Written Answers Nos. 1-74
63. Deputy Richard Boyd Barrett asked the Minister for Health if he will address the increasingly long waiting times for operations at Cappagh Hospital in County Dublin, where waiting times of 18 months and longer are leading to some patients developing conditions arising out of the long-term use of pain medication, which is necessary given the waiting times; and if he will make a statement on the matter. [3942/16]
View answerThe latest National Treatment Purchase Fund Waiting List data, published on 8 January last, shows that clear progress was made to reduce the numbers of patients on waiting lists by end December 2015. These figures continue to show the positive trend which was seen in November 2015, with improvements across all waiting list categories. This can be seen in Cappagh Hospital where no patient is waiting longer than 15 months for in-patient / day case treatment. This is within the maximum permissible waiting times that I set in January 2015 of 18 months by 30 June 2015 and 15 months by year end 2015.
In 2015, the HSE was provided with additional funding to maximise capacity across the public and voluntary hospitals or to fund outsourcing activity, so that patients’ needs could be met within the maximum allowable waiting times.
- An additional allocation of €3.5 million was provided to Cappagh Hospital which enabled it to treat 537 more in-patients and 571 more day case patients in 2015 as compared with 2014. Since the start of 2015 (with the enhanced 2015 allocation) the Hospital has increased its theatre use from between 2 and 3 Theatres per day in 2014 to between 3 and 4 Theatres per day in 2015
67. Deputy John Browne asked the Minister for Health if hospital acute bed capacity here is sufficient and if the norm for hospital bed occupancy should be 85% capacity, as is the case in other countries; the details of the acute bed capacity here on 1 January 2016 and the number of additional beds that are required in order that the bed capacity here will have a norm of 85% occupancy; and if he will make a statement on the matter. [3929/16]
View answerThe number of acute beds reduced by 1,845 between 2005 and 2011. Last year additional funding of €18 million was provided to support acute hospitals over the winter period by providing additional bed capacity and other initiatives to improve access to care. As a result of this an additional 301 beds were commissioned across various locations and to date 202 of these beds have been opened. Taking into account these beds recently opened, there are 10,705 acute beds available in January 2016.
In short I have reversed the policy of previous Governments to reduce the number of acute hospital beds.
The HSE advised that the occupancy rate to the end of December 2015 for hospitals with an emergency department is 91.1% which is above the norm of 85%, although there is variation between hospitals and over time.
It is not just a case of how many beds you have but the type of beds, how efficiently they are used and the extent to which primary ambulances and community care contributes to reducing the need for acute hospital stays. The understanding and focus has shifted from an over-reliance on in-patient acute beds to a more comprehensive range of care options as are found in advanced health systems. The aim is to ensure the patient or service user has his or her needs met in the most effective way possible with the majority of care provided through community based facilities, supported by appropriate technology and specialist expertise. The HSE is continually developing and improving day services and developments which facilitate hospital admission avoidance that include:
- increased provision of Community Intervention Teams delivering services outside of hospitals;
- better access to diagnostics on an ambulatory basis so that people don't have to be admitted just for tests;
- the development of infusion clinics in hospitals so that people can have chemotherapy and other therapies without having to stay overnight;
- increased day surgery rates;
- medical Assessment Units and Acute Medical Assessment Units opened at all major hospitals;
- intravenous administration of antibiotics whether organised at outpatients departments, in the community or at home, which can deliver bed-day and cost savings and reduce risk of healthcare associated infections; and
- Better use of technology to support patients and primary care professionals in managing illnesses and accessing specialist opinion and support.
69. Deputy Michelle Mulherin asked the Minister for Health the status of the review of the emergency department at Mayo General Hospital; when the recommendations will be published; and if he will make a statement on the matter. [3889/16]
View answerI assume that the Deputy is referring to the review of Emergency Care Units which the Saolta University Hospital Group has been undertaking. The Group has been reviewing emergency medicine in all hospitals within the Group with a view to improving quality and safety of emergency care provided.
Each hospital group will be required to develop a strategic plan to describe how it will provide more efficient and effective patient services and reorganise its services to provide optimal care to the population it serves.
Recommendations of the review of emergency care units in the Saolta Group will be considered by the Board as part of the development of the Group's Strategic Plan for all hospitals in the area. This will be done in conjunction with the HSE national Acute Hospitals Division and in accordance with Department of Health policy.
70. Deputy Billy Kelleher asked the Minister for Health why two fundamental health commitments in the 2011 programme for Government, namely, the undertakings on universal health insurance and the introduction of free general practitioner care for the entire population, were not met; and if he will make a statement on the matter. [3926/16]
View answerThe Government has embarked upon a major multi-annual programme of health reform, the aim of which is to deliver universal healthcare, where all people can access the health services they need, of sufficient quality to be effective, while ensuring that the use of these services does not expose them to financial hardship.
In April 2014, the White Paper on Universal Health Insurance was published. Following its publication, the Department of Health initiated a major costing project, involving the ESRI, the Health Insurance Authority and others, to examine the cost implications of a change to the particular UHI model proposed in the White Paper.
The reports detailing the estimated cost of this UHI model were published on the 18 November 2015. Having considered the findings, I concluded that the high costs associated with the White Paper model of UHI are not acceptable and decided that further research and cost modelling in relation to the best means to achieve universal healthcare are needed.
The next phase of research will include deeper analysis of the key issue of unmet need and a more detailed comparative analysis of the relative costs and benefits of alternative funding models. This work will be carried out under the auspices of the joint Department of Health/ESRI Three-Year Research Programme on Health Reform. Both the research undertaken to date and that planned in the next phase of the costing exercise will assist in deciding on the best long-term approach to achieving the goal of universal healthcare.
I should add that when I assumed the Office of Minister for Health, I concluded that, whilst progress had and was being made in relation to the programme of health reform, the original timeline for implementation of UHI was too ambitious. However, I also emphasised both my commitment to progressing health reform and my determination to push ahead with four key building blocks: Healthy Ireland and the public health agenda, building sufficient capacity to satisfy unmet demand, the expansion and development of primary and social care and reforming structures, ICT and financial systems with key initiatives such as the phased extension of GP care without fees, the establishment of Hospital Groups and Community Healthcare Organisations, the implementation of activity-based funding and the improved management of chronic diseases. These are all major milestones on the road to universal healthcare and have the potential to drive performance improvement and deliver significant benefits in terms of timely access to high quality care.
Already GP care without fees has been successfully introduced for children under the age of 6 years and all people aged 70 years and over. This has resulted in approximately 800,000 people now being eligible for GP care without fees, without having to undergo a means test. The under 6s service includes age-based preventive checks focused on health and wellbeing and the prevention of disease, including the asthma and diabetes of care.
In Budget 2016, the Government made financial provision for the extension of GP care without fees to all children aged 6 to 11 years. It is envisaged that this third phase will bring the total number of those eligible for universal GP care, without having to be assessed by a means test, to approximately 1.2 million people.
The progress made in recent years in introducing universal health care together with the improvement in public finances provides a very good basis upon which to plan the next phase of improvement in our health services.
71. Deputy John Halligan asked the Minister for Health where he has amended the Health (Miscellaneous Provisions) Bill 2015, which is shortly due to come before both Houses of the Oireachtas and which will seek to amend the Medical Practitioners Act 2007, to remove the requirement for an equivalence of a certificate of experience for doctors who qualified outside the European Union and who are seeking registration in the trainee specialist division of the register; if he made a commitment to so amend the Bill; and if he will make a statement on the matter. [3933/16]
View answerLast November I received approval from Government to the drafting of a Health (Miscellaneous Provisions) Bill. This Bill is now being drafted as a matter of priority. This is a different Bill to the Health (Miscellaneous Provisions) Bill currently before the Houses of the Oireachtas. The latter is effectively a Health (Miscellaneous Provisions) No. 1 Bill, with the other a No. 2 Bill as soon as it is introduced.
The Health (Miscellaneous Provisions) Bill being drafted provides for amendments to the Medical Practitioners Act 2007; the Dentists Act 1985; the Health and Social Care Professionals Act 2005; the Pharmacy Act 2007; the Nurses and Midwives Act 2011; and the Health Acts 1953 and 2004 to provide for:
- consequential amendments required by the transposition of Directive 2013/55/EU;
- an appeal against minor sanctions;
- amendments in relation to a number of issues.
As the provisions in relation to registration are being amended consequential to the Professional Qualifications Directive, I am taking the opportunity to remove the equivalence of the certificate of experience as a requirement for entry to the Trainee Specialist Division. This would mean that entry to the Trainee Specialist Division for doctors with non-EEA qualifications would be by way of the Pre-Registration Examination System (unless exempted) and the offer of a specialist training post by the HSE in a recognised training programme.
72. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he is aware of the drug Nivolumab, an immunosuppressant drug treatment for cancers that experts have described as a game-changer; if he will license this drug once clinical trials are completed; and if he will make a statement on the matter. [3936/16]
View answerThe cancer drug Nivolumab (trade name Opdivo) was authorised by the European Medicines Agency in June 2015; this means that it is approved for use in all EU Member States.
The HSE has statutory responsibility for decisions on pricing and reimbursement of medicinal products under the community drug schemes in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013. Prior to reimbursing any medicine, the HSE considers a range of statutory criteria, including clinical need, cost-effectiveness and the resources available to the HSE.
Decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds by the HSE on the advice of the National Centre for Pharmacoeconomics. They are not political or ministerial decisions. The National Centre for Pharmacoeconomics conducts the health technology assessment of pharmaceutical products for the HSE, and can make recommendations on reimbursement to assist the HSE in its decision-making process.
Nivolumab is currently being considered by the HSE under the national medicines pricing and reimbursement assessment process. As the assessment process is ongoing, it would not be appropriate for me to comment further on this process, which is an independent function of the HSE.
73. Deputy Seán Kyne asked the Minister for Health the progress in improving emergency vehicle response times in rural areas and in Connemara, County Galway, in particular; if the stationing of ambulances at primary care centres or local hospital facilities and the introduction of advance emergency vehicles, with a paramedic, is being considered; and if he will make a statement on the matter. [3887/16]
View answerOver the past few years, the National Ambulance Service (NAS) has undertaken very significant reconfiguration, and modernisation, of its services. The NAS now operates on a national and regional, rather than a local, basis. Ambulance resources, including rapid response vehicles with advanced paramedics, are dynamically deployed over an area, from individual stations within, and surrounding, that area. This helps to ensure that optimum cover is provided, and that the NAS is best placed to respond to incidents as they arise. In the Connemara area, for example, resources, including a rapid response vehicle, are located strategically at bases in Clifden, Carraroe, Galway, Loughrea, Tuam and Ballinasloe.
I understand that the NAS Capacity review has now been completed and will inform how NAS deploys resources across specific areas in the future. The review involved a comprehensive analysis of overall resource levels and their distribution against demand and activity. It will help NAS identify where resources should be placed to best meet the needs of the service at national and regional level, including from bases outside traditional ambulance stations. For example, in Connemara, a rapid response vehicle, crewed by an advanced paramedic, may offer a more effective model of pre-hospital emergency care for the needs of the area. This resource could be used to ensure that a patient receives advanced life support, at the scene, prior to the arrival of an ambulance.
I also draw the Deputy's attention to the Emergency Aeromedical Support (EAS) Service which was established on a permanent basis last year. 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 EAS is targeted mainly at western counties, where the road network may not allow for rapid transport to the nearest appropriate hospital. Helicopter-based transport for these patients allows for greatly reduced transit times, particularly for time-critical transfers such as STEMI heart attacks, stroke or major trauma. Last year, the EAS received over 800 requests for medical assistance and completed 400 aeromedical missions. University Hospital Galway received 143 EAS-transferred patients.
Additional funding of €7.2m provided in the National Service Plan will provide for further improvements in 2016, and ensure that response times are maintained. This includes €2m to recruit and train extra staff and expand the Community First Responder (CFR) Scheme. The CFR Scheme trains and supports local volunteer groups to respond to cardiac emergencies and is, I believe, particularly important in rural areas such as Connemara. The NAS will continue to work with CFR Ireland to develop CFR schemes within the area to enhance patient care delivery. They are also engaging with HSE Estates regarding the utilisation of new primary care centres as ambulance deployment points.
74. Deputy John Halligan asked the Minister for Health the number of beds that were allocated to University Hospital Waterford in the recent winter hand-out allowance for overcrowded hospitals; the number of beds allocated, by hospital, in tabular form; and if he will make a statement on the matter. [3931/16]
View answerAs part of the winter capacity planning initiative for 2015/16, an additional 301 beds were commissioned to open on a phased basis to ease pressures in emergency departments. 202 of these beds are open to date and it is expected that the remainder will be available by the end of February. In addition, the HSE identified a further 154 closed beds in the system, which it is intended to reopen in order to support hospitals during the winter period. Currently, 111 of these beds are available.
The detailed information sought by the Deputy on the location of the additional beds is set out in the tables. It should be noted that the numbers identified are the beds available at a particular date in time. The number of beds available can, of course, fluctuate due to short term closures, such as, for example, infection control measures. I understand that, while no additional beds were commissioned in University Hospital Waterford (UHW) directly under the initiative, 48 beds have been made available in the South/South West Hospital Group, of which UHW is a constituent hospital; 30 of these beds have been opened to date.
Along with other acute hospitals, UHW has prepared a winter capacity plan to help address the expected increase in demand for services. Measures taken have included opening additional beds as required, better managing patient flow, discharging patients appropriately, providing internal surge capacity, both of beds and staff, as well as prioritising diagnostics for in-patients to facilitate their earlier discharge. A new Community Intervention Team is now in place to help manage the clinical needs of some patients within the community, obviating their need for admission or reducing their length of stay in the hospital.
In addition to UHW’s winter planning measures, the HSE has approved further funding to support the opening of an additional 15 beds in UHW. I am advised that staff recruitment to support these beds is currently being progressed.
Table 1: Additional capacity to open during winter period.
|
Hospital |
Total planned in July 2015 |
Total number of beds open at 21 January 2016 |
|
RCSI Hospital Group |
||
|
Our Lady of Lourdes Drogheda |
8 |
8 |
|
Louth |
12 |
5 |
|
Connolly |
24 |
16 |
|
Ireland East HG |
||
|
St Vincent's University Hospital |
22 |
22 |
|
Loughlinstown |
10 |
0* |
|
Navan |
15 |
15 |
|
Kilkenny |
12 |
12 |
|
Wexford |
10 |
10 |
|
Cappagh |
10 |
0 |
|
Dublin Midlands HG |
||
|
Tallaght |
16 |
12 |
|
University Of Limerick HG |
||
|
University Hospital Limerick |
27 |
26 |
|
South/South West HG |
||
|
Cork University Hospital |
30 |
30 |
|
Mercy University Hospital |
18 |
0* |
|
Saolta HG |
||
|
Merlin Park |
14 |
14 |
|
Galway |
30 |
17 |
|
Letterkenny |
10 |
10 |
|
Portiuncula |
5 |
5 |
|
Children's HG |
||
|
Temple Street |
14 |
0* |
|
Tallaght |
14 |
0* |
|
TOTAL |
301 |
202 |
Table 2: Additional capacity being progressed over and above the 301 beds agreed in July 2016.
|
Hospital |
Total planned in July 2015 |
Total number of beds open at 21 January 2016 |
|
Sligo |
14 |
14 |
|
Naas |
11 |
11 |
|
TOTAL |
25 |
25 |
Table 3: Closed beds in the process of re-opening.
|
Hospital |
Beds closed in October 2015 |
Beds open at 21 January 2016 |
|
Galway |
17 |
0* |
|
Beaumont |
33 |
21 |
|
University of Limerick |
29 |
23 |
|
Naas |
15 |
15 |
|
St James's |
5 |
5 |
|
Tullamore |
15 |
15 |
|
St John's |
20 |
12 |
|
Cork University Hospital |
20 |
20 |
|
TOTAL |
154 |
111 |
*No additional beds have been opened yet, pending recruitment of required staff which is ongoing.
