Written Answers Nos. 27-41
27. Deputy Ruth Coppinger asked the Minister for Health if he will report on the measures his Department has taken to resolve the immediate risks to patients' health arising from the closure of the pancreas transplant unit in Beaumont Hospital in Dublin 9, and to maintain the quality of services. [27647/15]
View answerThe consultant who undertook pancreas transplants at Beaumont Hospital retired at the end of 2014. While Beaumont Hospital is making every effort to recruit a suitable replacement, the hospital is also collaborating with St Vincent’s University Hospital in relation to a combined approach to kidney/pancreas transplants. It is proposed that pancreas transplants, of which 6 were performed in 2014, will move to St Vincent’s University Hospital. As St Vincent’s is already established as the National Liver Transplant Centre, and is a designated centre for pancreas cancer services, it is well placed to undertake pancreas transplants.
Most pancreas transplants are combined with a kidney transplant. The arrangements being put in place for such cases will involve transplant surgeons from St Vincent’s University Hospital and Beaumont Hospital working together on the St Vincent’s campus. In addition to working with St Vincent’s Hospital in relation to a combined approach to kidney/pancreas transplants, Beaumont is also collaborating with that hospital in regard to the development of an intra-abdominal organ retrieval service that will facilitate a more effective and cohesive overall procurement and transplant service.
Beaumont Hospital wrote in May to all patients who have received a pancreas transplant, as well as to patients who are on the transplant waiting list. They have also written to all referring consultants. At this point all pancreas transplant recipients have been seen by clinicians in Beaumont or have appointments in place. Future pathways of care are being discussed with all patients at these meetings. A joint assessment clinic for the 8 patients who are waiting for a pancreas transplant, involving consultants and nurses from both Beaumont and St. Vincent's, will be held on 24th July.
Every effort is being made to have all the necessary arrangements and protocols in place to facilitate St. Vincent's being in a position to undertake pancreas transplants from mid-September, should a suitable donor/recipient match occur.
28. Deputy Catherine Murphy asked the Minister for Health if he is aware that there is no respite facility in County Kildare for children who are under seven years of age, who have significant physical, emotional and behavioural challenges, and who require full-time adult supervision; that County Kildare is the fourth most populous county in the State with a very significant need in this area; the measures he proposes to address this issue; and if he will make a statement on the matter. [27700/15]
View answerAs the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy. If the Deputy has not received a reply from the HSE within 15 working days, she can contact my Private Office and they will follow the matter up with the HSE.
29. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he continues to monitor the number of patients awaiting various elective procedures at all public and private hospitals; the extent to which the through-put of patients will be compared with a view to ensuring a more rapid and effective process; the extent to which he has identified the various obstacles to achieving this objective; and if he will make a statement on the matter. [27600/15]
View answerAs this is a service matter, I have asked the HSE to respond to you directly. If you have not received a reply from the HSE within 15 working days please contact my Private Office and my officials will follow the matter up.
30. Deputy Barry Cowen asked the Minister for Health the measures being put in place to reduce waiting times at the Midland Regional Hospital in Tullamore in County Offaly; and if he will make a statement on the matter. [27670/15]
View answerAs this is a service matter, I have asked the HSE to respond to you directly. If you have not received a reply from the HSE within 15 working days please contact my Private Office and my officials will follow the matter up.
31. Deputy Billy Kelleher asked the Minister for Health when the new national maternity strategy will be published; the timeframe in place for the relocation of the three Dublin maternity hospitals; and if he will make a statement on the matter. [27659/15]
View answerPublication of the National Maternity Strategy is one of my priorities for 2015. The National Maternity Strategy Steering Group, which is advising on the strategy, has now met four times. I attended the most recent meeting of the Group and I am satisfied with the progress made to date.
I was pleased to recently announce the relocation of two of the three Dublin maternity hospitals, following a review by my Department in liaison with a wide range of stakeholders. The current model of stand-alone maternity hospitals is not the norm internationally. KPMG, in their 2008 report on maternity services in the greater Dublin area, recommended that, in order to provide optimal clinical outcomes, maternity hospitals should be co-located with an acute hospital, with one forming part of a tri-located acute, paediatric and maternity facility.
The Rotunda Hospital will be co-located with adult acute services at Connolly Hospital campus, Blanchardstown, while the Coombe will be tri-located at St James's campus with adult acute services and the new national children’s hospital. Co-location of maternity services with adult services provides mothers with access to a full range of medical and support services, should the need arise. Tri-location with paediatric services enhances the clinical benefits for the sickest newborn babies.
The moves, which will align with the established hospital groups, have been welcomed by the Masters of both maternity hospitals. My Department is currently examining alternative funding models, so that the new facilities can be delivered as early as possible.
The relocation of Holles Street to St Vincent's Hospital is currently on programme. Design Stage 1 (preliminary design) was completed in December 2014. The project has now proceeded to Stage 2a – Scheme Design. It is anticipated that a Strategic Infrastructure Development planning application will be submitted to An Bord Pleanála later this year. Assuming no planning difficulties, building is tentatively expected to commence in 2016 and take approximately 30 months to complete.
The progress made on these projects to date provides clear evidence of the Government’s commitment to improving and modernising maternity services in Ireland.
32. Deputy Robert Troy asked the Minister for Health the support his Department and the Health Service Executive will provide to children who have suffered serious health complications following the administering of the human papillomavirus vaccination, and to their parents; and if he will make a statement on the matter. [27721/15]
View answerImmunisation is regarded as one of the safest and most cost-effective of health care interventions. International studies and scientific assessments suggest that the best way to prevent most disease due to human papillomavirus (HPV) is to vaccinate as many girls and women as possible. The HPV vaccine protects girls from developing cervical cancer when they are adults. It is available free of charge from the HSE for all girls in 1st year of secondary school. This is in accordance with the recommendation received from the National Immunisation Advisory Committee (NIAC) which indicated that the HPV vaccine should be offered on an annual basis to all girls aged 12. The advice, based on public health considerations and supported by the cost-effectiveness analysis, is that HPV vaccines confer maximum benefit both individually and on a population basis if administered prior to HPV exposure.
In Ireland, the Health Products Regulatory Authority (HPRA) is the regulatory authority for medicines in Ireland. Gardasil® is a medicinal product which has been authorised for use across the European Union since September 2006 following a positive opinion from the Committee for Medicinal Products for Human Use (CHMP) at the European Medicines Agency (EMA). With this authorisation, the vaccine can be marketed in all EU Member States. Since first authorisation the HPRA has continuously monitored the safety of Gardasil® . This monitoring includes a review of global safety data in addition to national experience with use of the vaccine. The EMA is responsible for the scientific evaluation of medicines developed by pharmaceutical companies for use in the European Union.
While no medicine (including vaccines) is entirely without risk, the safety profile of Gardasil® has been continuously monitored since it was first authorised both nationally and at EU level. This is done by both monitoring of individual adverse reaction reports received by competent authorities across Europe (including the HPRA) and Periodic Safety Update Reports (PSURs) submitted by the Marketing Authorisation Holder (i.e. license holder) for the vaccine on a regular basis. The most recent EU review of cumulative global safety update data completed in December 2014 concluded that the benefit/risk profile for Gardasil® remains positive and concluded that no updates to the product information (Summary of Product Characteristics (SmPC) and Package Leaflet (PL)) were considered necessary.
Up to the 8 June 2015, the Health Products Regulatory Authority (HPRA) has received 873 reports of suspected adverse reactions/events notified in association with Gardasil®. National monitoring experience has been consistent with the expected pattern of adverse effects known to occur with the vaccine, as outlined in the approved product information (Summary of Product Characteristics (SmPC) and Package Leaflet (PL)) for Gardasil® . The majority of the reports received to date involved events/reactions related to injection site reactions, malaise, headache, myalgia, fatigue, gastrointestinal symptoms and skin reactions. Vaccination related events such as dizziness and syncope (fainting) was also reported and would not be unexpected in this patient population.
The HPRA continues to ensure that the quality, safety and efficacy of all vaccinations licensed in Ireland including HPV meet the required standards. The safety profile of Gardasil® has been continuously monitored since it was first introduced both nationally and at EU level and like all medicines and vaccines will continue to be so.
33. Deputy Richard Boyd Barrett asked the Minister for Health his plans to commission any reviews on the over-use of drugs in mental health and disability services for children; and if he will make a statement on the matter. [27668/15]
View answerA Vision for Change provides for a comprehensive model of mental health care which highlights a person-centred and recovery-focussed approach across a span of mental health services.
Where a person is referred to an appropriate health professional, and has been assessed and diagnosed as having a mental health condition, the diagnosis will inform the treatment plan for each individual. A range of interventions may be indicated in line with the agreed care plan and can include counselling, psychotherapeutic interventions, occupational therapy, social work input, or behavioural therapies. Other forms of support and intervention, including medication, are also designed to address identified biological, psychological or social needs and improve a person’s mental health.
Treatment with medication, where clinically indicated, is administered in line with best practice and all available evidence. Medication can be a very important component of a treatment plan in promoting recovery and well-being. Such treatment is determined by the nature, severity and complexity of presenting problems and will always be accompanied by other therapeutic interventions. In certain situations, particularly where people are experiencing acute symptoms of a serious psychiatric disorder, medication treatment is a key intervention in alleviating distress and in the treatment of this phase of the illness.
The HSE is committed to ensuring that all aspects of Child and Adolescent Mental Health Services (CAMHS) are delivered in a consistent and timely fashion, regardless of where the service is accessed throughout the country. The HSE recently launched a Standard Operating Procedure for both in-patient and community CAMHS, the purpose of which is to ensure that the delivery of services for those with mental health issues is carried out in a consistent and transparent manner, and that the care and treatment reflects the identified clinical needs of the child.
The Mental Health Act 2001 also provides that the Office of the Inspector of Mental Health Services must also visit and inspect every approved centre, both for adults and children, both public and private, at least once in each year and furnish an annual report to the Mental Health Commission. This includes the quality of care and treatment given in such facilities, and examination of individual care plans, as appropriate.
In relation to Disability Services, inspections of designated centres are carried out under the Health Act 2007. The regulations in this area contain provisions relating to safeguards in respect of medication and pharmaceutical services, and set out the obligations of the service provider for medication management, and monitoring and review of medications.
Many children with disabilities take medications to support and improve their health conditions. Residential services have an overall responsibility to ensure that children receive effective and safe support to manage their medications when such assistance is required. Service providers are required to have policies and procedures in place to support this, outlining the parameters of the assistance that can be provided.
Records are kept to account for all medicines and these records must be available for examination by HIQA, the independent statutory body with responsibility for the registration and inspection of designated centres for children and adults with disabilities.
The Department, and the HSE will continue to provide the best possible standards of care for children, irrespective of setting, and to advance the concepts of Quality and Safety at all times. Given the safeguards in place, I have no plans to commission any reviews on the over-use of drugs in either mental health and disability services for children at this time. However, if the Deputy has any concerns concerning a particular care facility or an individual case, he should immediately contact the HSE, which has operational responsibility to deliver services at individual levels.
34. Deputy Mick Wallace asked the Minister for Health if he is satisfied with the roll-out of service delivery reform in the area of mental health as envisaged under A Vision for Change, particularly in County Wexford; and if he will make a statement on the matter. [27698/15]
View answerSince coming into office, this Government has prioritised the reform and resourcing of our mental health services in line with the recommendations in A Vision for Change. Additional funding totalling €125 million has been provided primarily to strengthen Community Mental Health Teams for both adults and children and to enhance specialist community mental health services for older people with a mental illness, those with an intellectual disability and mental illness, and forensic mental health services.
This sustained investment in mental health since 2012 is enabling the funding of over 1,150 new staff for the sector. As at the April 2015, of the 416 approved posts in 2012, approximately 96% (397.5) are now filled. Of the 477 posts approved in 2013, 85% (405.5) are filled. The remainder of the vacant posts are at various stages of recruitment, with some difficulties in identifying some outstanding candidates, primarily for geographic and qualification reasons. The recruitment of the 251 approved posts for 2014 has commenced, 52 have been hired of which 31 have started by 31st March 2015 and a further 70.5 at various stages of the recruitment process.
A great deal of progress has been made with the accelerated closure of old psychiatric hospitals and their replacement with bespoke new facilities, better suited to modern mental health care. Progress also includes the establishment of the HSE Mental Health Division which delivers on key recommendations of Vision including, the development of child and adolescent services, shorter episodes of in-patient care, the adoption of a recovery approach in the delivery of services and the involvement of service users in all aspects of mental health policy, service planning and delivery.
In relation to Wexford, progress continues to be made. In line with Vision, Wexford Mental Health Services have reorganised the provision of its services through the amalgamation of the Acute Mental Health Unit in St Senan's Hospital with Waterford Mental Health Services, which are now provided for in a 44 bed Acute In-patient Mental Health Unit in University Hospital, Waterford. In addition to this, arrangements are in place whereby service users who live in North Wexford who attend Tara House Mental Health Services in Gorey, and require acute in-patient admission, have access to 5 beds at Newcastle Hospital, Greystones, Co. Wicklow. This allows for 49 acute in-patient beds in total which meets the requirements as set out in Vision for Change, which recommends 50 acute in-patient beds for each mental health extended catchment area of 300,000 population.
To support the amalgamation of acute mental health services, a comprehensive €18m capital investment programme was implemented with the main developments taking place in Co Wexford as follows: Tara House Community Mental Health Centre in Gorey – Day Hospital; Tus Nua, Rehabilitation Unit in Enniscorthy (12 bedded unit); Havenview (14 bedded unit) and Millview (12 bedded unit) Intellectual Disability and Rehabilitation Units, Enniscorthy; Farnogue Psychiatry of Later Life Unit and Team Headquarters, Wexford (50 long stay elderly beds); Upgrade of Summerhill Community Mental Health Unit, Wexford.
The amalgamation of Waterford/Wexford Mental Health Services together with the development of community Mental Health Services, and the capital development programme, has facilitated a reduction (by approximately 40% from March 2011 to present) in the need for acute admission to the Acute In-patient Mental Health Unit at University Hospital Waterford.
In July 2014 a new purpose built 10-bed Crisis Respite Unit, An Tearmann, opened in Enniscorthy to provide 10 respite beds for service users who are referred through their mental health community team for respite care.
In addition to the above, there are a number of Mental Health Services in operation in Wexford, seven days a week from 9 am – 5 pm, at Tara House Gorey, Carn House Enniscorthy, Summerhill Wexford and Maryville, New Ross. There is also a 7-day Specialist Liaison Services at the Emergency Department Wexford General and the Suicide Crisis Assessment Nurse (SCAN) service is available in Wexford, working with General Practitioners in the Community.
35. Deputy Terence Flanagan asked the Minister for Health the action that is being taken to address the overcrowding crisis in the accident and emergency unit in Beaumont Hospital in Dublin 9; and if he will make a statement on the matter. [27372/15]
View answerAs this is a service matter, I have asked the HSE to respond to you directly. If you have not received a reply from the HSE within 15 working days please contact my Private Office and my officials will follow the matter up.
36. Deputy Seán Kyne asked the Minister for Health the policies being pursued to increase ambulance response times in rural areas; and if he will make a statement on the matter. [27653/15]
View answerAs this is a service matter, I have asked the HSE to respond to you directly. If you have not received a reply from the HSE within 15 working days please contact my Private Office and my officials will follow the matter up.
37. Deputy Sean Fleming asked the Minister for Health his plans to improve services in the emergency department at the Midland Regional Hospital in Portlaoise in County Laois; and if he will make a statement on the matter. [27570/15]
View answerI am committed to the further development of the role of Portlaoise Hospitals as a constituent hospital within the Dublin Midlands Hospital Group, which also includes St. James's, Tallaght, Tullamore, Naas and the Coombe Hospitals.
The Dublin Midlands Hospital Group and the HSE Acute Hospitals Division are examining the scope of services in Portlaoise, and other hospitals in the Group, subsequent to the recent HIQA report on the hospital. There is a progressive complex planning process underway within the HSE involving many interdependencies and the engagement and input of relevant staff to develop the best clinical services for all patients. Decisions will be made on the basis of maximising patient safety and outcomes, not financial considerations. Any change to services at Portlaoise, including ED services, will be undertaken in a planned and orderly manner and will take account of existing patient flows, demands in other hospitals and the need to develop particular services at Portlaoise in the context of overall service reorganisation in the Dublin Midlands Hospital Group.
In relation to services in the Emergency Department, as this is a service matter, I have asked the HSE to respond to you directly. If you have not received a reply from the HSE within 15 working days please contact my Private Office and my officials will follow the matter up.
38. Deputy Niall Collins asked the Minister for Health his position regarding the continuing problem of drug abuse in Dublin city centre; his position on the proposal to allow the creation of injecting rooms in Dublin; and if he will make a statement on the matter. [27046/15]
View answerThere is currently a problem with street injecting in Dublin and elsewhere which is unhygienic and unsafe both for drug users and the general public. Medically supervised injecting facilities exist in a number of other countries, and have been suggested as a response to the problem of street injecting in this country. According to a recent report from the European Monitoring Centre for Drugs and Drug Addiction, drug consumption facilities can be effective for difficult-to-reach populations of drug users and have resulted in immediate improvements in hygiene and safer use for clients, as well as wider health and public order benefits.
I have recently received a copy of the draft Health (Injecting Centres) Bill 2015 and supporting documentation regarding the proposal referred to by the Deputy. I have asked my officials to examine the matter. It should be noted that a change to existing legislation would be required to facilitate the introduction of these facilities.
39. Deputy Paul Murphy asked the Minister for Health his views on providing sufficient financial support to sufferers of fibromyalgia who, due to the nature of the condition, often incur significant costs for their treatment; and if he will make a statement on the matter. [27665/15]
View answerUnder the provisions of the Health Acts, medical cards are provided to persons who are, in the opinion of the HSE, unable without undue hardship to arrange GP services for themselves and their dependants. In the assessment process, the HSE can take into account medical costs incurred by an individual or a family.
The Government recognises that the health service needs to be responsive to the circumstances of people with significant medical needs. Following publication of the Report of the Expert Panel on Medical Need for Medical Card Eligibility and the Medical Card Process Review in November 2014, the Minister for Health and I announced a series of measures to enhance the operation of the medical card scheme and make it more sensitive to people’s needs, especially where serious illness is involved. Where deemed appropriate in particular circumstances, the HSE may exercise discretion and grant a medical card even though an applicant's means exceed the prescribed threshold. Where a person does not qualify for a medical card, they may be provided with a GP Visit Card, appropriate therapy or other community supports or drugs.
In addition, is important to note that all Irish residents are eligible to register for the Drug Payment Scheme, under which no individual or family pays more than €144 per calendar month towards the cost of approved prescribed medicines. The scheme significantly reduces the cost burden for families and individuals incurring ongoing expenditure on medicines.
40. Deputy Richard Boyd Barrett asked the Minister for Health considering his Department's concerns regarding the over-use of drugs with elderly and adult patients, if he has similar concerns regarding children in mental health and disability services; and if he will make a statement on the matter. [27667/15]
View answerA Vision for Change provides for a comprehensive model of mental health care which highlights a person-centred and recovery-focussed approach across a span of mental health services.
Where a person is referred to an appropriate health professional, and has been assessed and diagnosed as having a mental health condition, the diagnosis will inform the treatment plan for each individual. A range of interventions may be indicated in line with the agreed care plan and can include counselling, psychotherapeutic interventions, occupational therapy, social work input, or behavioural therapies. Other forms of support and intervention, including medication, are also designed to address identified biological, psychological or social needs and improve a person’s mental health.
Treatment with medication, where clinically indicated is administered in line with best practice and all available evidence. Medication can be a very important component of a treatment plan in promoting recovery and well-being. Such treatment is determined by the nature, severity and complexity of presenting problems and will always be accompanied by other therapeutic interventions. In certain situations, particularly where people are experiencing acute symptoms of a serious psychiatric disorder, medication treatment is a key intervention in alleviating distress and in the treatment of this phase of the illness.
The HSE is committed to ensuring that all aspects of Child and Adolescent Mental Health Services (CAMHS) are delivered in a consistent and timely fashion, regardless of where the service is accessed throughout the country. The HSE recently launched a Standard Operating Procedure for both in-patient and community CAMHS, the purpose of which is to ensure that the delivery of services for those with mental health issues is carried out in a consistent and transparent manner, and that the care and treatment reflects the identified clinical needs of the child.
The Mental Health Act 2001 also provides that the Office of the Inspector of Mental Health Services must also visit and inspect every approved centre, both for adults and children, both public and private, at least once in each year and furnish an annual report to the Mental Health Commission. This includes the quality of care and treatment given in such facilities, and examination of individual care plans, as appropriate.
In relation to Disability Services, inspections of designated centres are carried out under the Health Act 2007. The regulations in this area contain provisions relating to safeguards in respect of medication and pharmaceutical services, and set out the obligations of the service provider for medication management, and monitoring and review of medications.
Many children with disabilities take medications to support and improve their health conditions. Residential services have an overall responsibility to ensure that children receive effective and safe support to manage their medications when such assistance is required. Service providers are required to have policies and procedures in place to support this, outlining the parameters of the assistance that can be provided.
Records are kept to account for all medicines and these records must be available for examination by HIQA, the independent statutory body with responsibility for the registration and inspection of designated centres for children and adults with disabilities.
The Department, and the HSE, will continue to provide the best possible standards of care for children, irrespective of setting, and to advance the concepts of Quality and Safety at all times. The Executive, which has operational responsibility to deliver service at individual levels, should be notified immediately of any concerns arising in a particular care facility or in an individual case.
41. Deputy Denis Naughten asked the Minister for Health the reason the west Roscommon and east Mayo ambulance blackspot is not to have an ambulance permanently appointed to it, as is the case in Tuam and Mulranny; and if he will make a statement on the matter. [27375/15]
View answerAs this is a service matter, I have asked the HSE to respond to you directly. If you have not received a reply from the HSE within 15 working days please contact my Private Office and my officials will follow the matter up.
