Written Answers Nos. 1-25
5. Deputy John Halligan asked the Minister for Health the current staffing levels at the dermatology department of University Hospital Waterford; if the unit is fully staffed and operating to its full potential; when the full dermatology services at the hospital will be restored; the plans the Health Service Executive has to make this happen; and if he will make a statement on the matter. [36668/15]
View answerI understand that University Hospital Waterford has experienced staffing and recruitment difficulties in the Dermatology Department. However, I can assure the Deputy that the HSE and the South/South West Hospital Group is committed to restoring the dermatology service as soon as possible to full operation.
There are three approved consultant dermatologist posts in University Hospital Waterford. I am advised that one consultant dermatologist returned from leave in March but the other two posts are currently vacant. However, the two posts are being filled and the successful candidates are in the process of being cleared by the Public Appointments Service. It is expected that they will commence duty early in the New Year. Once these two dermatologists are in post, it is intended to restore a full regional service, including regular outreach clinics in the hospital's wider catchment area.
In the interim, and pending the appointment of the remaining consultants, University Hospital Waterford has an arrangement in place with the dermatology service at South Infirmary Victoria University Hospital in Cork city. Arrangements for urgent referrals for dermatology, such as for patients with melanomas or suspicious pigmented lesions, those on biologic agents and patients requiring emergency reviews, are referred to the Department at the South Infirmary, or to the nearest Dermatology Unit as appropriate.
13. Deputy Michael Moynihan asked the Minister for Health if he has received representations regarding the vaccination for Human Papilloma Virus; and if he will make a statement on the matter. [36259/15]
View answerI am aware of and have been monitoring the situation in relation to the human papilloma virus (HPV) vaccine. The HPV vaccine protects women from developing cervical cancer. The vaccine 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.
In Ireland, the Health Products Regulatory Authority is the regulatory authority for medicines in Ireland. There are 2 licensed HPV vaccines available in Ireland (Gardasil® and Cervarix®). Gardasil® is the vaccine used by the HSE in the School Immunisation Programme.
While no medicine, including vaccines, is entirely without risk, the safety profile of Gardasil® has been continuously monitored since it was first authorised nationally and at EU level. This is done by monitoring both individual adverse reaction reports received by competent authorities across Europe and Periodic Safety Update Reports submitted by the Marketing Authorisation Holder for the vaccine on a regular basis. The introduction of new vaccines is based on the expert advice of the National Immunisation Advisory Committee. Decisions on the continued supply of vaccines into the market are undertaken by specific expert agencies rather than being the responsibility of the Minister of the day.
As of the 9 October, the Authority has received 921 reports of suspected adverse reactions or events notified in association with the use of HPV vaccines. The vast majority have been consistent with the expected pattern of adverse effects for the vaccines, as described in the product information, such as gastrointestinal symptoms, malaise, headache, dizziness and injection site reactions.
The European Medicines Agency has commenced a review of the HPV vaccine "to further clarify aspects of their safety profile," although the agency points out that this review "does not question that the benefits of HPV vaccines outweigh their risks." The review is specifically focusing on rare reports of two conditions, complex regional pain syndrome and postural orthostatic tachycardia syndrome associated with heart rate increase.
The European Medicines Agency has advised healthcare professionals that available data does not warrant any change to the use of HPV vaccines. Healthcare professionals should therefore continue using Gardasil® and Cervarix® in accordance with the current product information.
14. Deputy Joe Carey asked the Minister for Health the number of west and north Clare persons, and their age bracket, being catered for by dialysis in the home, at University Hospital Galway and at University Hospital Limerick; and if he will make a statement on the matter. [35557/15]
View answerI have been advised by the HSE that 27 patients from west and north Clare are currently receiving dialysis under the care of University Hospital Limerick and University Hospital Galway. Of these patients, 21 are receiving their treatment in Limerick, and the majority are aged between 35 and 50 years. The remaining 6 patients are receiving dialysis care in Galway, and they are between 30 and 90 years old.
With regard to both hospital group areas, the numbers of patients receiving home dialysis is less than 5. I am not in a position to provide more specific details in relation to this cohort of patients. I am sure the Deputy will appreciate that, given the small numbers involved, the provision of such information might compromise patient confidentiality.
It is worth noting that, as part of a number of significant capital projects across the University of Limerick Hospitals Group, University Hospital Limerick is currently developing a new renal dialysis unit. The new unit will comprise 13 additional and 11 replacement beds, as well as a continuous ambulatory peritoneal dialysis unit. The new dialysis unit, which is part funded with philanthropic funds provided by the Mid-Western Hospitals Development Trust, will be located above the new emergency department. Work is underway and it is expected that the new renal unit will be operational in August 2016.
15. Deputy Mary Mitchell O'Connor asked the Minister for Health if he will recognise deafblindness as a distinct disability; and if he will make a statement on the matter. [36260/15]
View answerThe Minister for Health does not classify specific medical illnesses or conditions as a disability. There are a number of definitions of disability that are used for particular purposes e.g. the Disability Act, Education for Persons with Special Educational Needs Act, Equal Status Act, Employment Equality Acts and qualifying criteria for income supports such as Domiciliary Care Allowance and Disability Allowance etc. These definitions describe disability in terms of an individual's functional ability in their environment, rather than a medical diagnosis or a named condition.
The Government currently provides funding of over €1.4 billion to the Disability Services Programme through the HSE's National Service Plan for 2015. Persons with disabilities, including deafblindness, can access a broad range of acute, primary and community based health services, as well as specialist disability services, which are provided in a variety of community and residential settings in partnership with service users, their families and carers and a range of statutory and non-statutory groups.
The Anne Sullivan Foundation for Deaf-Blind is funded by the Health Service Executive (HSE) under Section 39 of the Health Act, 2004. The Foundation received over €1.9 million in 2014 from the HSE for the provision of supports to people who are deaf-blind.
16. Deputy Joan Collins asked the Minister for Health given that on 13 May 2015 this Deputy received a reply further to Parliamentary Question No. 377 of 6 May 2015, and was informed by University Hospital Galway that from 21 January 2015 to 13 May 2015 one scoliosis patient out of nine had undergone surgery, and given that this Deputy was informed that significant progress is being made in relation to ensuring the required resources are in place in the context of bed availability, access to diagnostics, purchase of special spinal equipment and access to theatre, the reason a person (details supplied) who is on the list since July 2014 is still waiting; and if he will make a statement on the matter. [36653/15]
View answerIn January, taking into account current pressures on acute hospital services, I put in place maximum permissible waiting times for inpatient and day case treatment and outpatient appointments of 18 months by 30 June and 15 months by year end. In June, the HSE reported a performance against the 18 month maximum waiting time of 99.6% for in-patient/day cases and 92% for out-patients.
The HSE was provided with additional funding of €51m to ensure that these maximum waiting times would be achieved. The funding provided is intended to maximise capacity across public and voluntary hospitals as well as outsourcing activity where the capacity is not available to meet patient needs within the maximum allowable waiting time.
It is recognised that issues of capacity and complexity adversely impact a small number of specialties, including spinal surgery for scoliosis. I have been assured that the waiting list for such surgery is a high priority for the Saolta Healthcare Group, and that Galway University Hospital is working to ensure that the necessary resources and arrangements are in place in order to address the needs of patients with scoliosis. These include appropriate bed availability, access to diagnostics, purchase of specialist spinal equipment and access to theatre. Within the last two months, two Consultant Orthopaedic Surgeons have been appointed at Galway University Hospital to support this service. In the short term the hospital is planning to assign 5 dedicated beds to support this service and when the new ward block is completed, this will increase to 8 dedicated beds.
Saolta Healthcare Group has informed my Department that they have treated 3 scoliosis patients since May of this year and that the patient in question remains on the waiting list which currently comprises thirteen patients. The scheduling of appointments for individual patients is a matter for the hospital to which the patient has been referred taking into account the length of time the patient has been on the waiting list and clinical prioritisation within the resources available.
17. Deputy Willie O'Dea asked the Minister for Health when he expects to see an improvement in services at University Hospital Limerick, especially in the emergency department and in the numbers on waiting lists; and if he will make a statement on the matter. [36570/15]
View answerThe UL Hospitals Group is currently performing much better than other regions or hospital groups in managing wait times. Plans are in place to ensure that by year end, all appointments offered will be within the maximum permissible waiting times.
The Group has developed a comprehensive plan to manage the expected increase in ED presentations over the coming months. Key measures include:
- recruitment of 124 extra personnel to staff extra beds across all areas;
- opening of 24 new inpatient beds in November, to coincide with the opening of the Leben building, the first phase of which will care for stroke/neurology and adult CF patients;
- re-opening of a 24 bed isolation ward following refurbishment;
- development of a five day specialty geriatric ward at St John's Hospital;
- reservation of 20 acute medical unit and medical assessment unit slots across the group daily for patients aged over 75;
- establishment of rapid access clinics;
- opening a second emergency theatre at weekends;
- appointment of a second community discharge nurse; and
- prioritising diagnostics for in-patients to facilitate earlier discharge.
The Deputy will also be aware that a new emergency department is under construction at University of Limerick Hospital. The new facility, which will provide a much improved and larger facility for patients and staff, is scheduled to open in early 2017.
18. Deputy Mick Wallace asked the Minister for Health the measures his Department is taking to address the issue of staffing in mental health services, which, according to Mental Health Reform, was 22% below recommended levels in April 2015; the action he is taking to tackle mental health staffing issues in County Wexford; and if he will make a statement on the matter. [36266/15]
View answerThe Government, despite severe financial pressures overall, has provided additional ring-fenced funding of €125 million since 2012 up to end 2015 for mental health to modernise services in line with A Vision for Change and Programme for Government commitments.
A key focus has been the provision of additional posts to strengthen Community Mental Health Teams for adults, children and adolescents, and to enhance specialist community mental health services. This sustained investment is enabling the recruitment of approximately 1,150 new staff for the sector. As at the end of July, the following was the position regarding the additional posts provided:
- 400.5 or 96% of the 416 development posts for 2012 have started;
- 427 or 88% of the 477.5 development posts for 2013 have started;
- Of the 251.1 posts allocated in 2014, 81 have been recruited of which 77 have started by 31 July and a further 88.5 are at various stages in the recruitment process.
The number of staff employed in the Mental Health Service has fluctuated in recent years due to departures for various reasons, including redundancy, retirement or staff moving to take up employment elsewhere. The HSE Mental Health Division have been actively working to improve the underlying recruitment issues largely relating to Nursing and Medical staff, with some challenges in the recruitment of Psychology staff.
The Waterford/Wexford Mental Health Services (MHS) serve a population of 278,000. It aims to provide an integrated approach to service delivery across the catchment area, with access barriers removed. The HSE is committed to the ongoing provision of a quality and safe mental health service in Waterford and Wexford. In this regard, in 2015 the overall budget allocation for Waterford/Wexford Mental Health Services was increased by over €2m from an allocation of €39,093,300 in 2014 to an allocation of €41,194,903 in respect of 2015.
In addition to the increased budget allocation, Waterford/Wexford MHS have received a total of 61 new development posts since 2012 (23 posts in 2012; 27 posts in 2013 and 11 posts in 2014). These included medical, nursing and allied health professional posts. Whilst many of these posts have been filled (and some are at various stages of recruitment), there are a number of these posts for which there are difficulties in identifying suitable candidates due to factors including the availability of qualified candidates and geographic location. There is a difficulty nationally in terms of the recruitment of Consultant Psychiatrists and Non-Consultant Hospital Doctor posts, and this is also the case for Waterford/Wexford MHS where 2 new Consultant Posts are unfilled due to recruitment challenges.
The HSE Staffing Census for Wexford Mental Health Nursing stated that there were 142.35 nurses in August 2015 compared to 147.5 in December 2012. In addition to a number of retirements in recent years, there are currently 19 nurses on maternity leave in Wexford. It is challenging to recruit candidates for temporary short-term position such as maternity leave cover. Following the national recruitment moratorium a number of replacement nursing posts have been approved for Wexford MHS. In addition in recent years, 6 nursing development posts were approved for Wexford Mental Health Services. However, there have been challenges with the recruitment to these posts.
HSE management and mental health service personnel are working with the HSE National Mental Health Division on the nurse staffing issues. In addition a national mental health workforce planning review group has been established. Management from HSE Waterford/Wexford MHS continue to monitor staffing levels on an ongoing basis and will explore all possible options within resources available in order to try to improve service provision.
19. Deputy Denis Naughten asked the Minister for Health his plans for the expansion of the air ambulance service based at Custume Barracks in Athlone; and if he will make a statement on the matter. [36583/15]
View answerFollowing a Government decision last July, the Emergency Aeromedical Support Service has been established on a permanent basis. This very valuable service ensures that seriously ill or injured people in more remote areas have timely access to appropriate high quality clinical care. The service is targeted mainly at western counties, where the road network may not allow for timely transport to hospital for these patients.
Paramedics are provided by the National Ambulance Service, with pilots and helicopters from the Air Corps. Since the service was introduced on a trial basis in 2012, almost 1,200 patients have been brought to major acute hospitals for treatment. Approximately one third of the missions to date have been in response to STEMI heart attacks, allowing patients to be treated in a specialist setting within 90 minutes of diagnosis.
My Department is currently developing a Service Level Agreement with the Department of Defence, to set out the scope of support to be provided by the Air Corps. It is intended to keep the operation under review, to ensure a sustainable, long term service arrangement.
20. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he will provide or avail of step-down bed accommodation as a means of alleviating overcrowding in public hospitals in general; if he has examined the potential use of decommissioned beds or wards in or adjacent to the public hospitals, thereby providing an available solution; and if he will make a statement on the matter. [36262/15]
View answerDelayed discharges arise when a patient has been judged clinically to no longer have a requirement for acute hospital care but remains in an acute hospital bed, thus rendering that bed unavailable for patients who need admission. As of 14 October (latest figures available) there are 561 delayed discharges nationally, of which 284 are in the Dublin Academic Teaching Hospitals (DATHs). Delayed discharges can arise for a number of reasons in addition to difficulties in finding a suitable nursing home place. For example, some patients have yet to apply for the Nursing Homes Support Scheme, and others are in the course of having their applications assessed and validated. Applicants are entitled to choose their own nursing home and while a facility may be available, the applicant may decide to wait for an option closer to home or to their family.
The Government committed an additional €25m in Budget 2015 to address delayed discharges. Of this:
- €10m was allocated to the Nursing Homes Support Scheme (NHSS) to provide additional 300 places;
- €8m was allocated for the provision of 50 additional short-stay beds, in addition to the establishment of Mount Carmel as a short-stay facility for the Dublin area;
- €5m was allocated for an additional 400 Home Care Packages;
- €2m was allocated to strengthen community care teams.
In a further initiative earlier this year, the Government approved additional funding of €74m, of which €44m was allocated to the NHSS to provide an additional 1,600 places. €30m was used to cover the cost of a range of additional measures including transitional care beds (temporary contract beds) and additional community, convalescence and district hospital beds on a permanent basis.
The waiting time for approved applicants for the Nursing Homes Support Scheme has been reduced from a previous high of 17 weeks to 2-4 weeks. It is intended to maintain this at a maximum of 4 weeks.
At 30 September 2015, there were a total of 1,936 Short Stay Community Public Beds nationally. These are a combination of 'step up/step down' care, intermediate care, rehab and respite care. These beds are interchangeable in their use depending on demand in the units. The opening of further additional short stay beds in the majority of our public residential facilities has now been exhausted, particularly in areas of high demand including Dublin, Cork, Galway and Limerick. HIQA regulations set out strict guidelines around the numbers of beds that can be operated in any one unit.
In addition to Community Short Stay Beds described above, a number of Acute Hospitals also operate direct managed step down beds both on their hospital campus and in off-site locations.
The provision of Short Stay Support Beds will be a fundamental component of the integrated model of care being planned for the delivery of services to Older People.
21. Deputy Michael Moynihan asked the Minister for Health his response to concerns regarding the Gardasil vaccine; and if he will make a statement on the matter. [36258/15]
View answerI am aware of and have been monitoring the situation in relation to the human papilloma virus (HPV) vaccine. The HPV vaccine protects women from developing cervical cancer when they are adults. The vaccine 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.
In Ireland, the Health Products Regulatory Authority is the regulatory authority for medicines in Ireland. There are 2 licensed HPV vaccines available in Ireland (Gardasil and Cervarix). Gardasil is the vaccine used by the HSE in the School Immunisation Programme.
While no medicine, including vaccines, is entirely without risk, the safety profile of Gardasil has been continuously monitored since it was first authorised nationally and at EU level. This is done by monitoring both individual adverse reaction reports received by competent authorities across Europe and Periodic Safety Update Reports submitted by the Marketing Authorisation Holder for the vaccine on a regular basis.
As of the 9 October, the Authority has received 921 reports of suspected adverse reactions or events notified in association with the use of HPV vaccines. The vast majority have been consistent with the expected pattern of adverse effects for the vaccines, as described in the product information such as gastrointestinal symptoms, malaise, headache, dizziness and injection site reactions.
The European Medicines Agency has commenced a review of the HPV vaccine "to further clarify aspects of their safety profile," although the agency points out that this review "does not question that the benefits of HPV vaccines outweigh their risks." The review is specifically focusing on rare reports of two conditions, complex regional pain syndrome and postural orthostatic tachycardia syndrome associated with heart rate increase.
The European Medicines Agency has advised healthcare professionals that available data does not warrant any change to the use of HPV vaccines. Healthcare professionals should therefore continue using Gardasil and Cervarix in accordance with the current product information.
22. Deputy Brendan Smith asked the Minister for Health the number of persons currently waiting for inpatient or day patient orthopaedic treatment in the north east [36579/15]
View answerImproving timely access to care is a key priority for the Government. In January, I put in place maximum permissible waiting times for inpatient and day case treatment and outpatient appointments of 18 months by 30 June and 15 months by year end. The HSE was provided with additional funding of €51m to ensure that these maximum waiting times are achieved. The funding provided is intended to maximise capacity across public and voluntary hospitals as well as outsourcing activity where the capacity is not available to meet patient needs within the maximum allowable waiting time.
In June, the HSE reported a performance against the 18 month maximum waiting time of 99.6% for in-patient/day cases and 92% for out-patients. Concerted efforts have been made to reduce outpatient waiting lists by facilitating additional clinics outside conventional working hours and outsourcing where capacity is limited. The success of this approach is evident, with the reduction of over 4,300 in the overall outpatient waiting lists in the six weeks to end of September.
Over 4,620 outpatient appointments will be provided specifically for those waiting 15 months and over in the next 6 weeks, and approx 20,250 patients from the waiting list will undergo an inpatient or daycase procedure or scope in that period also. The most recent published NTPF report for 30 September, indicates that in the North East there is a total of 320 people waiting for elective orthopaedic surgery in Our Lady's Hospital in Navan. No patients are waiting over 15 months and just 1 patient is waiting over 12 months. Our Lady of Lourdes, Drogheda does not undertake elective orthopaedic surgery and patients are referred for surgery to Navan.
23. Deputy Brian Stanley asked the Minister for Health the Government's plans to upgrade Shaen and Abbeyleix hospitals in County Laois to meet Health Information and Quality Authority standards. [35556/15]
View answerAbbeyleix currently has capacity for 20 beds, which are utilised for some patients requiring long term care, with the majority of beds providing respite for patients from the area. St Brigids Shaen has capacity for 23 beds. However due to refurbishment works currently taking place in the unit, 9 beds are temporarily out of use. It is anticipated that refurbishment will be completed by the end of the year.
Both facilities, Abbeyleix & Shaen are providing an important service and the HSE will continue to utilise these 43 beds to support the needs of these areas.
24. Deputy Thomas P. Broughan asked the Minister for Health for an update on the proposed new accident and emergency unit for Beaumont Hospital in Dublin 9; if the necessary planning and construction funding will be included in the new capital programme; and if he will make a statement on the matter. [35549/15]
View answerThe HSE has advised that Beaumont Hospital has appointed a design team, incorporating architects and healthcare planners, to undertake a feasibility study on the location, size and cost of building a new Emergency Department at the hospital. This is currently at stakeholder consultation phase, with a number of proposals being considered and the report is expected to be available in mid-December 2015.
The HSE is concentrating on applying the funding available for infrastructure development in the most effective way possible to meet current and future needs. Any future investment at Beaumont must be considered within the overall acute hospital sector infrastructure programme, within the overall capital envelope available to the health service and in the context of the establishment of hospital groups. Each hospital group will be required to develop a strategic plan to describe how they will provide more efficient and effective patient services and reorganise these services to provide optimal care to the populations they serve.
In order to support acute hospitals over the winter period, additional funding of €18 million was provided in July for a winter initiative to include the provision of approximately 300 additional hospital beds. As part of its winter capacity planning, Beaumont is extending the Day Hospital at St. Joseph's, Raheny from a 2 day to a 5 day service. The Day Hospital provides a multi-disciplinary team for frail older people, thus providing an alternative care pathway for these patients, helping them to avoid ED admission. Rehabilitation and transitional care services are also provided in St. Joseph's, which facilitates earlier discharge from Beaumont and assists in avoiding re-admissions.
25. Deputy Denis Naughten asked the Minister for Health when a decision will be made on a commitment to fund the refurbishment of the Sacred Heart Hospital in Roscommon; and if he will make a statement on the matter. [36584/15]
View answerCommunity Nursing Units are an essential part of our national infrastructure of nursing homes and provide approximately 20% of the total stock of nursing home beds nationally.
Because of their age, many such units are housed in buildings that are less than ideal in the modern context, but notwithstanding this, the standard of care delivered to residents is generally of a very high standard.
Residents and their families frequently express their appreciation of the care that they receive and continue to choose such facilities, even when other alternatives are available.
On 29 September Minister Varadkar and I announced a €3bn investment package for health services over six years.
The overall plan includes €300m for the development of Community Nursing Units for older people and new improved models of accommodation for people with a disability. The additional funding will, building upon the existing projects, allow for an enhanced programme to replace, upgrade and refurbish long term care facilities. This will significantly improve the standard of residential facilities and facilitate person centred care.
The Department will work with the HSE to prioritise the use of the available funding having regard to the condition of nursing homes and their compliance with national standards.
