Written Answers Nos. 75 - 89
75. Deputy Seán Kyne asked the Minister for Health the type of measures he is considering to help support the provision of general practitioner services in rural areas, given the global pressures on the recruitment and training of health care staff; and if he will make a statement on the matter. [3888/16]
View answerThe Government is committed to ensuring that patients throughout the country continue to have access to GP Services, especially in remote rural areas and also in certain disadvantaged urban areas, and that general practice is sustainable in such areas into the future.
Rural practice is top of the agenda as part of the discussions for the new GP contract currently underway between the Department of Health, the HSE and the Irish Medical Organisation. Options, including enhanced rural practice payments, are being considered by all parties to support and sustain rural practices. As proposals are being considered by the parties as part of ongoing discussions about the GP contract, I am not in a position to comment on the outcome at this stage.
76. Deputy Billy Kelleher asked the Minister for Health the status of the negotiation of a new contract for general practitioners; and if he will make a statement on the matter. [3925/16]
View answerFollowing the signing of a Memorandum of Understanding by the Health Service Executive, the Department of Health and the Irish Medical Organisation in February 2015, the parties commenced talks on a new GP contract. A priority of these discussions is the inclusion of chronic disease management for patients. As a first step in this process, agreement was reached on the introduction of a Diabetes Cycle of Care for adult patients with Type 2 Diabetes who hold a medical card or GP visit card. This service commenced on 1st October 2015.
Rural practice is top of the agenda as part of the ongoing discussions between the parties. Options, including enhanced rural practice payments, are being considered by all parties to support and sustain rural practices. The parties are planning to hold further meetings.
77. Deputy Joan Collins asked the Minister for Health his views on survivors of severe acquired brain injury depending on a maintenance programme in nursing home care rather than in proper rehabilitation therapy; and if he will make a statement on the matter. [3944/16]
View answerThe HSE has informed the Department that there are currently 1,047 people under the age of 65 years who are resident in nursing homes under the Nursing Homes Support Scheme. A diagnosis is not required under the Nursing Home Support Scheme, so we are not in a position to clarify how many of these have an Acquired Brain Injury. Although most families would prefer to be able to care for their loved ones at home, hospital/nursing home care is at times necessary and it forms part of the continuum of care. The Nursing Home sector is used in developing options to meet the needs of young adults with a disability where no other alternatives are possible. The HSE need to regularly review these individuals to see if through their care plan a more appropriate option might be available. In the longer term the policy is to develop a more tailored service suitable to meet the needs of these service users.
The Health Service Executive provides for the health needs of those affected by brain injury through a range of measures. Brain injury health services are provided across a range of settings, by different organisations and by many health professionals and carers. The HSE Clinical Strategy and Programmes Directorate have a number of clinical programmes that are working in the area of neurology, including Neurology, Epilepsy, Stroke and Rehabilitation Medicine. The clinical programmes are focusing on reducing waiting times/lists, addressing disease specific pathways and models of care with a view to developing a national framework for the management of long-term neurological conditions. The HSE also provide services for those with brain injury through Primary Care Teams with community based therapy services and personal social services. Substantial funding is also provided to a number of organisations such as Acquired Brain Injury Ireland, Headway Ireland, Enable Ireland, Spina Bifida Hydrocephalus Ireland among others, to provide supports and services to people with a neurological condition.
Last year, the Government, announced an additional €15 million for the redevelopment of the National Rehabilitation Hospital in Dún Laoghaire. This allocation will enable the National Rehabilitation Hospital and the HSE to proceed with a new 120 bed building on the Dún Laoghaire campus. The redeveloped facility will be purpose built to accommodate integrated therapy services, hydrotherapy and sports facilities.
The Government recognises that neurological illness or injury has significant implications for the individual and their family and impacts on their health, social, educational, vocational and recreational participation. It is important that the continuum of services and supports required are made available by the health system and by those other State agencies to provide specific services, consistent with their statutory remit.
78. Deputy Colm Keaveney asked the Minister for Health why the Health Service Executive target for moving persons out of congregated settings was not met in 2015; and if he will make a statement on the matter. [3886/16]
View answerThe HSE’s report “Time to Move on from Congregated Settings – A Strategy for Community Inclusion”, (2011) proposes a new model of support in the community by moving people from institutional settings to the community, over a seven year time frame. The plan will be rolled out at a regional and local level and will involve full consultation.
In terms of housing, the Department of Health and the Department of the Environment, Community and Local Government are working in collaboration to support the transition of people with a disability from institutions to social housing in the community under the Government's National Housing Strategy for People with Disability 2011 to 2016.
The HSE Social Care Operational Programme 2015 set a target of moving 150 people from institutions into the community in 2015. I am pleased to note that significant progress has been made in achieving this goal as 137 individuals had moved from congregated settings at the end of December 2015. I understand that the majority of this number, moved to community placements and others moved to alternative appropriate accommodation, including moving in with family and moving into long term nursing home care, in line with their personal care plans.
All such moves require careful care planning by service providers in association with clients, families and communities. The HSE has advised me that there are a number of factors which meant that fewer people than planned moved to the community in 2016. These included:
- a shortage of suitable housing
- difficulties in accessing Capital Assistance Funding (CAS) from the Department of the Environment
- inability of service providers to support individuals with capacity issues to sign tenancy agreements pending the enactment of ‘Capacity Legislation’,
- inability of some service providers to support transition costs
- changes in family and or personal circumstances.
I am pleased to note that Department of Health officials followed up with the HSE, Department of the Environment and the Housing Agency to resolve problems regarding access for people with disabilities to funding from the Capital Assistance Scheme. Arising from this process, the Department of Health and the Department of the Environment developed new Guidelines under the Capital Assistance Scheme to enable housing associations/service providers to apply for funding to acquire suitable accommodation for people moving from institutions in 2016.
I am assured that HSE and local authorities will continue to work together under the structures set up under the Housing Strategy to inform and guide local housing provision for people with disabilities over the next few years.
79. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if he is aware, and if it is acceptable, that there are approximately 250 children with scoliosis who are waiting for an operation to fix their spine or waiting to see a consultant; that many of these children have been waiting for more than 15 months for vital treatment; how he will ensure that these children who are in chronic pain are treated as soon as possible; and if he will make a statement on the matter. [3935/16]
View answerLong waiting times for scoliosis surgery are unacceptable and I have been clear in my determination that these waiting times are reduced, through additional resources and capacity.
Our Lady’s Children’s Hospital, Crumlin is the largest provider of scoliosis surgery for children and young people. Funding was allocated in 2015 for additional consultant posts including two consultant orthopaedic surgeons, anaesthetist and support staff at Crumlin. Capital funding was also provided for a new theatre on site to expand theatre capacity further. The 2016 Service Plan specifically provides for support for the new theatre capacity and the continued development of paediatric scoliosis services to address ongoing capacity deficits.
In order to address waiting times in the interim, patients from Crumlin have been transferred to other hospitals where capacity is available and where that is clinically appropriate. These include Temple Street, Cappagh, Tallaght and the Blackrock Clinic. External capacity has also been identified at the Royal National Orthopaedic Hospital at Stanmore in the UK.
As a result of these initiatives, at the end of 2015 no child was waiting longer than 15 months for scoliosis surgery. In addition, I am advised that no child is currently waiting longer than 15 months at Crumlin for an outpatient appointment at the hospital. The Department of Health is continuing to work with the HSE, the Children’s Hospital Group and the hospitals themselves to ensure that we continue to make strong progress in addressing this issue and to identify all options to further improve access times for surgery.
80. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if the Health Service Executive is negotiating with the drug supplier Vertex, which produces the drug Orkambi, a drug which has been found to significantly improve the lives of cystic fibrosis sufferers, to ensure that the best possible treatment is available to the thousands of sufferers; if he has considered a pan-European Union approach to acquiring this drug; and if he will make a statement on the matter. [3937/16]
View answerThe 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.
The 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 (NCPE). They are not political or ministerial decisions. The NCPE 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.
Orkambi 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.
81. Deputy Caoimhghín Ó Caoláin asked the Minister for Health why he has not honoured commitments by his predecessor to fund academic appointments to University Hospital Waterford in the context of the reconfiguration of acute hospital services in the south east; if an agreement was entered into in 2013 to fund a number of specific posts at the hospital over an initial five year period; if he will issue a direction in the closing days of Dáil Éireann to honour this commitment; and if he will make a statement on the matter. [3938/16]
View answerMy Department is keen to progress academic linkages between hospital groups and their academic partners. The Deputy can therefore be assured that my Department supports the development of academic and teaching capacity at University Hospital Waterford, and recognises the benefits that this will bring in terms of clinical standards and the ability to attract and retain clinical staff. However, my Department does not directly fund clinical posts; this is a matter in the first instance for the South/South West Hospital Group and the HSE.
It is the case that Hospital Groups, and indeed the HSE, must manage competing priorities for funds and posts. In order to progress these particular posts, they must first be prioritised within the Hospital Group, and a business case submitted to the HSE Acute Hospitals Division for consideration and prioritisation in the national context. My understanding is that this work is in train.
82. Deputy Clare Daly asked the Minister for Health the steps he is taking to address the chronic shortage of nursing staff in St. Joseph's Association for the intellectually disabled in Portrane, County Dublin; if he has consulted with the Health Service Executive on this issue; and if he will make a statement on the matter. [3891/16]
View answerThere is an international nursing and medical manpower shortage, leading to difficulties in recruiting nurses, doctors and consultants. This difficulty is being experienced by other English speaking countries including the UK, Australia, and Canada. Notwithstanding this, the HSE Census returns for the end of November 2015 show that we have over 880 more nurses employed in the public health services than a year ago.
Recruitment of additional nurses is the subject of considerable ongoing activity by the HSE and voluntary hospitals. Recruitment campaigns are underway in Ireland and abroad. This includes recent and ongoing national and local interviewing of General Nurses, Mental Health, Intellectual Disability, Registered Children's Nurses and Midwives.
A number of measures have been put in place to support recruitment of nurses from abroad. In 2015 the HSE initiated a targeted international recruitment drive. This focused initially on Irish trained nurses who left for the UK during the moratorium and has now been expanded to countries further afield. It also facilitated seven adaptation programmes and made 405 places available to the nursing home sector for overseas nurses. Further adaptation courses are being provided in 2016 for nurses who are required to complete a course prior to registration. The NMBI have approved, on a pilot basis until June 2016, a new aptitude test with the RCSI as an alternative method to assess candidates for registration. Nurses are currently being advised of the availability of this test. The first theory test for 22 people took place on the 5 December 2015 with the practice tests on the 12/13 December and repeats on the 7 January 2016. All candidates were successful between the 2 practical tests. Further tests are planned by RCSI in January, February and March, with 67 prospective nurses having expressed an interest in taking the test.
In the context of supporting recruitment and retention of nurses, consideration is being given to the pay rates for fourth year student nurses undertaking the 36 week clinical placement and whether the placement should attract incremental credit, as provided for in a Chairman's Note to the Lansdowne Road Agreement.
All of the measures mentioned above will facilitate the recruitment and retention of nursing staff at all grades and disciplines within the Irish health service. My Department is in regular contact with the HSE on matters concerning the recruitment of nurses and midwives and other key staff.
83. Deputy Billy Kelleher asked the Minister for Health the number of commissioned units in public and voluntary hospitals that have yet to open, including the patient accommodation capacity in each, in tabular form; when they will open; and if he will make a statement on the matter. [3928/16]
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.
84. Deputy Robert Troy asked the Minister for Health the progress he has made in ending the practice of placing children and adolescents in adult psychiatric wards, further to the commitment of the programme for Government. [3205/16]
View answerThe Government has provided an additional €160m ringfenced funding over 2012-16 to modernise mental health services in line with A Vision for Change (AVFC) and Programme for Government commitments. This provided around 1,150 additional posts to enhance mental health and suicide prevention services generally. Of these, approximately 950 posts were filled at the end of November last, and the remainder are at various stages of the recruitment process. Around 300 of these posts were approved for the Child and Adolescent Mental Health Service (CAMHS). There are continuing challenges in relation to recruitment of Child and Adolescent Mental Health Consultants and we are actively trying to recruit both at home and internationally.
The HSE National Service Plan 2016 aims to improve placement of children in age appropriate mental health settings. The 95% target indicated in the Plan allows for some operational flexibility surrounding emergency placements in Adult Units. It is generally accepted that it remains quite challenging for the HSE to meet this ambitious target, relative to progress over recent years and in light of increasing demands generally on CAMHS. Progress on this important issue has nonetheless been significant, underscored by the fact that, while there were 247 such admissions to adult units in 2008, the trend has been declining annually since, to 89 admissions in 2014. It is a priority for the HSE to keep such admissions to a minimum and this is kept under constant review.
I have prioritised CAMHS in the new funding made available by Government, designed to support timely access to appropriate services to address the mental health needs of all children, while emphasising the early intervention and integrated service perspectives. Additional resources and facilities means that we now have 67 CAMHS Teams, and 3 Paediatric Liaison Teams, supported by 66 operational CAMHS beds across the country.
The HSE is committed to ensuring that all aspects of CAMHS services are delivered in a consistent and timely fashion, including improved Access to age appropriate units. The Executive introduced, around June last, a new Standard Operating Procedure for both in-patient and community CAMHS services. This has contributed to improving the services overall, including reducing inappropriate admissions of adolescents to adult units. It is designed also to help reduce CAMHS Waiting Lists, particularly for those waiting over 12 months.
There were 90 admissions of the type raised by the Deputy over the period January-November 2015. The majority of these were voluntary with parental consent. Approximately 85% of these were 16 -17 year old; a third of these were discharged within 2 days of admission, and two thirds within a week. However, in relation to this latest trend, it should be noted that an extra 8 CAMHS beds recently opened in the new Linn Dara Unit in Dublin, which should help decrease pressures on CAMHS admissions to adult units. It is intended to open further CAMHS beds in the system, as on-going staffing and recruitment difficulties generally for the mental health area are addressed.
Bearing in mind all the circumstances, I am satisfied that the HSE is making good progress in relation to the issued raised by the Deputy, including the wishes of each young person and their parents or guardians, taking account the complexities of each case. In many cases, a multi-disciplinary or inter-agency approach is required. I will continue to closely monitor this issue, in conjunction with the HSE, to ensure that the new funding I secured for mental health overall for 2016, will contribute to improving CAMHS services, and aiming for age appropriate admissions across all regions.
85. Deputy Colm Keaveney asked the Minister for Health why the Health Service Executive's service plan makes no provision for an increase in the number of personal assistant hours for persons with disabilities in 2016; and if he will make a statement on the matter. [3885/16]
View answerThe Health Service Executive (HSE) is committed to protecting the level of Personal Assistant (PA) services available to people with disabilities. In their 2016 National Service Plan, the HSE's priority is to provide 1.3 million hours of personal assistance to more than 2,000 people with a disability. This is the same activity level that was funded in 2014 and 2015. PA hours are reviewed on an ongoing basis to ensure that the service is at all times responsive to client's needs and that the hours available are allocated appropriately and in a timely manner. The HSE has confirmed that in excess of €30 million is spent annually on the provision of PA Services. I have also arranged for the question to be referred to the HSE for a more detailed response to be supplied to the Deputy. If the Deputy has not received a reply from the HSE within 15 working days, he can contact my Private Office and they will follow the matter up with the HSE.
86. Deputy Michelle Mulherin asked the Minister for Health the measures he it taking to address the issue of patients on trolleys at Mayo General Hospital, including the capacity problem that sees the emergency department at the hospital dealing with 36,000 patients as opposed to 20,000 patients, for which it was designed; and if he will make a statement on the matter. [3890/16]
View answerI recognise that overcrowding in Emergency Departments is an issue of genuine public concern. It is regrettable when patients experience long waits in Emergency Departments and I appreciate that this can be particularly distressing for patients and their families. The Saolta Group is working with hospitals within its region, including Mayo General Hospital, on an on-going basis to manage and alleviate this situation.
Over the last number of months, a range of initiatives have been introduced to address ED overcrowding and work on these initiatives will continue to be a priority in 2016. During 2015, significant additional resources of €117m, additional hospital beds and increased staffing levels have been put in place to address the problem.
Last April, the HSE published the ED Taskforce Action Plan, with a range of time-defined actions to: (i) optimise existing hospital and community capacity; (ii) develop internal capability and process improvement and (iii) improve leadership, governance, planning and oversight.
I have been attending the ED Taskforce Implementation Group meetings to oversee the implementation of these actions.
During this peak winter period, my Department, the HSE and key members of the Implementation Group are engaging in weekly meetings to monitor ED performance and patient waiting times on trolleys.
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.
87. Deputy Billy Kelleher asked the Minister for Health the funding and the number of hours being provided for home help, and the funding and the number of packages being provided for home care in 2016; and if he will make a statement on the matter. [3927/16]
View answerAs this is a service matter it has been referred to the Health Service Executive for direct reply. 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.
88. Deputy John Halligan asked the Minister for Health the amount spent on agency staff at University Hospital Waterford in each of the years 2013 to 2015, in tabular form; and if he will make a statement on the matter. [3934/16]
View answerThe agency expenditure totals in respect of University Hospital Waterford, for each of the last three years can be seen in the table below.
|
Year |
€ expenditure |
|
2013 |
3,597,747.50 |
|
2014 |
6,289,020,99 |
|
2015 |
5,145,766.47 |
The November HSE Performance Report stated that in 2015 a particular focus was given to reducing agency costs and overtime. Overall, agency costs are falling in the HSE. The November figure of just over €26 million was a €1.2 million reduction on the October figure, a decrease for a second consecutive month. The November Year To Date expenditure of €304.1m was down by approximately €7m or 2.3% on the 2014 November year to date figure.
The reduction has been greater in the acute sector where agency expenditure reduced from €208 million year to date in November 2014 to €189 million year to date in November 2015.
89. Deputy John Browne asked the Minister for Health the number of Health Service Executive community intervention teams by local health office; the local health offices that do not have a community intervention team exclusive to their locale; and if he will make a statement on the matter. [3930/16]
View answerThere are currently 12 Community Intervention Teams (CITs) in operation. The twelve operational CIT areas are Galway, Mid-West, Cork, Carlow/Kilkenny, Waterford, Dublin South East, Wicklow, Dublin South, Kildare, Louth, Meath and Dublin North. There is also a short-term CIT in place in South Tipperary which commenced on 20th January 2016.
In 2015, the HSE replaced the former Local Health Office structure with nine Community Healthcare Organisations (CHOs) in accordance with the recommendations of the CHO Report launched in October 2014. The only CHO area with no formal CIT in place at present is the North West, although work is currently underway to extend an existing service to cover Sligo during the Winter months. The longer-term plan is to have CITs in place on a country-wide basis as part of an extended range of Community Services to reduce unnecessary referrals to Acute Hospital Emergency Departments.
