who have been diagnosed have been provided to allow unlimited access to GP care and any prescribed medication, ex-gratia reimbursement of vouched expenses incurred in the process of diagnosis and treatment, including travel expenses for attending medical appointments; physiotherapy, occupational therapy assessments, dental assessments and dietary services all on a needs basis. Regional co-ordinators have been appointed to assist individuals to provide advice, information and access to local services.
On the education side, the National Educational Psychological Services (NEPS) engaged with all of the schools being attended by children with narcolepsy to provide guidance and assistance on the condition and the supports available. These include special education home tuition, the provision of supplemental learning support/resource teaching support on a needs basis and the provision of Special Needs Assistants (SNA) support if required. Furthermore, reasonable accommodations, including special examination centres and rest breaks were provided for students who sat state exams in June this year. Similar arrangements will be available on a needs basis to students sitting state exams in future years. The Department of Education and Skills issued circulars providing information to schools on the nature, likely symptoms, possible effect of the condition of narcolepsy on students and the supports available for students.
With regard to third level, students diagnosed with narcolepsy following pandemic vaccination can access the Disability Access Route to Education (DARE) scheme, which is a college/university scheme which offers enhanced access routes to third level education.
All health and educational services and supports will continue to be provided on an ex-gratia basis. Those services and supports will be reassessed on an ongoing basis to take account of the individual's condition and circumstances.
In relation to the number of identified narcolepsy cases, the Health Products Regulatory Authority has received 64 reports to date which confirm a diagnosis of narcolepsy with symptoms onset following pandemic vaccination.
436. Deputy Pearse Doherty asked the Minister for Health the reason a child care and preschool facility (details supplied) in County Donegal is allocated only €8.30 per hour by the Health Service Executive to pay for a special needs assistant, this being despite the fact that the facility must comply with employment legislation which sets the minimum wage at €8.65 per hour; his plans to increase this payment made to the facility by the HSE; and if he will make a statement on the matter. [43296/14]
View answerThe particular issue raised by the Deputy is a service matter for the Health Service Executive. Accordingly I have arranged for the question to be referred to the Health Service Executive for direct reply to the Deputy. If you have not received a reply from the HSE within 15 working days please contact my Private Office and they will follow up the matter with them.
437. Deputy Pearse Doherty asked the Minister for Health the reason persons (details supplied) in County Donegal were not provided an allowance in respect of their medical card application for life assurance; the reason only one allowance was given for one child over 16 years financially dependent on the applicant when there are two children over 16 financially dependent on the applicant; the reason the spouse's income was assessed at €479.53 when the gross income provided shows €524.07 less tax, PRSI and USC which amounts to €449.87; and if he will make a statement on the matter. [43315/14]
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. If the Deputy has not received a reply from the HSE within 15 working days, please contact my Private Office who will follow up the matter with them.
438. Deputy Robert Troy asked the Minister for Health if he will expedite a hospital appointment in respect of a person (details supplied) in County Westmeath. [43320/14]
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.
As this is a service matter, I have asked the HSE to respond to you directly. If you have not received a reply from the HSE within 15 working days please contact my Private Office and they will follow up the matter with them.
