Written Answers Nos. 1-108
94. Deputy Mick Wallace asked the Minister for Health the way ambulance services here are regulated to ensure compliance with best operational and clinical practice; and if he will make a statement on the matter. [42783/14]
View answerClinical and operational standards for ambulance services in Ireland are set by the Pre-Hospital Emergency Care Council. PHECC registers pre-hospital practitioners - emergency medical technicians, paramedics and advanced paramedics – to practise in Ireland, and conducts fitness to practise proceedings. As the competent authority for Ireland, PHECC sets education and training standards for pre-hospital care. It also carries out and funds research.
In seeking to ensure the safety of patients in the care of ambulance services, PHECC firstly assesses and confirms the qualifications of each paramedic. This ensures that registered paramedics have the necessary education, training, experience and skills to fulfil the requirements of their role.
Secondly, PHECC licenses an organisation to provide ambulance services. Licensed providers are allowed to use and implement specific clinical practice guidelines. The Council prepares such guidelines and makes them available to pre-hospital emergency care providers as appropriate.
Finally, PHECC sets the scope and limits of practice for paramedics working for a particular licensed provider. This ensures that the paramedic provides care and services within the organisation’s licensed limits.
It is clear that the organisation of pre-hospital care in Ireland has come a long way in the last two decades. Since its establishment as an independent statutory body in 2001, PHECC has put in place the structures for pre-hospital care in Ireland to ensure that ambulance services continue to develop in line with best operational and clinical standards.
95. Deputy Thomas P. Broughan asked the Minister for Health if he or his Department carried out detailed analysis or studies in its preparations for budget 2015 or otherwise of the amount of funding or the funding model that would be required to have an adequate number of medical personnel and facilities to eliminate all waiting lists for surgical and other medical procedures. [42751/14]
View answerAs part of the Estimates process, my Department and the HSE considered the demands in all services, including acute hospital services and the issue of waiting lists. The elimination of waiting lists would entail very significant additional resources, including capital developments. It is not currently possible to provide a comprehensive total of the funding required.
Over the last ten years, the health service has delivered significant productivity gains and there is further scope to build on this by reference to international best practice and in the context of acute hospital reform. Department of Health figures show that between 2004 and 2013 - in-patient discharges increased 11.2% whilst in-patient beds reduced by 12.4% and in-patient length of stay reduced by 13.5% - daycases increased 80.3 % excluding dialysis - total discharges excluding dialysis went up 41.3 % and daycases as a percentage of total discharges went up 27.7% excluding dialysis.
With regard to targeted investment, an additional €25 million has been provided in 2015 to address delayed discharges and thereby improve timelines for admissions from Emergency Departments and waiting lists. Plans to address inpatient and daycase waiting lists are being considered in the 2015 Service Planning process which is currently under way. Actions to address the waiting lists will include the undertaking of additional surgical lists, using theatres outside of regular hours and more efficient inter-hospital use of capacity within hospital groups.
96. Deputy Brendan Smith asked the Minister for Health his plans to improve access to the fair deal scheme; and if he will make a statement on the matter. [42780/14]
View answerI am aware that waiting times on the Nursing Homes Support Scheme placement list are now at around 15 weeks. This is a matter of concern for me, and my Department and the HSE are working to ensure that the resources that are available deliver the best possible outcomes for older people. This will require an integrated approach across community, residential and other service areas.
The HSE controls the release of funding to manage the financial allocation that is available across the course of the year. Funding is released to approved applicants according to their place, in order of their approval date, on the national placement list. Over the course of the year to date, demand has exceeded what could be funded and the national placement list has grown as a result.
In July this year, the HSE allocated €5 million for an initiative to improve access to appropriate care for older people. To date, this has funded over 300 transitional care beds for patients in acute hospitals from the placement list for the Nursing Homes Support Scheme and over 200 home care packages to assist patients in the acute hospitals who require a home care package to be discharged.
The Government has provided additional funding of €25 million in 2015 to address delayed discharges. This funding will be targeted at hospital and community services which can demonstrate initiatives to address the specific needs of delayed discharge patients most positively and, therefore, improve timelines for admissions from Emergency Departments and waiting lists. These will include measures to place patients in more appropriate settings through the use of home care packages and intermediate and long-term care. It will include provision for an increased allocation to the Nursing Homes Support Scheme. Planning for this initiative is well advanced. Details will be finalised in the HSE's Service Plan later this month, with a view to their early implementation.
The Review of the Nursing Homes Support Scheme which is currently under way will consider the future funding and sustainability of the Scheme as well as how community and residential services are balanced. This Review will be completed in the coming months following which the Government will be considering how best to meet the needs of older people in the future.
97. Deputy Maureen O'Sullivan asked the Minister for Health the funding available for the treatment abroad scheme for 2012, 2013 and to date in 2014; the criteria for deciding the person availing of the scheme and the types of treatment and procedures accepted for funding; and if he will make a statement on the matter. [42732/14]
View answerThe Treatment Abroad Scheme, operated by the Health Service Executive, provides for the referral of patients to another EU/EEA country or Switzerland for a treatment not available in Ireland or where undue delay is experienced in accessing necessary treatment in Ireland.
Under the Scheme, the HSE provides for the cost of approved treatments abroad through the issue of form E112. Where an application meets the qualifying criteria the funding is approved and that decision to approve is not based on budgetary implications.
The health authority of these countries issues invoices to the HSE for care provided to those approved patients. These invoices are received in arrears; often 2 or 3 years in arrears. Therefore the figures detailed below are the costs as currently available to the HSE and are likely to change as invoices for previous years are received and paid and should be interpreted in that context.
In 2012, 791 applications were approved at a cost of over €7.5 million.
In 2013, 640 applications were approved at a cost of over €7.8 million.
In 2014 to date, 500 applications have been approved at a cost of over €9.4 million.
Treatment must be medically necessary, must meet the patient’s needs and may not be an experimental treatment. The hospital outside the State must accept the form E112. The application must be assessed and a determination given before that patient goes abroad. The HSE is not required to approve a treatment which is not available in Ireland where an equivalent treatment which will meet the patient’s needs is available.
The most common treatment types that patients accessed under the Scheme are Deep Brain Stimulation, Cardiac Transplantation, Sap Scan and Paediatric Liver Transplantation.
98. Deputy Billy Kelleher asked the Minister for Health if the upward trend in waiting lists will reverse before the end of this year; and if he will make a statement on the matter. [42771/14]
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 under way and progress in this area will be a priority for hospital groups throughout next year.
99. Deputy Lucinda Creighton asked the Minister for Health the steps he is taking to address the fall-off of 300,000 Irish persons from the private health insurance scheme since 2008; his plans to examine the possibility of breaking up the VHI monopoly of the health insurance sector here; and if he will make a statement on the matter. [42786/14]
View answerFollowing a long period of rising premiums and a severe decline in health insurance numbers, the number of policy holders is now showing modest growth, with an increase of 1,000 in the number insured between July and September 2014. I recently announced a series of measures which I hope will contribute to a continuation of this trend. The Health Insurance (Amendment) Bill 2014, which I will bring before the House this Thursday, will provide the legislative basis for some of these measures, including:
- Risk equalisation credits (based on age, gender and level of cover) payable in respect of members aged 60 and over.
- The Hospital Bed Utilisation Credit which acts as a proxy for health status, is increased from €60 a night to €90 and is payable in respect of overnight stays for all ages. The combined impact of the Bed Utilisation and RE Credits brings the average net claims down to 130% of market average compared to 133% in 2014.
- Revised stamp duty rates of €80 for a child and €240 for an adult, which represent a 20% reduction in the levy for those aged 17 and under and a 17% reduction for those aged 18 and over, for products not providing advanced cover.
- No change to adult and child rates of stamp duty for advanced products (last year it increased by €49).
The Bill will also make provision for the introduction of young adult rates, to address the sudden increase in premiums that occurs for most young adults after age 21. In addition, Lifetime Community Rating regulations were signed in July and will come into effect from 1 May 2015, the aim of which is to encourage younger people to purchase private health insurance before age 35. Separately, I have decided to reduce the levy which insurers pay to meet the running costs of the Health Insurance Authority. A nominal rate of just 0.01% of insurers' premium income will apply for two years, resulting in savings for the insurance companies of €2m for each of these years. The rate will then be set at 0.9%, a 25% reduction on the current rate.
Taken together, all of these measures are designed to try to limit the need for increases in premiums, and make private health insurance affordable again for as many people as possible.
The VHI is one of four health insurers operating in a commercial insurance market. While it is the largest of the four, I do not consider that it holds a 'monopoly' position in the market but I am very conscious of the need for real competition and good consumer choice. I want to ensure a sustainable and competitive private health insurance market.
100. Deputy Paul Murphy asked the Minister for Health his views on a co-payment for holders of a general practitioner visit card aged under six and over 70 when visiting their doctor; and if he will make a statement on the matter. [42766/14]
View answerThe Government committed to introducing, on a phased basis, a universal GP service without fees within its term of office, as set out in the Programme for Government. The Government has commenced this process in respect of all children under 6 years. The Health (General Practitioner Service) Act 2014, which provides an entitlement for all children aged under 6 to a GP service without fees, was enacted on 25th July 2014. Under a Framework Agreement, the Department of Health, the HSE and the IMO are engaged intensively on the introduction of GP services without fees for children aged under 6.
In July 2014, the Government approved the drafting of a Bill to amend the Health Act 1970 to provide a GP service, without fees, for all persons aged 70 years and over. Drafting of the Bill by the Department and the Attorney-General’s Office is nearing completion and this will allow for the introduction of access to GP care without fees for persons aged 70 and over.
The Government's aim is to have the first two phases for the under-6s and over-70s implemented early next year subject to the conclusion of the present discussions and the completion of a fee-setting process. By the end of next year, approximately half of the population will have access to GP services, without charges. That's a major step on the way to universal health care.
Some GPs have raised concerns that there could be a high level of inappropriate or unnecessary attendances at GP practices when a service is free and have suggested that there could be an option for a GP to apply a nominal fee to deter such unnecessary visits to a GP, and free up GP time for genuine patients. However, the Minister for Health is currently implementing the phased introduction of a universal GP service without charges in line with existing and planned legislation.
101. Deputy Lucinda Creighton asked the Minister for Health the steps that have been taken to address the issues raised by the chief medical officer in his report into the Portlaoise hospital babies scandal; if he will confirm that his position is consistent with his predecessor in his unambiguous commitment to the introduction of legislation to enforce mandatory reporting in such instances; when this legislation will be published; and if he will make a statement on the matter. [42785/14]
View answerI believe that it is vitally important that we restore public confidence in the quality of maternity services at Portlaoise and steps have already been taken to do so. Following the publication of the Chief Medical Officer's Report into perinatal deaths in Portlaoise the Health Service Executive established an Implementation Group to oversee and ensure the recommendations of the Report are progressed in a timely and effective manner. The HSE submits regular progress reports on the implementation process to my Department.
One of the recommendations of the Portlaoise Report was that the HSE's National Open Disclosure Policy which was developed jointly by the HSE and the State Claims Agency and launched in November 2013, should be implemented in full. The Policy is designed to ensure an open, consistent approach to communicating with patients and their families when things go wrong in healthcare. This includes expressing regret for what has happened, keeping the patient informed, providing feedback on investigations and the steps taken to prevent a recurrence of the adverse event. Implementation of the policy across all health and social services has now commenced by the HSE. At the recent Patient Safety First Conference last Friday, 7th November, the National Lead for Open Disclosure in the HSE advised that over 250 staff briefing sessions and 95 workshops have taken place to date. An evaluation of the Pilot sites indicates that there has been positive feedback from the process with staff having gained confidence to engage in open disclosure.
Ireland currently has no express legislation to assist the open disclosure process. However, it is intended that this situation will change with the Health Information Bill which is expected to be ready for publication in 2015. That Bill will contain a number of measures to better promote patient safety including a provision to encourage open disclosure by affording a degree of protection for healthcare personnel. This is consistent with the Report of the Commission on Patient Safety and Quality Assurance. It is also in line with a recommendation in a consultation paper published by the Law Reform Commission in 2008 that "a statutory provision be considered which would allow medical practitioners to make an apology and explanation without these being construed as an admission of liability in a medical negligence claim".
102. Deputy Finian McGrath asked the Minister for Health his plans to improve services at Beaumont Hospital, Dublin 9 in 2014-2015; and if he will make a statement on the matter. [42749/14]
View answerThe approved revenue allocation for Beaumont Hospital in 2014 is €236 million, an increase of €3 million over 2013. Beaumont Hospital has a continuous quality improvement programme in place to improve and enhance the services it delivers to its patients. Hospital management works on an ongoing basis with relevant Divisions in the HSE in respect of funding for major capital development projects to support the growth in hospital activity and to deliver healthcare to modern international standards.
Several developments in Beaumont Hospital have been approved and are in progress. The most significant of these relate to improvements associated with the National Renal Transplant Programme. The refurbishment of St. Damien's Ward is a key improvement for transplant patients, providing fit-for-purpose ward accommodation, with single, en-suite accommodation and hepa-filtration to minimise the spread of infection between graft recipients. Separation between transplantation and urology or nephrology patients will further reduce the risk of post-operative infection. The Histocompatibility and Immunogenetics Laboratory will be extended and the first floor of the Acute Mental Health Department will be fitted out to provide accommodation for an additional 44 dialysis stations. In terms of resources, staff for an additional theatre will be provided for two days per week and staff will also be provided to undertake a greater number of donor assessments.
In relation to other services, the reconfiguration and re-equipping of the existing Cardiac Catheterisation Laboratory and the provision of a second Cath Lab are ongoing and the Cochlear Implant Programme will be expanded to include simultaneous and bilateral implantation.
103. Deputy Joan Collins asked the Minister for Health the reason children are on waiting lists for orthopaedic surgery at the children's hospital, Dublin 12; the number of children waiting over nine months for surgery for spinal curvature; the number waiting over six months and the number waiting over three months. [42755/14]
View answerScoliosis in children and young people is predominantly managed at Our Lady’s Children’s Hospital, Crumlin. The hospital has an agreed capacity to carry out 58 full spinal cases per year as part of its annual Service Level Agreement with the Health Service Executive. A total of 68 full spinal surgeries were carried out in 2013 (10 more than funded). In total, 147 spinal procedures were carried out in 2013; this included children requiring repeat procedures and rod lengthening as well as full spinal surgeries.
There has been an increase in the number of outpatient department referrals of spinal review, and a consequent increase in surgical demands. Currently there are 140 patients waiting over 13 weeks for various procedures including spinal assessment, cast change, full spinal surgery, insertion of growing rods and lengthening of growing rods. Of these, 103 patients are waiting over six months and of these in turn, 79 are waiting over nine months. In addition to the above active waiting list numbers there are also 31 patients that have planned dates that also fit within the above mentioned categories.
The Children's Hospital Group has advised that it is working to identify a comprehensive plan for utilisation of all orthopaedic resources across Tallaght and Crumlin to address trauma and other orthopaedic surgery, as well as spinal services. The resource requirements to address service needs are being considered in the 2015 Service Planning process which is currently under way.
104. Deputy Sandra McLellan asked the Minister for Health the location of the medical records, including the birth registers and the maternity theatre registers, for each year from 1950 to 2007, inclusive, relating to maternity and obstetric services formerly provided at the Erinville Hospital, County Cork, under arrangements pursuant to maternity services legislation; and if he will make a statement on the matter. [42777/14]
View answerI am advised by the HSE that all available historic records for Erinville Hospital are stored in an offsite storage facility.
105. Deputy Charlie McConalogue asked the Minister for Health the number of patients Letterkenny General Hospital outsourced under the 2013 outpatients initiative; the number of these deemed to require continuing management or procedures; of these, the number that has been provided for; and if he will make a statement on the matter. [42762/14]
View answerAs part of the 2013 outpatient waiting list initiative, Letterkenny General Hospital outsourced outpatient consultations in respect of a total of 2,722 patients. 919 of these patients were seen and discharged back to GP care, with no further intervention required. 953 patients were deemed to require diagnostic investigation. These tests have been approved and are being scheduled by the treating hospitals. About 300 patients to date have had diagnostic investigations carried out. The remaining patients will be catered for either by outsourcing to a private provider or within the existing resources of the hospital.
190 paediatric patients require surgery. All paediatric surgery has been approved and the treating hospitals are scheduling and treating these patients. All of the paediatric surgery cases are either done or have scheduled dates in place and will be completed by the end of the year. 550 adults require surgery. These patients are awaiting approval for referral to the private sector or return to the Saolta University Health Care Group. However, 27 emergency adult patients have had their surgery performed already. Similarly, 110 patients require further outpatient review and are awaiting approval for referral to the private sector or return to the Saolta University Health Care Group.
106. Deputy Finian McGrath asked the Minister for Health if he will withdraw all cuts to front-line disability services; and if he will make a statement on the matter. [42745/14]
View answerThe vision for the Health Service Executive's Disability Services Programme is to contribute to the realisation of a society where people with disabilities are supported, as far as possible, to participate to their full potential in economic and social life, and have access to a range of quality personal social supports and services to enhance their quality of life.
The Health Service Executive National Service Plan 2014 and accompanying Operational Plan for the Social Care Division outline the quantum of specialist disability services, the key reform initiatives and the additional investment in 2014, all of which provide for significant progress in furthering this vision in 2014.
The HSE will spend €1.4 billion and employ a staff level of approximately 15,000 whole time equivalents in 2014 to provide specified levels of services. An additional investment of €14m in 2014 also has been made to address deficits in disability services, a reform programme to transform services to a community based model of person centred supports, and to focus on the implementation of the Health Information and Quality Authority standards for residential services for people with a disability.
These developments and reform proposals, which were outlined in the VFM and Policy Review published in 2012, are being carried out in an environment of effective communications and engagement with all those involved in services, including people with a disability through the HSE's consultative and programme implementation structures.
The VFM Review identified fundamental issues that need to be addressed in the way in which HSE-funded disability services are managed and operated, and lays the groundwork for the introduction of a significant restructuring of the Disability Services Programme. As well as migration from an approach which is predominantly organised around group-based service delivery towards a model of person-centred, individually chosen, supports, the VFM Review also highlighted the need for greater efficiencies in the use of resources.
VFM efficiency targets of €5 million were identified this year in the National Service Plan. In order to arrive at a fair and equitable allocation of these efficiency targets, the Social Care Division of the HSE has been assessing the capability of the voluntary disability providers to implement the necessary measures.
In recognition of the time required to complete this work I understand that only 50% of the 2014 requirement, i.e. €2.5 million, is being assigned to agencies this year. I have been assured that the HSE will continue to work with disability agencies to ensure that efficiencies are achieved without impacting on service provision.
107. Deputy Maureen O'Sullivan asked the Minister for Health the location of the birth registers and the maternity theatre registers for each year from 1950 onwards relating to maternity and obstetric services provided at the Rotunda Hospital, Dublin, under arrangements pursuant to maternity services legislation; and if he will make a statement on the matter. [42731/14]
View answerI am advised by the HSE that birth registers-labour ward entries, theatre and admission registers from 1963, and theatre records from 1967 are held on site in the healthcare records department in the Rotunda Hospital. Operating theatre books from 1941 to 1967 are held in the National Archives.
108. Deputy Ruth Coppinger asked the Minister for Health in order to honour Ireland's positive human rights obligation not to interfere with the right to obtain the highest possible standard of health, if he will make the appropriate changes to allow mifepristone and misoprostol to be available here, in view of their inclusion on the World Health Organization's list of essential medicines. [42794/14]
View answerThe Health Products Regulatory Authority (HPRA) is the competent authority for the regulation of medicines in Ireland. Medicinal products can only be placed on the market in Ireland after a marketing authorisation is granted by the HPRA following an application from the manufacturer. Medicines may also be authorised for use across Europe by virtue of a centralised marketing authorisation issued by the European Commission on behalf of the EU. In both cases, such medicines are entitled to be marketed in Ireland under the terms of their marketing authorisations. A pharmaceutical company may make an application to the HPRA for a marketing authorisation for a product to facilitate its use on an authorised basis in a manner which is in compliance with current legislation.
The conditions of the marketing authorisation are laid down in the product information which accompanies and forms part of the marketing authorisation. Authorised medicines containing misoprostol are available in Ireland under the brand names Cytotec™ and Mysodelle™. Cytotec is a tablet containing 200 micrograms of misoprostol which is indicated for the management and prophylaxis of peptic ulcers associated with the use of non-steroidal anti-inflammatory medicines. It is also indicated in the short-term management of duodenal and gastric ulcers. Mysodelle is a vaginal device containing 200 micrograms of misoprostol and is indicated for the induction of labour in women with an unfavourable cervix from 36 weeks of pregnancy in whom induction of labour is clinically indicated. There are currently no products containing mifepristone authorised in Ireland nor has any application to authorise such a product been received.
