Written Answers Nos. 78 - 85
78. Deputy Paul Murphy asked the Minister for Health his views on the recent increase in the Nursing and Midwifery Board’s registration fee from €100 to €150 (details supplied) and on reports that nurses and midwives that do not pay the additional €50 have been threatened with being taken off the register. [2380/15]
View answerI am concerned regarding the implications for the health service and patient safety should the current impasse over the annual retention fee increase continue. I have therefore written last week to the President of the Board of NMBI and asking that options be explored to bring a resolution to issues surrounding the annual retention fee. I recognise that the Board must meet its obligations within the financial resources available. At the same time this demands that obligations are met on the most economic basis possible and all planned expenditure can be demonstrated as necessary.
I have again requested that the Board of NMBI re-engage in discussions with the staff associations, as a matter of urgency. An outcome must be found which secures the Board’s minimum financial operating requirements but avoids a scenario where nurses and midwives are removed from the Register for non-payment of fees with potential consequences for service availability.
I will continue to monitor the situation closely in the interests of patient safety and continuity of care.
I have offered that both my officials and I are available to engage with the Board should that be of assistance.
The board is an independent body, answerable to the Oireachtas, with the responsibility to ensure that it has the financial capacity to undertake all its legal obligations. The cost of enacting the additional requirements under the Nurses and Midwives Act 2011 was set out in the Regulatory Impact Analysis that was carried out prior to the enactment of the legislation.
It was also made clear at the time of the legislation that the Board would continue to be self-funding and needed to plan and cost how it would fulfil its legal obligations. Following detailed negotiations with the Executive and Board members in 2013 it was agreed in October 2013 that an initial once-off sum of €1.6m would be granted by the Department to the Board to cover 2013/2014 costs, but that the Board would have to increase its income in 2015 to undertake its commitments in the legislation. The Board of the NMBI made the decision to increase the annual registration fee at its meeting on 17th September, 2014.
79. Deputy Colm Keaveney asked the Minister for Health if CCTV and covert inspections will be introduced in nursing homes to monitor standards of care; and if he will make a statement on the matter. [2376/15]
View answerI welcome this opportunity to outline the progress being made by the HSE in relation to this very serious matter.
Like others, I was shocked and distressed by the revelations of extremely poor and unacceptable standards of care and mistreatment of vulnerable adults in Áras Attracta. Every person who uses our disability services is entitled to expect and receive supports of the highest standard and to live in an atmosphere of safety and care.
The safeguarding and protection of vulnerable people in the care of the health service is of paramount importance and the Director General of the HSE has written to all staff instructing them to take personal responsibility for ensuring that individuals supported by the HSE in any setting are treated with dignity and respect.
In December 2014 the HSE initiated both an expert investigation chaired by Mr Christy Lynch, and an independently chaired review of services at this facility led by Dr Kevin McCoy.
Mr Lynch’s investigation team is working independently of the HSE and will form an important input into any disciplinary process which the HSE will undertake.
Dr McCoy is undertaking an Assurance Review of the services at Áras Attracta and the final report will include an individual plan for improvement in each bungalow within the complex. The review will identify system wide learning involving engagement with relevant expertise as well as input from staff.
I welcome the fact that the Gardaí have now cleared the way so that Mr. Lynch’s investigation can commence. I have asked the HSE to keep me informed of progress.
The HSE has undertaken a number of additional initiatives to ensure that quality and safe care in residential services for people with disabilities is appropriately implemented and monitored.
A six-step plan will address this in a systematic way. These steps are:
- The establishment of a National Implementation Taskforce, including a series of National Summits to improve client safety, dignity, respect and culture;
- Implementation of the National Policy & Procedures on Safeguarding Vulnerable Persons at Risk of Abuse;
- Development of an Advocacy programme;
- Implementation of an evaluation and quality improvement programme in disability residential centres;
- Development of an implementation plan for any recommendations arising from the McCoy review of residential services in Áras Attracta when complete, and,
- Development of long term sustainable & evidence-based safeguarding practices and training programmes specific to residential settings.
The HSE is considering plans to monitor practices in social care facilities through the use of surveillance cameras, undercover persons and /or other means. However, it is very conscious of potential difficulties that could arise in relation to privacy and data protection, and given the complex issues involved, has decided to engage expert consultants to advise it on the best way to proceed. A Prior Information Notice under EU procurement rules was published in mid-December in this regard.
I can assure the Deputy that my Department will monitor progress on the initiatives and processes commissioned by the HSE in relation to Áras Attracta, to ensure that the learning from this incident is promulgated throughout our health system.
80. Deputy Bernard J. Durkan asked the Minister for Health the current position regarding the development plans for the national children’s hospital; the extent to which the project has been advanced to the next stage; the degree to which the actual space and related facilities have been agreed; when he will announce a starting date for on-site operations; and if he will make a statement on the matter. [2370/15]
View answerThe National Paediatric Hospital Development Board is the statutory body responsible for planning, designing, building and equipping the new children's hospital. The new hospital will be co-located with St James's Hospital, and ultimately tri-located with a maternity hospital to be developed on campus. In addition to the main hospital, the project includes two satellite centres at the campuses of Tallaght and Connolly Hospitals.
The Development Board submitted the Project Brief to the Department of Health in May 2014 for the Minister’s consent and separately to the HSE for approval, in line with the approval process set out in the Board’s Establishment Order (SI 246 of 2007). Minister Reilly informed the Government on 1 July of his consent and HSE approval. The Project Brief sets out details of the specialties to be provided and the planned accommodation. This will include 384 in-patient beds, all in single en-suite rooms with in-room parent accommodation, a further 85 daycare beds and 14 theatres, including three hybrid theatres to facilitate access to imaging during surgery, all in the main hospital. There will be 111 outpatient consulting examination rooms across both the main hospital and the two satellite centres, as well as ED and urgent care facilities.
A design team has been procured and is working on detailed design development, with the aim of submitting a planning application in June 2015. Subject to planning, work will commence at the main site at St. James's, and at the satellite centre sites at Connolly and Tallaght, in January 2016.
81. Deputy Barry Cowen asked the Minister for Health his plans to address the overcrowding problems at Midland Regional Hospital, Tullamore, County Offaly; and if he will make a statement on the matter. [2400/15]
View answerEmergency Department over-crowding is a priority issue for me and for the Government. All hospitals, including the Midland Regional Hospital Tullamore have escalation plans to manage not only patient flow but also patient safety in a responsive, controlled and planned way that supports and ensures the delivery of optimum patient care.
The Midland Regional Hospital Tullamore enacts its escalation policy at peak activity times, the main elements of which include twice daily ward rounds as required by Consultants, twice daily bed management meetings, fast tracking of all home help-home care packages, the prioritisation of diagnostic requests, funding of patients in private nursing homes until Fair Deal is granted, and opening of additional beds where necessary. The HSE has advised that this policy, along with additional measures such as the establishment of a short-stay ward, have ensured that the Midland Regional Hospital Tullamore is in a position to respond quickly to peak activity levels.
The Government has provided additional funding of €3 million in 2014 and €25 million in 2015 to address delayed discharges and actions being taken include the provision of additional home care packages, additional transition beds in nursing homes, 300 additional Fair Deal places and an extension in Community Intervention Teams.
I convened the Emergency Department Taskforce last month to find long term solutions to overcrowding by providing additional focus and momentum in dealing with the challenges presented by the current trolley waits. Following a second meeting last week, the HSE is working on an action plan to be finalised by the end of the month to specifically address ED issues with a view to a significant reduction in trolley waits over the course of 2015.
82. Deputy Denis Naughten asked the Minister for Health his plans to address poor ambulance response times; and if he will make a statement on the matter. [2363/15]
View answerThere has been much discussion about ambulance response times recently. I would like to clarify that response time performance is improving in the face of increasing demands on the service. The latest published data shows that nationally, in October 2014, the volume of ECHO calls rose by 5% compared to the same period in 2013, and DELTA calls by 10%. Despite this, an ambulance arrived within the target time for 76% of ECHO calls and for 67% of DELTA calls - an improvement of 3.3% and 4% respectively on the same period in 2013.
It is worth noting that response time targets only measure one aspect of ambulance performance and they should be part of a suite of assessments. Internationally, many services are moving to patient outcomes as a better indicator of performance. The National Ambulance Service introduced a patient outcome target for out-of-hospital cardiac arrests in 2014, and more are being developed.
I can assure the Deputy that the National Ambulance Service, will in 2015, continue to focus on service improvements. A significant programme of reform and modernisation is ongoing, and, this year we will see a number of further developments. A key component of the reform programme is the single national control system. This will be completed later this year and will, along with the single Computer Aided Dispatch system, further improve call taking and dispatching. The Intermediate Care Service, which received additional vehicles and staff in 2014, will continue to free up emergency vehicles for emergency calls and we are focussed on improving hospital turnaround times.
A €5.4m budget increase in 2015 will help address service gaps, particularly in the west, by reforming rostering and staffing additional stations. We will also expand the number of community first response teams, particularly in more rural and sparsely populated areas. In addition, the Emergency Aeromedical Support Service, which has been very successful, will continue to provide rapid access to appropriate treatment for very high acuity patients where this might be difficult to achieve by road.
The Deputy will be aware that there are currently three major reviews of ambulance services, the recently published HIQA review, as well as the awaited national capacity and Dublin ambulance service reviews. These three reviews, when taken together, will provide us with very good information which will help drive further service improvement. I have therefore asked the HSE to prepare an action plan on completion of the three reviews, with timelines to realise a new vision for our ambulance services.
83. Deputy Mick Wallace asked the Minister for Health his plans for the replacement of the existing system of measuring ambulance response times in view of the findings of the recent report on this issue commissioned by the Health Service Executive, particularly in relation to rural areas; and if he will make a statement on the matter. [2378/15]
View answerIn its recent report, HIQA acknowledged our geographic challenges and recommended different rural and urban response time targets. I also understand that the draft executive summary of the National Capacity Review, recently circulated to the Joint Committee on Health and Children, suggests that the response time targets recommended by HIQA cannot be met, even with substantially increased resources. However, as that report is not yet finalised, I believe it is premature to make any concrete decisions in relation to response time targets.
It is worth noting that response time targets only measure one aspect of ambulance performance and they should be part of a suite of assessments. Internationally, many services are moving to patient outcomes as a better indicator of performance. The NAS introduced a patient outcome target for out-of-hospital cardiac arrests in 2014, and more are being developed.
In relation to rural response time targets, I think it is accepted that these are difficult to achieve for any ambulance service. However, I can assure the Deputy that we are already adapting our ambulance services for the needs of rural populations through, for example, the use of rapid response vehicles. In addition, the Emergency Aeromedical Support Service which has proven to be very successful, will continue to provide rapid access to appropriate treatment for very high acuity patients where this might be difficult to achieve by road. A €5.4m budget increase in 2015 will help address service gaps, particularly in the west, by reforming rostering and staffing additional stations. We will also expand the number of community first response teams, particularly in more rural and sparsely populated areas. The Intermediate Care Service, for non-emergency clinical transport, will continue to free up frontline ambulances, and their highly skilled paramedics and advanced paramedics, for emergency calls.
In addition to the recent HIQA review, the national capacity review and the review of Dublin ambulance services are awaited. These three major reviews of our ambulance service, when taken together, will provide us with very good information which will help drive service improvement. I have therefore asked the HSE to prepare an action plan on completion of the three reports, with timelines to realise a new vision for our ambulance services.
84. Deputy Michelle Mulherin asked the Minister for Health the test that is performed in the State under the public health system to diagnose a person for Lyme disease; the location at which the test is performed; and if he will make a statement on the matter. [2331/15]
View answerLyme Disease (also known as Lyme borelliosis) is an infection caused by a spiral-shaped bacterium called Borella burgdorferi. It is transmitted to humans by bites from ticks infected with the bacteria. The infection is generally mild affecting only the skin, but can occasionally be more severe and highly debilitating. The commonest noticeable evidence of infection is a rash called erythema migrans that is seen in about 80-90% of patients.
Lyme borelliosis is diagnosed by a medical history and physical examination and can be difficult if there has been no erythema migrans rash. The infection is confirmed by blood tests which look for antibodies to B. burgdorferi produced by an infected person's body in response to the infection. These normally take several weeks to develop and may not be present in the early stages of the disease. The standard approach to Lyme diagnostics is a two-stage approach and involves using a sensitive enzyme immunoassay (EIA) as an initial, screening step. Screening EIAs can be insufficiently specific, giving false-positive reactions in the presence of other spirochaete infections including syphilis, and certain viral infections including glandular fever. In addition, sera from patients with autoimmune disorders and other inflammatory conditions can also lead to false-positive results. Samples giving reactive or equivocal tests in screening tests are further investigated in a second-stage immunoblot (Western blot) tests. Use of immunoblot testing greatly increases specificity. Using this outlined two stage approach will give a great degree of certainty around the diagnosis of Lyme Disease. Testing for Lyme borelliosis is currently undertaken in most of the larger hospitals in Ireland.
There is an ongoing publicity campaign regarding Lyme Disease. The Health Protection Surveillance Centre (HPSC) of the HSE is establishing a Lyme Borelliosis Sub-Committee with the primary aim to examine best practice in prevention and surveillance of Lyme Disease and to develop strategies to undertake primary prevention in order to minimise harm caused by Lyme borelliosis in Ireland. This will involve raising awareness among clinicians and the general public. It will explore ways to ensure these messages are brought to the general public with the frequency and in forms in which they can be most effective.
Each year, as part of its ongoing awareness raising regarding prevention and treatment of Lyme Disease, the HPSC holds a Lyme Disease Awareness Week in which media releases are sent out with the intention that media outlets would take up the important Lyme prevention messages. As part of last year's Awareness Week, a supply of information was made available to the public and attention was drawn to a "Tickborn Disease Toolkit", developed by the European Centre for Disease Control (ECDC). This toolkit was modified for use in Ireland and posted on the HPSC website. Indeed, the ECDC informed the HPSC that Ireland was the first European Member State to make such extensive use of this material. Following the Awareness Week, a 100% increase of web traffic to the various Lyme Disease sections of the HPSC website was noted.
85. Deputy Maureen O'Sullivan asked the Minister for Health the amount of the €20 million allocated for community mental health services in budget 2014 spent in 2014; if he will provide a breakdown on the way the money was spent; and if he will make a statement on the matter. [2365/15]
View answerIn relation to the €20 million provided in Budget 2014, the HSE National Service Plan provided for the phasing-in of the expenditure, in order for the HSE to live within its overall available resource across its service areas. It was planned that recruitment of 2014 posts would be started in order to provide for posts to come on stream during Quarter 4 and to this end, an amount of €5 million was expected to be spent in 2014 from the 2014 allocation.
The HSE have informed me that a detailed analysis took place during 2014 of all 9,000 staff in Mental Health Services to inform the decision making process on the prioritised allocation of approximately 250 new posts. Although full recruitment did not take place during Quarter 4 2014, the posts appointed required €0.250m with the remainder of the €5 million largely expended on the opening of unfunded but approved capacity in the National Forensic Service in order to provide sufficient extra capacity to meet the requirements of the Criminal Law Insanity Act. This €20 million is available to spend in full on mental health services in 2015, along with the new additional funding of €35m provided in Budget 2015.
