Written Answers Nos. 1-25
7. Deputy Colm Keaveney asked the Minister for Health if reports that the Health Service Executive's 2015 service plan target, to reduce the number of young persons with mental health problems admitted to adult psychiatric units, is unlikely to be met, are accurate; and if he will make a statement on the matter. [8034/15]
View answerThe HSE National Service Plan 2015 aims to improve placement of children in age appropriate mental health settings. The 95% target indicated in the Plan allows for some flexibility surrounding emergency placements in Adult Units. The corresponding target set in the 2014 Service Plan was 75% or above.
It is generally accepted that it will be most challenging for the HSE to meet the ambitious target for 2015, relative to the 2014 outturn position of around 70% for age appropriate placements. However, progress in this area has been significant over recent years, as evidenced by the fact that the number of such admissions to adult units in 2008 was 247, and that the trend has been declining annually since then to the most recent draft figure of 89 admissions for 2014. Clearly, there remains room for improvement and this issue has therefore been flagged as a Key Priority in this year's Service Plan.
At present, there are 54 in-patient beds for children and adolescents in the HSE. Overall, the HSE is targeting an operational capacity of 74 public Child and Adolescent beds nationally by the end of 2015. It should be noted that difficulties with re-opening some existing beds at local level, already resourced in the system, primarily relates to securing or retaining staff rather than the non-availability of funding.
The HSE has recently refocused various operational initiatives to achieve improvement in this service area in 2015. This includes a set of priority actions to enhance performance and national oversight in relation to Child and Adolescent Mental Health Services, including reducing admissions of children and adolescents to Adult Units.
I make no apologies for setting an ambitious target in this important area particularly in the context of the increased funding which is being made available for child and adolescent mental health services. I can assure the House that I, and the Department of Health, will continue to closely monitor progress by the HSE on the agreed target for this important initiative over the remainder of the year.
8. Deputy Richard Boyd Barrett asked the Minister for Health his views to the recent reports suggesting that there is no evidence that the universal health insurance model leads to reductions in the cost of health care; and if he will make a statement on the matter. [8052/15]
View answerA report titled The impact of the financial crisis on the health system and health in Ireland has been produced by the World Health Organization with full co-operation by my Department. The report emphasises the need for reform of our health services and acknowledges that this Government is the first in the history of the Irish State to commit to the principle of a universal, single-tier health service, which guarantees access to medical care based on need, not income. We remain committed to this goal of universal healthcare and to driving forward key health reforms.
With regard to the potential cost of a competitive universal insurance system, my Department is currently working with the ESRI, the Health Insurance Authority and others on a major costing exercise. This exercise will examine the cost implications of a change to a multi-payer, universal health insurance model, as proposed in the White Paper on UHI. The analysis will include a review of evidence of the effects on healthcare spending of alternative systems of financing, and of changes in financing methods and entitlements.
It will also estimate the cost of UHI for individuals, households, employers and the Exchequer. I expect to have the initial results from this exercise in April, following which I will revert to Government with a roadmap on the next steps to UHI.
10. Deputy John Halligan asked the Minister for Health if he will confirm, following the closure of two operating theatres in University Hospital Waterford in 2013-2014, then known as Waterford Regional Hospital, if his attention has been drawn to the fact that there is now limited facility to allow for emergency surgery at the hospital; in view of the fact that there is now a full complement of surgeons within the hospital, if he finds it incredible that they do not have sufficient operating facilities; if he will commit to having these surgeries reopened to allow planned surgeries recommence; and if he will make a statement on the matter. [8047/15]
View answerI am aware that every aspect of our health service has had to try and do the same, or more, with less. This has only been possible through everyone's best efforts. However, this year is the first year in a long time where the overall health budget has actually increased. I look forward to being in a position, as economic conditions further improve year on year, to continue to press for better resourcing of our health service.
University Hospital Waterford has been no exception to the restraints on acute hospital spending and has had to adjust its service provision to reflect the resources available. In 2013 and 2014, two operating theatres at Waterford were closed, as part of measures to achieve the cost containment required, while continuing to offer as many services as possible within a restricted budget. I am pleased to report that, since January this year, the hospital has been in a position to resolve staffing and resource issues and re-open one of the closed theatres. The hospital now has a dedicated emergency theatre open for four and a half days per week, with additional capacity being provided when necessary. In addition to the emergency theatre, the emergency orthopaedic trauma theatre is available on a 24/7 basis. I am advised that, during the closure, all efforts were made to make the most efficient use of the remaining facilities and that surgical activity still reached 97% or more of the annual target in each year.
12. Deputy Mattie McGrath asked the Minister for Health if he will decrease from 18 years of age to 16 or 17 years of age, the age at which blood donations are accepted, with parental consent, thereby increasing the amount of donations; and if he will make a statement on the matter. [7896/15]
View answerThe Irish Blood Transfusion Service is responsible for providing a safe and reliable blood service to the Irish health service. Blood, and the products derived from it, are an integral element of healthcare delivery. A major objective of the organisation is to ensure that it always has the necessary programmes and procedures in place to protect both the donors and the recipients of blood and blood products.
I want to pay tribute to those who regularly donate blood. Their altruism allows the health service to deliver a full range of important and sometimes life saving treatment. Interestingly, just 3% of the eligible population currently donates blood and so, despite extensive promotion by the Irish Blood Transfusion Service, there is considerable scope to achieve more donation from within the currently eligible population.
The Irish Blood Transfusion Service has no plans to reduce the age of consent for blood donations from 18 to 16 or 17 years of age. They advise that they do not propose to reduce the age of consent due to a higher rate of adverse reactions, such as fainting, in younger donors.
13. Deputy Robert Troy asked the Minister for Health if he is satisfied that working conditions at the Midland Regional Hospital, Mullingar, County Westmeath, are safe for staff and patients; and if he will make a statement on the matter. [8037/15]
View answerI acknowledge the challenge that the recent surge in activity has presented for patients and the staff of the Midland Regional Hospital, Mullingar who are doing their utmost to maintain standards of care. Addressing this issue, nationally and locally, is a priority for me and for the Government and the Deputy will be aware that I established the Emergency Department Taskforce at the end of last year to develop sustainable solutions to ED overcrowding.
A number of initiatives have been put in place to alleviate the situation in Mullingar Hospital. These include the operation of an Acute Medical Assessment Unit, at least twice daily ward rounds and late evening hours worked by clinicians, daily bed management meetings, improved patient discharge, initiatives to limit or avoid admissions for certain conditions and close communication with local GPs.
The HSE has also advised that it has reviewed overall staffing levels at Mullingar, particularly in the Emergency Department and Obstetrics & Gynaecology. Additional staff posts have been agreed, along with the ongoing process of agency conversion and replacement of vacant positions, with 90 staff in total to be recruited. This includes a net increase of 35 nursing staff. The recruitment of midwives and general nurses is well underway.
Mullingar Midland Regional Hospital is part of the Ireland East Hospital Group. In 2015, there will be an enhanced co-operation amongst all the hospitals in this Group, which will provide further support for the staff in Mullingar hospital to deliver high-quality, safe patient care on an ongoing basis.
15. Deputy John Halligan asked the Minister for Health if it is correct that only one ambulance is available for call-outs in the County Waterford area, to University Hospital Waterford, between the hours of 5.00 a.m. and 8.00 a.m.; if his attention has been drawn to the fact that, when a cardiac patient has to be brought to another hospital for treatment, the area is left without any ambulance cover; his views that this is a sufficient level of cover for the County Waterford area; if he is satisfied, and if he will provide a guarantee that all emergency calls in the area will be answered; and if he will make a statement on the matter. [8044/15]
View answerAmbulance services have changed considerably in recent years. With the establishment of the National Ambulance Service, the service is now organised on a national rather than a localised basis. The regional call centre structure has gradually been dismantled and we are working towards the establishment of a single national control centre. Ambulance resources are now deployed in a dynamic manner, to provide coverage over a region, rather than just in the area around an ambulance station or within a particular county boundary. This dynamic deployment of ambulance resources ensures that the nearest appropriate resource is mobilised to the location of any incident.
In the Waterford region, resources are deployed, as required, between Waterford, Dungarvan, New Ross, Kilkenny and Tipperary to maintain coverage and capacity in any particular area where emergency resources may be fully utilised. In Waterford City, two ambulances provide night cover, with one covering the period 8 p.m. to 8 a.m. and the other 8 p.m. to 5 a.m. In the event that an ambulance is required to transfer a patient out of the region between 5-8 a.m,, resources are dynamically deployed from the surrounding areas to provide cover for that period.
In responding to emergency calls, the National Ambulance Service uses the Advanced Medical Priority Dispatch System in its control and communications centres. The system uses internationally recognised protocols and standards to assess and prioritise 112 and 999 calls to ensure that life-threatening situations receive an appropriate priority response.
16. Deputy Seán Kyne asked the Minister for Health his plans to increase the number of first responders in communities, particularly in rural communities; if he will provide details of the work ongoing to improve ambulance response rates, particularly in north west Connemara, County Galway; and if he will make a statement on the matter. [7979/15]
View answerAdditional funding of €5.4m has been provided to the National Ambulance Service in 2015 to address service gaps, particularly in the West, by reforming rostering and staffing additional stations. In this regard, 50 paramedic posts have been allocated to East Galway and Mayo. It is also intended to expand the number of community first response teams, particularly in more rural and sparsely populated areas, to add to the more than 100 teams already operating around the country.
In addition, the Emergency Aeromedical Support Service, which is specifically targeted at the West, 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 may wish to note that response time performance is improving in the face of increasing demands on the service. The latest available data shows that nationally, in December 2014, the volume of ECHO calls rose by 7% compared to the same period in 2013, and DELTA calls by 11%. Despite this, an ambulance arrived within the target time for 78% of ECHO calls and for 64% of DELTA calls - an improvement of 9% and 4.6%, respectively, on the same period in 2013. Of course response time targets only measure one aspect of ambulance performance. Internationally, many services are moving to patient outcomes as a better indicator of performance. The National Ambulance Service has therefore introduced a patient outcome target for out-of-hospital cardiac arrests in 2014, and more are being developed.
HIQA recently published its review of ambulance services. In addition, the national capacity review and the review of Dublin ambulance service are expected to be finalised shortly. 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.
17. Deputy John Halligan asked the Minister for Health further to Parliamentary Question No. 33 of 14 May 2014, if he will confirm the appointments that have been made to the physiotherapy staffing complement in University Hospital Waterford in the past year; the improvement that has been seen in the waiting times; and if he will make a statement on the matter. [8046/15]
View answerThe physiotherapy staff level in University Hospital Waterford is currently 20.65 whole-time equivalents, which represents an increase of 2 whole-time equivalents over the past year.
Waiting list figures for January 2015 compare favourably with those of June 2014, with 63 people waiting for an appointment in January 2015 compared to 115 in June 2014, despite an increase in new referrals. None the less, the position requires close ongoing attention and can vary depending on volumes of referrals, prioritisation of inpatient care and other acute complex demands.
The HSE has advised that University Hospital Waterford will be seeking to retain current staffing levels in 2015 and replacing vacancies caused by resignations and retirements where they occur in this service.
18. Deputy Ruth Coppinger asked the Minister for Health his views on the investigation into the Miss Y case; and whether the Government will consider a review of the Protection of Life During Pregnancy Act 2013, and legislation around the termination of pregnancy; and if he will make a statement on the matter. [8040/15]
View answerAs the Deputy might be aware, last August the HSE initiated a review to establish all of the facts surrounding the care given to Ms Y. However, Ms Y's legal team has now successfully applied to the Courts for a Judicial Review of this review and I will await the outcome of this judicial review before I decide whether any further action needs to be taken.
In relation to legislation around the termination of pregnancy, the Protection of Life During Pregnancy Act 2013 was enacted in July 2013 and commenced in January 2014. The purpose of this Act is to restate the general prohibition on abortion in Ireland while regulating access to lawful termination of pregnancy in accordance with the X case and the judgment in the European Court of Human Rights in the A, B and C v Ireland case. The Act received very careful consideration by the Houses of the Oireachtas and the Joint Oireachtas Committee for Health and Children, including three days of public hearings.
I am not proposing any amendments to the Act or the 8th Amendment of the Constitution at present.
19. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he will provide details of the roll-out of free general practitioner care for the whole population; and his views on reports that it is to be delayed by three years, or more; the stage the negotiation regarding free general practitioner care for children under six years of age is currently at; and if he will make a statement on the matter. [7970/15]
View answerThe Government is committed to introducing a universal GP service for the whole population. This is being introduced on a phased basis. The objective is to have universal GP care without fees for children under 6 years in place in Quarter 2 of 2015, subject to the conclusion of discussions with the Irish Medical Organisation and the completion of a fee-setting process. The Government is also prioritising universal GP care for persons over 70 years to coincide with the introduction of universal GP care for children under 6. This will be facilitated under the existing GMS contract.
The Health (General Practitioner Service) Act 2014, which provides the legal framework for the under-six GP service, was passed by the Oireachtas in July 2014. I expect the Bill to extend GP services without fees to all over-70s to be published in March. These measures represent a major step on the way to universal health care.
20. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he will provide details of progress by the group tasked with an examination of medical card issuing criteria; if the revised criteria for granting medical cards will take account of medical need; when this group will make its recommendations; when these recommendations will be acted upon; and if he will make a statement on the matter. [7972/15]
View answerThe establishment of the Clinical Advisory Group for Medical Card Eligibility was announced by the HSE on 28 January. Its membership includes clinical experts from specialist services and professions, as well as patient representatives so that the views of patients are central to the process.
As recommended by the Report of the Expert Panel on Medical Need for Medical Card Eligibility, the Group will provide clinical oversight and guidance to the operation of a more compassionate and trusted medical card system. The Group has been asked to see how the burden of a medical illness can be accommodated in the award of a medical card, over and above financial hardship.
The Group held its first meeting on 10 February. It will provide an interim report by May of this year on the development of a framework and guidance on assessing medical card applications involving significant medical conditions.
Neither I, nor Minister Varadkar, wish to prejudge the outcome of the Group’s determinations. However, I can advise the Deputy that the medical card system is now operating in a more sensible and sensitive manner. Greater discretion is clearly being exercised by the HSE because the number of discretionary medical cards in circulation has increased by 52% - from about 52,000 in mid-2014 to nearly 79,000 at the end of January this year.
21. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he will improve the overcrowding at accident and emergency departments in various hospitals throughout the country, by way of bringing onstream, step-down beds available in existing public or private hospitals, as per submissions to his Department, from both the public and private sector, throughout the January 2015; if he will undertake a review of the availability of such facilities in this regard; if further improvement, in regard to staffing levels at accident and emergency departments, will be a feature of any review; and if he will make a statement on the matter. [7977/15]
View answerED overcrowding is a key 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. The Government has provided additional funding of €3 million in 2014 and €25 million in 2015 to address delayed discharges. The HSE is accessing all suitable non-acute accommodation to the maximum extent possible to allow those who have been clinically discharged to leave acute hospitals. Actions currently being taken to address ED overcrowding include the provision of 900 additional transitional care beds in nursing homes (500 in January and an additional 400 in February); 173 short stay public beds being opened across the country for a three month period; up to 300 overflow beds opened in acute hospitals; additional home care packages; 300 additional Fair Deal places and an extension in Community Intervention Teams.
The HSE has the capacity to recruit where it is necessary to deliver front-line services. Arrangements are in place in the HSE to allow the recruitment of such staff where it has been established that there is an urgent service requirement and this year the number of nurses directly employed by the public health service will increase by at least 500. The HSE is currently finalising an action plan under the auspices of the ED Taskforce to specifically address ED issues with a view to a significant reduction in trolley waits over the course of 2015.
22. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the recommendations of the National Immunisation Advisory Committee regarding the introduction of a meningitis B vaccine; when a decision on the recommendation will be taken; if positive, the timeframe within which the vaccine will be introduced; and if he will make a statement on the matter. [7973/15]
View answerThe immunisation programme in Ireland is based on the advice of the National Immunisation Advisory Committee (NIAC). NIAC is a committee of the Royal College of Physicians of Ireland comprising of experts in a number of specialties including infectious diseases, paediatrics and public health. The committee's recommendations are informed by public health advice, international best practice and a cost effective analysis conducted by the National Centre for Pharmacoeconomics.
My Department has recently received a letter from the Chairman of NIAC regarding the introduction of the Meningitis B vaccine into the Primary Childhood Immunisation Schedule. In this letter the committee recommends the inclusion of Meningococcal B vaccine in the primary immunisation programme, if the vaccine can be made available at a cost-effective price. It should be noted that Meningococcal B vaccine has not been included in any population based immunisation programme by any other country.
NIAC has issued guidance in relation to the use of the Meningococcal B vaccine in the control of clusters or outbreaks of the disease. The vaccine has been used in accordance with the NIAC guidance, along with other measures, to control outbreaks of the disease.
The recommendation from NIAC is being considered by my Department.
23. Deputy Terence Flanagan asked the Minister for Health if he will provide an update regarding his plan to roll out primary care centres throughout the country; and if he will make a statement on the matter. [8003/15]
View answerThe development of Primary Care Centres, through a combination of public and private investment, is supporting the delivery of an enhanced range of multidisciplinary, locally accessible primary health care services. To date, there are 86 Primary Care Centres in operation throughout the country, 43 of which have opened since 2011.
The HSE uses three mechanisms to deliver primary care infrastructure:
- Direct build (by HSE);
- Public Private Partnership (PPP) project; or
- Operational Lease with the private sector.
There are currently 37 locations where Primary Care Centres are at an advanced planning stage using one of these three methods of delivery.
Direct Build centres are funded by the HSE’s capital allocation with funding provided for 16 centres.
14 centres are being progressed through Public Private Partnerships. Tenders for this project have been returned and are currently being evaluated. It is expected that the preferred bidder will be selected in Quarter 2, 2015. Subject to successful completion of financial and contractual arrangements, it is expected that construction work will commence before the end of 2015, with the centres expected to be completed by the first half of 2017.
To date, 43 Primary Care Centres have been delivered through the Operational Lease model funded from the HSE's revenue allocation. The HSE is at advanced stages with developers in 25 locations where Agreements for Lease have been entered into, and it is currently at negotiation stage in an additional 31 locations where Letters of Intent have been issued.
In November 2014, the HSE advertised an additional 73 locations for delivery of Primary Care Centres by Operational Lease. January 16, 2015 was the closing date for receipt of Expressions of Interest. The HSE is reviewing all Expressions of Interest to determine which are suitable for more detailed consideration and progression to the next stage of the process.
Despite constraints on the availability of public capital and revenue in recent years, a very ambitious programme is under way to develop Primary Care Centres and support the provision of an enhanced and more integrated range of services within communities.
24. Deputy Billy Kelleher asked the Minister for Health his plans for the fair deal scheme; and if he will make a statement on the matter. [8029/15]
View answerThe budget for the Scheme in 2015 is €948.8m, which reflects an increase of €10m from the 2014 position. This increase of €10m is part of the initiative to tackle delayed discharges and has provided for an additional 300 long stay care places under the NHSS. The budget for 2015 is expected to provide long-term residential care for 22,361 people.
The review of the Nursing Homes Support Scheme which is currently in progress will include consideration of the balance between community and residential services as well as the future financing and sustainability of the Scheme. It is expected that the review will be completed by the end of this quarter after which it will be made publicly available.
25. Deputy Maureen O'Sullivan asked the Minister for Health if he is satisfied that enough credence, support, resources and funding are provided to the recovery model, as is provided to the harm reduction model, for those in addiction; and if he will make a statement on the matter. [7924/15]
View answerA core objective of the National Drugs Strategy is the development of a national integrated treatment and rehabilitation service that provides drug free and harm reduction approaches for problem substance users. Harm reduction interventions, such as needle exchange services and methadone maintenance treatment, are an important component of the response to problem substance use as such interventions encourage problem substance users to engage with, and avail of, drug treatment services.
The importance of promoting the recovery of people in treatment is recognised in the National Drugs Strategy. Problem drug users have complex needs and may require multiple interventions from a range of agencies to assist them in their recovery. The National Drugs Rehabilitation Implementation Committee, chaired by the HSE, is overseeing the roll out of a National Drugs Rehabilitation Framework. The aim of the Framework is to provide a 'continuum of care' for the recovering drug user through promoting a more integrated and client-centred approach to rehabilitation, based on shared care planning. The roll out of the Framework is currently being advanced through the HSE's Addiction Services and the Drug and Alcohol Task Forces.
My Department is commencing work on the development of a new National Drugs Strategy for the period after 2016. The process will involve a comprehensive consultation with key stakeholders and the public on the current national drugs policy and future priorities. This will provide an opportunity to ensure that our strategic approach into the future continues to be firmly focused on recovery. I have also asked my Department to examine the feasibility of utilising Social Impact Bonds as a funding model to improve both treatment and rehabilitation service outcomes. The outcome of this work will inform decisions as to the viability of this approach to maximising the social benefits which the National Drugs Strategy seeks to achieve.
