Written Answers Nos. 1 - 21
11. Deputy Brian Stanley asked the Minister for Health the position regarding the public consultation on the future of Abbeyleix and Shaen hospitals; the decisions by the Health Service Executive or his Department regarding same; and if he will make a statement on the matter. [2351/15]
View answerThe HSE seeks to manage all of its residential facilities in a way that maximises efficiency and the application of available resources. It must also maintain standards and provide a high quality service to its residents.
In this context all such facilities are subject to standards which are set and supervised by the Health Information and Quality Authority (HIQA). Many HSE facilities, particularly older facilities, face significant challenges in this context, and engagement between HIQA and the HSE is ongoing to address the issues arising.
In 2012 the HSE launched a public consultation process regarding a proposal to consolidate the number of public nursing units in the Midlands. At the time almost 100 submissions were received and over 60 meetings took place with interested parties, 55 of which were with residents and next of kin.
The HSE is in the course of considering all of the available relevant information with a view to finalising a recommendation in relation to St. Brigid's Hospital, Shaen and Abbeyleix Community Nursing Unit.
Abbeyleix CNU currently has 19 beds, 7 of which are occupied by long stay residents, the reminder being short stay and respite. The HSE is no longer admitting clients to long stay beds, but the respite service remains open to new clients subject to availability. There are 16 beds occupied at St. Brigid's Hospital, Shaen, 13 of these are for continuing care and 3 are for respite. The HSE are no longer admitting clients for either service.
The Department awaits the HSE's recommendations in respect of both facilities and an announcement will be made as soon as possible once the HSE’s definitive position is received.
12. Deputy Niall Collins asked the Minister for Health his plans to address the persistent problems in the emergency department at University Hospital Limerick; and if he will make a statement on the matter. [2404/15]
View answerI acknowledge that the Emergency Department in University Hospital Limerick is under pressure. As part of a comprehensive building programme at the hospital, a new Emergency Department will be completed and operational in 2016. Pending its completion, a number of initiatives have been put in place to address current limitations for patients and staff.
A 22 bed Emergency Department overflow area has been provided, staffed by additional nursing and support staff.
As part of the Group’s escalation plan and in line with best practice, lower acuity in-patients are routinely transferred to Ennis, Nenagh and St. John’s, thus freeing up beds in University Hospital Limerick for patients from the Emergency Department. A separate paediatric emergency area has also been opened, providing a separate child friendly environment.
As well as these initiatives, University of Limerick Hospitals Group has developed several processes to improve emergency services. This includes a daily teleconference for all hospitals in the Group, led by a senior manager, with a focus on patient flow, risks and resource challenges. Multidisciplinary teams are in place to review, plan and manage demand and capacity on a daily basis within the hospital. There is extensive collaboration with the community sector to facilitate the transfer, back to the community or into long term care, of patients whose discharge may otherwise be delayed.
The HSE, through its Acute Hospitals Directorate and Special Delivery Unit, continues to support the University Hospital Limerick team in developing interim and long term sustainable solutions to deal with bed capacity, excessive trolley waits and overcrowding in the Emergency Department.
13. Deputy Mattie McGrath asked the Minister for Health his views on the latest Health Service Executive report on ambulance response times; his views that the current ambulance service is fit for purpose; and if he will make a statement on the matter. [2368/15]
View answerOur ambulance services are undergoing significant development and performance is improving. There has been significant upskilling of ambulance personnel, greater use of technology, improved response times, development of clinical protocols to promote better outcomes and dedicated aeromedical, paediatric and neonatal retrieval services. There is much development under way to further improve the outcomes achieved by the National Ambulance Service.
Response times only measure one aspect of ambulance performance. The overall goal is to improve outcomes for patients, so that lives are saved and disabilities are avoided. Response times do not indicate when treatment was commenced or the outcomes achieved by our highly trained paramedics in deploying their skills. In 2014, the National Ambulance Service introduced a patient outcome target for out-of-hospital cardiac arrests, and more are being developed. These will provide truer measures of the performance of our ambulance service.
It is important, in any event, to note that response time performance is improving, in spite of increasing demands on services. In October 2014, ECHO calls, for life-threatening cardiac and respiratory events, rose by 5% compared to 2013 and DELTA calls, for other life-threatening incidents, rose by 10%. Despite this, an ambulance arrived within the target time for 76% of ECHO calls and 67% of DELTA calls - an improvement of 3.3% and 4% respectively, which means that treatment by paramedics and advanced paramedics is reaching more patients, more quickly.
Achieving response time targets in rural and some urban settings is difficult for any ambulance service. In its recent report on ambulance services, HIQA recommended different rural and urban response targets. I also understand that a draft summary of the National Capacity Review, circulated to the Joint Committee on Health and Children, suggests that the response targets recommended by HIQA cannot be met, even with substantially increased resources. However, that report is not finalised and I cannot give a considered view at this stage.
In 2015, a €5.4m budget increase will help improve services, particularly in the west, by reforming rostering and staffing additional stations. The Emergency Aeromedical Service has completed over 800 missions, and will continue to provide rapid access to treatment for very ill patients. We will also expand community first response, particularly in more rural and sparsely populated areas.
We are working to improve the service though the finalisation of the single national control centre. The Intermediate Care Service continues to free up frontline ambulances, and we are focussed on improving hospital turnaround times.
The three current reviews of our ambulance service will provide us with very good information to improve services. I have 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, which will build upon recent achievements.
14. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the details of the medication soliris, eculizumab; if it will be funded for those with paroxysmal nocturnal haemoglobinuria; and if he will make a statement on the matter. [2415/15]
View answerThe HSE has statutory responsibility for decisions on pricing and reimbursement of medicinal products under the community drugs schemes in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013.
This requires consideration of a range of statutory criteria prior to reimbursing any medicine, including clinical need, cost-effectiveness and the resources available to the HSE.
The decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds by the HSE on the advice of the National Centre for Pharmacoeconomics. They are not political or ministerial decisions.
This drug Eculizumab is indicated for the treatment of patients with Paroxysmal Nocturnal Haemoglobinuria or PNH. It is considered to be one of the most expensive drugs in the world.
I understand that in 2010 the HSE entered into an interim Access with Evidence Development Agreement between the company Alexion Pharma and St James's Hospital to treat 10 patients with this drug. The interim agreement was put in place with the expectation that future evidence would emerge which would assist with the future decision making on this drug.
The HSE received an application for the inclusion of Eculizumab in the GMS and community drugs scheme. In accordance with agreed procedures the National Centre for Pharmacoeconomics conducted a pharmacoeconomic evaluation of Eculizumab.
The National Centre for Pharmacoeconomics published an evaluation of the medicine in October 2013 which found that the manufacturer failed to demonstrate the cost-effectiveness of this drug and reimbursement would have an estimated cumulative gross budget impact for the HSE of €33 million over 5 years. Consequently the National Centre for Pharmacoeconomics was unable to recommend reimbursement of the product under the community drugs scheme.
Notwithstanding the pharmacoeconomic evaluation of this drug, in recognition of the burden of illness experienced by those with PNH, the HSE has been engaging with the manufacturer, Alexion Pharma, for some time in seeking to arrive at a price that would assist it in its desire to fund this medicine for as many patients as possible within the resources available.
The price being offered at present would involve the medicine in question costing €420,000 per annum for each additional patient treated, with treatment continuing over a person's lifetime in most cases.
The HSE's engagement with the company has now been concluded. The Executive is considering the outcome of that engagement and I expect that the HSE will shortly make its determination. It is regrettable that to date the company has not been able to provide this drug at a more sustainable price to the HSE to reflect the clinical evidence.
I would like to assure the Deputy that I fully understand the concerns of patients regarding the availability of this drug and that every effort is being made to achieve a satisfactory outcome. While I appreciate that some may take the view that the taxpayer should reimburse every licensed medicine for whatever the price the drug company demands, the better interests of the health service require that we reimburse only the most effective medicines and only at a fair price.
15. Deputy Bernard J. Durkan asked the Minister for Health the steps he will take to address the serious issue of overcrowding at various general hospitals throughout the country including Naas General Hospital with particular reference to identifying specific measures applicable to individual cases whereby remedies such as the utilisation of appropriate space for emergency beds-trolleys other than in hospital corridors may be utilised thereby ensuring reasonable working conditions in compliance with health and safety standards for patients and staff in all situations; if he will identify currently unused or previously decommissioned wards/beds within the hospital system which may if re-commissioned help alleviate the immediate problems; the total number of step down beds available throughout the public health sector; the extent to which the number of such beds has fluctuated over the past ten years; if he will take specific measures to address these immediate and pressing issues and at the same time identify short to medium term solutions; and if he will make a statement on the matter. [2369/15]
View answerED Overcrowding is a priority issue for me and for the government. All hospitals, including Naas General Hospital, 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. These plans include the opening of additional overflow areas, reopening of closed beds, provision of additional diagnostic scans and Consultants doing additional ward rounds to improve the appropriate flow of patients through the hospital system.
The recent provision of Community Intervention services for Naas General Hospital, in particular the provision of IV Antibiotic therapy in patients homes, has avoided approximately 89 admissions to the hospital since service commenced in the last two weeks. In addition, the HSE is developing a substantial infrastructure project at Naas General Hospital which includes an endoscopy unit, oncology unit and physical medicine department. It is anticipated that construction will commence in the second half of 2015, subject to the awarding of planning permission.
The total number of beds available as of October 2014 is 12,483. However, these are beds available at a particular date in time and this number can fluctuate over time due to reasons such as ongoing refurbishment and maintenance work. The total number of step down beds in public residential units as of end December 2014 is 1,869. However it should be noted that vacant nursing home beds are not always located where needed. 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.
16. Deputy Gabrielle McFadden asked the Minister for Health the number of community geriatric teams comprising a geriatrician and specialist nurse currently operating here; his plans to expand such services nationwide to help relieve pressures on bed occupancy in hospitals, particularly at times of over-capacity; and if he will make a statement on the matter. [2332/15]
View answerConsultant Geriatrician posts are in general contracted to the acute hospital system with some exceptions. In practice, geriatricians will provide an extended service to the community by way of undertaking clinics in a variety of settings including community hospitals, rehabilitation facilities and primary care centres. This type of outreach service provided in an integrated manner is a significant support to community services and to maintaining older people in their own homes and communities.
Historically, consultant geriatrician appointments were made to acute hospitals and thereafter community links, including provision of dedicated sessions, were put in place once the geriatrician was in post. In more recent years, fuller consideration of such sessions has been undertaken in advance of appointment and the particular community duties of the post have formed part of the recruitment process.
It is the intention of the HSE to develop an integrated care programme for older people in 2015 which will examine the variety of ways that consultant geriatricians currently work across hospital and community and to determine what is the most effective way to do so into the future.
There are currently 8 nurse-led Community Intervention Teams nationally. These teams are not specific to older people but in practice much of the service provided is intended to support older people and avoid or reduce a hospital stay. New teams are being implemented in Naas, Drogheda and Waterford with an additional 8,000 patients planned to be treated nationally by such teams in 2015.
17. Deputy Brendan Smith asked the Minister for Health if he will expedite the introduction of BreastCheck for women aged 65-69; and if he will make a statement on the matter. [2402/15]
View answerI recently announced the extension of the BreastCheck screening programme to women aged 65 to 69 years of age. Planning for this is underway and screening of the extended cohort will commence in Quarter 4 of 2015. The age extension will be expanded on an incremental basis in order to manage the additional screening and follow up involved. It will be fully rolled out across all women in the extended age range by 2021. The additional eligible population is approximately 100,000 and, when fully implemented, 540,000 women will be included in the Breastcheck Programme.
Women of any age who have concerns about breast cancer should seek the advice of their GP who will, if appropriate, refer them to the symptomatic breast services in one of the eight designated cancer centres.
18. Deputy Brendan Griffin asked the Minister for Health if the MS drug fampyra will be made available on the public system to multiple sclerosis sufferers; and if he will make a statement on the matter. [2357/15]
View answerThe HSE has statutory responsibility for decisions on pricing and reimbursement of medicinal products under the community drug schemes in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013.
The decisions on which medicines are reimbursed by the taxpayer, are not political or ministerial decisions. These are made on objective, scientific and economic grounds by the Health Service Executive on the advice of the National Centre for Pharmacoeconomics.
The HSE received an application for the inclusion of Fampridine in the GMS and community drugs schemes. The application was considered in line with the procedures and timescales agreed by the Department of Health and the HSE with the Irish Pharmaceutical Healthcare Association for the assessment of new medicines.
In accordance with these procedures, the National Centre for Pharmacoeconomics conducted a pharmacoeconomic evaluation of Fampridine and concluded that, as the manufacturer was unable to demonstrate sufficient effectiveness and a fair price for Fampridine in the Irish healthcare setting, it was unable to recommend the reimbursement of the product. The report is available on the NCPE's website (www.ncpe.ie).
On foot of this, the HSE decided that it was not in a position to add the drug to the List of Reimbursable Items supplied under the GMS and other community drug schemes.
It is open to the supplier, at any time, to submit a new application to the HSE for the inclusion of Fampridine on the community drugs schemes incorporating new evidence which demonstrates the cost-effectiveness of the drug, by offering a reduced price or both. A revised application was received by the HSE on 25th July 2014. The HSE has since been engaging with the company seeking an improved commercial offering. These engagements have been completed and the HSE is now considering the outcome of those commercial engagements. Fampridine will be assessed along with a range of other applications for reimbursement of medicines for multiple sclerosis and other diseases.
19. Deputy Billy Kelleher asked the Minister for Health his plans for the ambulance service; and if he will make a statement on the matter. [2392/15]
View answerOur ambulance services are undergoing significant development and performance is improving. There has been significant upskilling of ambulance personnel, greater use of technology, improved response times, development of clinical protocols to promote better outcomes and dedicated aeromedical, paediatric and neonatal retrieval services. There is much development under way to further improve the outcomes achieved by the National Ambulance Service.
Response times only measure one aspect of ambulance performance. The overall goal is to improve outcomes for patients, so that lives are saved and disabilities are avoided. Response times do not indicate when treatment was commenced or the outcomes achieved by our highly trained paramedics in deploying their skills. In 2014, the National Ambulance Service introduced a patient outcome target for out-of-hospital cardiac arrests, and more are being developed. These will provide truer measures of the performance of our ambulance service.
It is important, in any event, to note that response time performance is improving, in spite of increasing demands on services. In October 2014, ECHO calls, for life-threatening cardiac and respiratory events, rose by 5% compared to 2013 and DELTA calls, for other life-threatening incidents, rose by 10%. Despite this, an ambulance arrived within the target time for 76% of ECHO calls and 67% of DELTA calls - an improvement of 3.3% and 4% respectively, which means that treatment by paramedics and advanced paramedics is reaching more patients, more quickly.
Achieving response time targets in rural and some urban settings is difficult for any ambulance service. In its recent report on ambulance services, HIQA recommended different rural and urban response targets. I also understand that a draft summary of the National Capacity Review, circulated to the Joint Committee on Health and Children, suggests that the response targets recommended by HIQA cannot be met, even with substantially increased resources. However, that report is not finalised and I cannot give a considered view at this stage.
In 2015, a €5.4m budget increase will help improve services, particularly in the west, by reforming rostering and staffing additional stations. The Emergency Aeromedical Service has completed over 800 missions, and will continue to provide rapid access to treatment for very ill patients. We will also expand community first response, particularly in more rural and sparsely populated areas.
We are working to improve the service though the finalisation of the single national control centre. The Intermediate Care Service continues to free up frontline ambulances, and we are focussed on improving hospital turnaround times.
The three current reviews of our ambulance service will provide us with very good information to improve services. I have 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, which will build upon recent achievements.
20. Deputy Richard Boyd Barrett asked the Minister for Health if he accepts the views expressed by the Irish Nurses and Midwives Organisation and other health professionals that the deepening crisis in accident and emergency departments and unacceptably long waiting lists may only be addressed by a significant increase in funding to the health service and the re-opening of thousands of closed hospital beds; and if he will make a statement on the matter. [2383/15]
View answerED Over-crowding is a priority issue for me and for the government and I acknowledge the difficulties which the current surge in ED activity is causing for patients, their families and the staff who are doing their utmost to provide safe, quality care in very challenging circumstances.
All hospitals 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. These plans include the opening of additional overflow areas, reopening of closed beds, provision of additional diagnostic scans and Consultants doing additional ward rounds to improve the appropriate flow of patients through the hospital system. 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.
It is undeniable that in recent years beds have been closed as services develop in acute hospitals. However, we need to move from the current hospital centric model of care towards a new model of integrated care which treats patients at the lowest level of complexity that is safe, timely, efficient, and as close to home as possible. This objective would not be best served by the permanent reopening of many of these beds. The management of competing demands for emergency and scheduled care requires changes in how and where patients are treated. The movement of care and treatment from in-patient to day case and from day case to OPD is most important as is ensuring the appropriate ratio of new to return appointments, reducing unnecessary return appointments.
Improved collaboration across hospitals and between acute, primary and community care has shown clearly that much can be achieved by encouraging local leadership, management, staff and unions to develop a common understanding of the issues and solutions which apply to their own hospitals and supporting them to implement appropriate responses. Following a second meeting of the ED Taskforce 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.
21. Deputy Catherine Murphy asked the Minister for Health his views on the optimum number or range of beds in the public system; the current number of available beds; the demographic projections taken into consideration when determining the optimum deployment of beds around the country; the way the existence of centres of excellence at major hospitals has impacted on the general medical services historically provided at those hospitals; and if he will make a statement on the matter. [2411/15]
View answerThe HSE has advised that the total number of acute hospital beds available at October 2014 is 12,483, comprised of 10,488 in-patient beds and 1,995 day case beds. The number of acute beds available can fluctuate greatly over time for various reasons, including ongoing refurbishment and maintenance work.
While the number of resourced acute hospital beds is clearly an important factor in meeting service demand, acute hospital care is just one component of a healthcare delivery system. The understanding and focus has shifted to a more holistic approach in which the aim is to provide services for the patient or service user in the right place in the system where his/her needs can best be met. As set out in Future Health - A Strategic Framework for Reform of the Health Service 2012-2015, the Programme for Government has committed to a fundamental reform of our health services. Key to achieving this is the need to move from the current hospital centric model of care towards a new model of integrated care which treats patients at the lowest level of complexity which is safe, timely, efficient, and as close to home as possible.
The HSE National Clinical Strategy and Programmes will commence the development of Integrated Care Programmes in 2015 that will provide the framework for the management and delivery of health services which will ensure that patients and clients receive a continuum of preventative, diagnostic, care and support services, according to their needs over time and across different levels of the health system.
The formation of Irish acute hospitals into Hospital Groups, each with its own governance and management, will provide an optimum configuration for hospital services to deliver high quality, safe patient care in a cost effective manner. In essence, the majority of patients, those who require only a routine straight forward level of urgent or planned care should be safely managed locally, with treatment being delivered at home or as close to home as possible. Those who require true emergency or complex planned care can and should be safely managed in larger hospitals where all the relevant clinical expertise can be provided with consultant delivered high quality care available round the clock.
