Written Answers Nos. 567 to 593
567. Deputy Finian McGrath asked the Minister for Health his views on the Irish Council for Psychotherapy’s submission on health and safety matters (details supplied); and if he will make a statement on the matter. [34577/15]
View answerThe Counselling in Primary Care (CIPC) service is a national service funded from the significant Programme for Government investment in Mental Health, to include access to counselling and psychotherapy, and supplementing existing services provided by Primary Care. Within the specialist secondary care mental health service, counselling and psychotherapy is provided within Community Mental Health Teams, when service users are clinically assessed as requiring this intervention provided by a health professional. There is a commitment in the HSE Service Plan 2015 to "Reviewing and improving access to psychotherapy and psychotherapeutic interventions in conjunction with the Primary Care Division", as a first step to further consolidate and direct counselling services generally.
In relation to the requirements for workforce planning generally, Action 46 of Future Health: (DoH, 2012) commits the Department of Health to work with the HSE to implement an approach to workforce planning and development that achieves the objectives of recruiting and retaining the right mix of staff; training and upskilling the workforce; providing for professional and career development; and creating supportive and healthy workplaces. This approach will include the development by the Department of a national integrated strategic framework for health workforce planning during 2016.
The Department will convene a cross-sectoral Working Group to develop the national integrated strategic framework in the near future. Preparation of terms of reference is well advanced and consultation with key stakeholders will form part of the Group’s work.
The Health and Social Care Professionals Act 2005 provides that the Minister for Health may, by regulation, designate a health and social care profession not already designated if he or she considers that it is in the public interest to do so and if specified criteria have been met.
The process of applying the Act to counsellors and psychotherapists is currently underway. A detailed report on the matter has been submitted by the Health and Social Care Professionals Council and is being examined in the Department. It is envisaged that the next stage will include a wider round of consultation involving the professional bodies and other interested parties.
In light of the above, all relevant issues raised in the submission of the Irish Council for Psychotherapy have been noted by the Department of Health. Other issues, such as those relating to VAT or tax reliefs, are a matter for the Minister for Finance.
568. Deputy David Stanton asked the Minister for Health the number of children on waiting lists to access paediatric occupational therapy services in the Cork north Lee Health Service Executive area; the average numbers waiting for up to three; three plus to six; six plus to nine; nine plus to 12, 12 plus to 18; 18 plus to 24; 24 plus to 30; 30 plus to 36; 36 plus months; and if he will make a statement on the matter. [34584/15]
View answerAs this is a service matter, it has been referred to the Health Service Executive for direct reply to the Deputy. If you have not received a reply from the HSE within 15 working days please contact my Private Office and they will follow up the matter with them.
569. Deputy David Stanton asked the Minister for Health further to Parliamentary Questions Nos. 148 and 149 of 27 May 2015 regarding assessment waiting times in the assessment of need process under the Disability Act 2005 in the Cork North Lee Health Service Executive area, if he will provide a breakdown of the length of time it takes from receipt of an Assessment request by the Executive to the issuing of a service statement, within six plus to nine, nine plus to 12; 12 plus to 18; 18 plus to 24; 24 plus to 30; 30 plus to 36; 36 plus months; and if he will make a statement on the matter. [34585/15]
View answerPart 2 of the Disability Act 2005 was commenced on 1 June 2007 in respect of children aged under 5 years. In 2008, the then Government decided, in the light of financial circumstances, to defer further implementation of the Disability Act 2005 and the Education for Persons with Special Educational Needs Act 2004. However, in light of legal advice following a ruling of the High Court, children born after 1 June 2002 are being treated by the Health Service executive as eligible to apply for an assessment under the Act. Part 2 of the 2005 Act provides for an assessment of the needs of eligible applicants, occasioned by their disability, to be commenced within three months of receipt of an application and completed within a further three months.
The HSE recognises that it faces significant challenges in respect of meeting the statutory time-frames which apply to the assessment of need process, given the number and complexity of cases, and has taken a number of measures to address the issue. While any delay in assessment or intervention for any child is not desirable, it should be noted that the assessment process under the Disability Act can take place in parallel with any intervention which is identified as necessary. The HSE has issued guidance to its staff that where there is a delay in the assessment process, this should not affect the delivery of necessary and appropriate interventions identified for a particular child.
Following the publication of a National Disability Authority report commissioned by the Department of Health and the HSE, a major emphasis is being placed on reconfiguring children’s disability services into integrated multi-disciplinary geographically-based early-intervention and school-aged teams under the HSE’s Progressing Disability Services for Children and Young People Programme. The key objective of this Programme is to bring about equity of access to disability services and consistency of service delivery, with a clear pathway for children with disabilities, including autism, and their families to services, regardless of where they live, where these children go to school or the nature of the individual child’s difficulties. Implementation of the Programme is a key priority for the HSE in 2015. In 2014 an additional €4 million was specifically allocated to drive implementation of the Programme, equating to approximately 80 additional therapy posts. A further additional €4m has been allocated to the Programme this year.
My Department has requested the HSE to respond directly to the Deputy in relation to the specific operational issues he has raised. If the Deputy has not received a reply from the HSE within 15 working days, please contact my Private Office who will follow up the matter with them.
570. Deputy Patrick O'Donovan asked the Minister for Health if a general practitioner is entitled to charge for issuing a prescription for a child who qualifies under the under-six medical card scheme; and if he will make a statement on the matter. [34587/15]
View answerSection 10 of the Under-6 GP Contract provides that the Medical Practitioner shall provide for Child Patients under 6 years all proper and necessary services to meet patient needs which are of a kind usually undertaken by a General Practitioner and/or his/her staff in a general practice setting and not requiring special skill or experience of a degree or kind which General Practitioners cannot reasonably be expected to possess.
Section 13 of the Under-6 Contract also states that the Medical Practitioner shall prescribe such drugs and medicines as he/she considers clinically necessary for any Child Patient for whom he/she is obliged to provide services, having regard to patient safety and clinical effectiveness considerations.
GPs that hold Under-6 contracts with the HSE must not seek or accept money in respect of Under-6 GP visit card holders for services covered under the Under-6 GP Contract.
571. Deputy Billy Kelleher asked the Minister for Health for details of the 80 new primary care facilities that will be provided under the new capital plan, by county; the overall Exchequer investment involved; the number that will be provided through, direct build by the State; public private partnership; and operational leasing [34591/15]
View answerThe Government’s “Building on Recovery: Infrastructure and Capital Investment Plan 2016-2021” was published on 30 September 2015. This Capital Plan presents the Government’s new €42 billion framework for infrastructure investment in Ireland over the period 2016 to 2021.
The Capital Plan includes just over €3 billion for investment in health infrastructure, and the Department of Health has identified five main priority areas to begin a long term programme of transformation of health care facilities across the country, including primary care.
The development of primary care remains central to the Government’s objective to deliver a high-quality, integrated and cost-effective health care system. The policy is to enable people to easily access a broad spectrum of services in the community, through their local Primary Care Team. The development of Primary Care Centres (PCCs), through a combination of public and private investment, will facilitate the delivery of multi-disciplinary services capable of meeting the great majority of people’s healthcare needs, in the most appropriate and economic setting.
During the period of the Plan, additional primary care facilities will be provided across the country, building on the 46 PCCs delivered since March 2011. This will be done through a combination of direct build by the State, through Public Private Partnership (PPP) and by way of operational leasing. The mechanism and timescale for delivery of primary care infrastructure is dependent on a number of factors. Regardless of the delivery mechanism, all potential primary care infrastructure is subject to suitable locations being offered / provided / available, to successful planning processes and GP commitment to sharing accommodation and delivering health care services with HSE staff. In addition, the operational lease mechanism is subject to market pressures such as the developers' access to adequate financing. Delivery of primary care infrastructure is a dynamic process, constantly evolving to take account of changing circumstances, including the feasibility of implementation.
At present, there are 50 locations where primary care infrastructure is under construction or at an advanced planning stage, under the three methods of delivery:
- 14 – Direct Build (funded by the HSE’s annual capital allocations);
- 14 – PPP (also funded by the HSE’s annual capital allocations); and
- 22 – Operational Lease (funded from the HSE’s annual revenue allocations).
Following the tender process for the above PPP project (14 PCCs), Prime Balfour Beatty has been appointed as the preferred bidder. 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.
Under the Operational Lease model, construction work has started in ten locations and the HSE is at advanced stages with developers in a further 14 locations where Agreements for Lease have been entered into and Letters of Intent have issued for a number of other locations.
In November 2014, the HSE advertised an additional 73 locations for delivery of Primary Care Centres by Operational Lease. The HSE is currently reviewing all Expressions of Interest to determine which are suitable for more detailed consideration and progression to the next stage of the process.
As the HSE has responsibility for the provision, maintenance and operation of Primary Care Centres, the Executive has been asked to reply directly to the Deputy in relation to the breakdown of proposed centres by county, progress on same and estimated expenditure. If you have not received a reply from the HSE within 15 working days please contact my Private Office and they will follow up the matter with them.
572. Deputy Billy Kelleher asked the Minister for Health for details of the €300 million investment in the new capital plan that is to be provided for the replacement, upgrade and refurbishment of long-term care facilities for older persons and persons with disabilities, by name; by county; and when he expects these works, as required for each facility, to commence; and to be completed [34592/15]
View answerThe position regarding individual facilities will only become clear after a careful process of prioritisation. Patient welfare will at all times remain an absolute priority.
573. Deputy Finian McGrath asked the Minister for Health his views on concerns expressed regarding the age limit applied to bowel cancer screening; and if he will make a statement on the matter. [34594/15]
View answerBowelScreen, the National Bowel Screening Programme, commenced offering free bowel screening nationwide to men and women aged 60 to 69 years in late 2012. The programme is focusing on those aged 60-69 years in the initial phase because, from a population perspective, this cohort will benefit most from bowel screening. It is envisaged that the programme will be expanded over time to the full 55-74 years target population.
Breastcheck has up to now provided free breast screening to women aged 50-64 years. However, last year I announced the extension of BreastCheck to women aged 65 to 69 and this is now commencing. The extension of the service will be fully rolled out by 2021.
574. Deputy Michael Healy-Rae asked the Minister for Health the position regarding a hip operation at Tralee General Hospital for a person (details supplied) in County Kerry; and if he will make a statement on the matter. [34610/15]
View answerUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The National Waiting List Management Policy, A standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the Health Service Executive, sets out the processes that hospitals are to implement to manage waiting lists.
In relation to the particular query raised, 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.
575. Deputy Michael Healy-Rae asked the Minister for Health the position regarding an appointment for a magnetic resonance imaging (MRI) scan for a person (details supplied) in County Kerry; and if he will make a statement on the matter. [34611/15]
View answerUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The scheduling of appointments for patients is a matter for the hospital to which the patient has been referred. Should a patient's general practitioner consider that the patient's condition warrants an earlier appointment, he or she should take the matter up with the consultant and the hospital involved. In relation to the specific case raised, 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.
576. Deputy Michael Healy-Rae asked the Minister for Health the position regarding an appointment at Tallaght Hospital in Dublin 24 for a person (details supplied) in County Kerry; and if he will make a statement on the matter. [34612/15]
View answerUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The scheduling of appointments for patients is a matter for the hospital to which the patient has been referred. Should a patient's general practitioner consider that the patient's condition warrants an earlier appointment, he or she should take the matter up with the consultant and the hospital involved. In relation to the specific case raised, 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.
577. Deputy Robert Troy asked the Minister for Health if he will arrange to schedule a child (details supplied) to have tonsils removed, as a matter of urgency, in the regional hospital in Tullamore in County Offaly, [34618/15]
View answerUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The National Waiting List Management Policy, A standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the Health Service Executive, sets out the processes that hospitals are to implement to manage waiting lists.
In relation to the particular query raised, 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.
578. Deputy Michael Healy-Rae asked the Minister for Health the position regarding a hernia and knee operation at Kerry General Hospital for a person (details supplied) in County Kerry; and if he will make a statement on the matter. [34619/15]
View answerUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The National Waiting List Management Policy, A standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the Health Service Executive, sets out the processes that hospitals are to implement to manage waiting lists.
In relation to the particular query raised, 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.
579. Deputy Michael Fitzmaurice asked the Minister for Health if he will provide a breakdown of moneys which were returned unspent to his Department for each year from 2010 to 2014, though it had been allocated to Galway / Roscommon mental health services; and if he will make a statement on the matter. [34620/15]
View answerAs this is a service issue this question has been referred to for direct reply. If you have not received a reply within 15 working days, please contact my Private Office and they will follow up the matter with them.
580. Deputy Michael Fitzmaurice asked the Minister for Health if he will provide a breakdown of the number of nurses who have been assigned to mental health services in County Roscommon, for each year from 2010 to 2014; and if he will make a statement on the matter. [34621/15]
View answer581. Deputy Michael Fitzmaurice asked the Minister for Health the number of family therapists; cognitive behavioural therapists; addiction counsellors currently (details supplied) employed in the mental health services in County Roscommon; his plans to increase the number of these posts; and if he will make a statement on the matter. [34622/15]
View answerI propose to take Questions Nos. 580 and 581 together.
As this is a service issue these questions have been referred to the HSE for direct reply. If you have not received a response within 15 working days, please contact my Private Office and they will follow up the matter with them.
582. Deputy Michael Fitzmaurice asked the Minister for Health the percentage of the overall health budget that is devoted to mental health services; if this percentage is in line with the amount advocated in A Vision For Change; and if he will make a statement on the matter. [34623/15]
View answerThe overall gross non-capital mental health budget for 2015 is around €792 million. This represents 6.4% of the overall gross non-capital health budget of €12.295 billion.
A Vision for Change recommended that there be a commitment to progressively increase the proportion of funding given to mental health services which, if implemented, would have increased the percentage total health spend on mental health to 8.24% by 2016. This Government has prioritised funding for mental health, despite the severe resource constraints of recent years.
Historically, funding for the mental health services constituted a high proportion of overall health spend in Ireland. In part, this reflected the traditional emphasis on an institutional model of service delivery with a clinical care focus. In addition, other areas of the overall health budget in Ireland may not have received an adequate level of funding appropriate to a modern community-focussed health service. This has been rectified in recent times in, for example, the primary and community care areas, whose development is also important for users of social care services such as people with mental health issues.
In line with A Vision for Change, the HSE mental health service is now moving towards a more person-centred recovery model of care, with an increasing focus on community delivery. This model of service is widely agreed to be more focussed on the needs of the service user in the first instance. It is also considered to be more cost effective, and aims for a planned greater integration of services across the primary and community care sectors over time. Therefore, while every effort will be made to maximise resources for mental health, the promotion of positive mental health extends on a much broader range of HSE service areas.
A total of €125m additional ring-fenced funding has been provided by this Government since 2012 for mental health developments. This has facilitated upwards of 1,100 new staff for the enhancement of community mental health teams, in particular, and to underpin a recovery-focussed and community-centred service. Bearing in mind the many competing demands on both the wider Health budget and Exchequer funding generally, this represents a substantial and widely acknowledged ongoing commitment to mental health services.
583. Deputy Michael Fitzmaurice asked the Minister for Health if there is an intensive care rehabilitation unit for psychiatric services in the west of Ireland; if he will provide a list of the number of such units that are in the country; where they are located; his plans to establish such a unit in the west; and if he will make a statement on the matter. [34624/15]
View answerAs this is a service issue this question has been referred to the HSE for direct reply. If you have not received a reply within 15 working days, please contact my Private Office and they will follow up the matter with them.
584. Deputy Michael Fitzmaurice asked the Minister for Health if it is still the practice for children and adolescents to be placed in adult psychiatric hospitals; if so, the number of children and adolescents who have been admitted to adult services in 2014; and if he will make a statement on the matter. [34625/15]
View answerAs this is a service issue this question has been referred to for direct reply. If you have not received a reply within 15 working days, please contact my Private Office and they will follow up the matter with them.
585. Deputy Michael Fitzmaurice asked the Minister for Health the number of suicide prevention nurses who have been appointed; by location; if any are based in the County Roscommon area; and if he will make a statement on the matter. [34626/15]
View answerSince coming into office, this Government has prioritised the reform of our mental health services in line with the recommendations in A Vision for Change. We are committed to reducing the stigma of mental illness, ensuring early and appropriate intervention and improving access to modern mental health services in the community. Additional funding totalling €125 million and some 1,150 new posts have been provided for mental health services since 2012.
This funding has enabled the HSE to develop a number of services and programmes for people who are in suicidal crisis, including the self-harm Clinical Programme which provides for assessment and management of patients presenting with self-harm to Emergency Departments, the development of the Liaison Psychiatry Service and the roll out of the Suicide Crisis Assessment Nurse (SCAN) service.
In relation to the number and location of the specialist nurses appointed, as this is a service matter this question has been referred to the HSE for direct reply to the Deputy. If you have not received a reply within 15 working days, please contact my Private Office and they will follow up the matter with them.
586. Deputy Michael McGrath asked the Minister for Health the number of children, under 18 years of age, in Cork city and county, currently on an outpatient waiting list to see an ophthalmologist; the number waiting for less than six, six plus 12, 12 plus to 24 plus and 24 plus months; the steps being taken to address the waiting lists; and if he will make a statement on the matter. [34635/15]
View answerAs this is a service matter, it has been referred to the Health Service Executive for direct reply to the Deputy. If you have not received a reply from the HSE within 15 working days please contact my Private Office and they will follow up the matter with them.
587. Deputy Richard Boyd Barrett asked the Minister for Health given recently expressed concern regarding inappropriate prescribing of psychotropic drugs to older or disabled patients, the arrangements his Department has put in place to monitor the appropriateness of the rapidly increasing prescription of psychotropic drugs for children; and if he will make a statement on the matter. [34652/15]
View answerMental health problems in children are generally treated at Primary Care level. However, where symptoms are moderate to severe in intensity, children are referred by their GPs to the Child and Adolescent Mental Health Services (CAMHS). A comprehensive assessment of the child is then carried out by professionals on the team to formulate a diagnosis following which an Integrated Care Plan is drawn up.
In most children, interventions are psychosocial. For some problems such as psychosis or severe depression, medication is essential and prescribed along with psychosocial interventions.
Another group of children and adolescents usually referred to CAMHS services are those with a possible diagnosis of Attention Deficit Hyperactivity Disorder (ADHD). Up to 5% of school going children will have ADHD and until recently it was poorly recognised and under-treated. The diagnosis is again made following assessment by skilled professional staff with subsequent care and treatment delivered as the relevant bio psychosocial interventions based on the assessed needs of the child. These may include occupational therapy, guidance to parents on managing behaviours and medication to reduce hyperactivity and improve concentration. Educational supports may be also required and schools are advised accordingly.
Hence, medication is used as one of a range of interventions with most children requiring two or more interventions. The medications are used in line with prescribing guidelines and monitored carefully. Primary Care Reimbursement Service data on the number of prescriptions for methylphenidate shows an approximate nine fold rise from 2001 and 2015 but the absolute number of prescriptions is not out of line with the known prevalence of ADHD. The increase in that time period reflects improved awareness and knowledge of ADHD at all levels including parents, schools and relevant professionals.
588. Deputy Richard Boyd Barrett asked the Minister for Health the standards in use regarding recommended staffing levels for primary care mental health services for children; and the progress made in achieving these standards. [34653/15]
View answerThe HSE supports timely access to appropriate services to address the mental health needs of all children and adolescents from a preventative care model and early intervention perspective. Primary care services are usually the first point of contact for children and adolescents when mental health problems initially present. Primary Care refers to health care delivered in local communities by Psychologists, GPs, Public Health Nurses, Social Workers and others in non-specialist settings.
The widely accepted policy A Vision for Change recognises a ‘pivotal role’ for primary care in providing mental health services. The policy assigns a key role to GPs as ‘gatekeepers’ to specialist mental health services who will detect and diagnose mental health difficulties, and either treat the individual or refer them to specialist services. The policy recommends a consultation/liaison model between primary care and mental health services to improve communication and coordination between the two. The Mental Health Division of the HSE has actively progressed communication and integration between primary and secondary mental health services, through the use of a “Stepped Care” approach. Psychological supports are accessed in primary care in the first instance, with CAMHS providing a secondary care service for those young people with more significant mental distress.
As the Deputy's question relates to operational issues, such as detailed resource provision determined by factors including assessed need, location or population requirements, I have asked the HSE to reply direct to him with the information sought. If you have not received a reply within 15 working days, please contact my Private Office and they will follow up the matter with them.
589. Deputy Richard Boyd Barrett asked the Minister for Health if emergency assessments by staff with child mental health qualifications are available for children, with identified mental health emergencies, who attend accident and emergency departments [34654/15]
View answer590. Deputy Richard Boyd Barrett asked the Minister for Health his views on comments made (details supplied) that adequate arrangements had been made for transferring children of 16 or 17 years of age to the child and adolescent mental health service; and if not, if he will clarify the matter [34655/15]
View answer591. Deputy Richard Boyd Barrett asked the Minister for Health the arrangements that have been made to resource the expansion of the child and adolescent mental health service, outlined in the new Health Service Executive child and adolescent mental health services standard operating procedure, to include children of 16 to 17 years of age; children with moderately severe mental health concerns; children referred by a wider group of professionals than previously [34656/15]
View answer592. Deputy Richard Boyd Barrett asked the Minister for Health the position on the child and adolescent mental health service being unable to accept referrals because of a lack of resources; the degree to which this issue is widespread; and the way this issue is being addressed [34658/15]
View answer593. Deputy Richard Boyd Barrett asked the Minister for Health the number of catchment areas that have no permanent child and adolescent mental health service consultant; and the number of those areas that are using a locum doctor who is not on the child psychiatry specialist register of the Medical Council; and if he will provide a list of these areas [34659/15]
View answerI propose to take Questions Nos. 589 to 593, inclusive, together.
As this is a service issue these questions have been referred to the HSE for direct reply. If you have not received a response within 15 working days, please contact my Private Office and they will follow up the matter with them.
