Written Replies Nos. 69 to 83
69. Deputy Pearse Doherty asked the Minister for Health when the national service plan process for 2017 will commence; when analysis of the 2016 funding position and the 2017 costs of initiatives for pre-budget purposes will be available; and if he will make a statement on the matter. [13707/16]
View answerThe National Service Plan sets out the type and volume of health and social care services to be provided by the HSE in a given year within the funding allocated by the Government. I understand that the HSE has already begun its preparatory work in relation to the 2017 National Service Plan, but detailed workings and finalisation can only be completed once the 2017 Budget is announced and final allocations for Departments are known. The 2017 Estimates process will be undertaken in Health in accordance with the timelines described in the recent joint Memo for Government, from the Departments of Finance and Public Expenditure and Reform.
The Minister for Public Expenditure and Reform will publish a Mid-Year Expenditure Report in July, which will set out the 2016 expenditure ceiling for all Departments. Following the publication of this report, my Department and the relevant sectoral Committee will consider the priorities for 2017, having regard to the available fiscal space, and taking account of the full year effect of developments and initiatives commenced in 2016 and relevant demographic challenges.
70. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the various public hospitals are allowed to recruit nursing staff in accordance with their needs; if he is aware of suggestions to the effect that some hospitals appear to have a difficulty meeting their requirements in respect of staff recruitment, with particular reference to nursing; if he will offer reassurance in this regard; and if he will make a statement on the matter. [13750/16]
View answerThe HSE has focused on the recruitment of additional front line staff to support service delivery and continues to do so, as additional resources have become available. From the end of April 2014 to the end of April 2016 the number of nursing and midwifery staff working in the public health service increased by 1,275 in whole time equivalent terms to 35,925.
Recent measures taken in relation to service areas in the HSE remaining within budget have been portrayed, incorrectly, as a recruitment freeze. These measures do not impact on a hospital’s ability to recruit where funding exists to facilitate that recruitment; for example in the case of replacement posts or where funding has been allocated for particular roles under the HSE service plan. Recruitment can also take place in areas of critical care and emergency services.
The HSE has clarified that while restrictions have been introduced in the acute hospital sector there is a mechanism in place for Hospital Group CEOs to agree priority recruitment of key posts on an exceptional basis. This includes, for example, Emergency Department staffing, in accordance with the agreement reached between the HSE and the INMO earlier this year.
The HSE is currently working with my Department on the preparation of their 2016 Pay and Numbers Strategy. This has involved the development of detailed workforce plans at hospital and community service level. The interim recruitment measures have been put in place by the HSE, while these plans are being developed.
71. Deputy Dara Calleary asked the Minister for Health the discussions his Department has had with representative groups in relation to a new agreement for supply of drugs to the Health Service Executive; and if he will make a statement on the matter. [13089/16]
View answerMy Department, together with the HSE, the Department of Public Expenditure and Reform and the Office of Government Procurement, entered negotiations with the Irish Pharmaceutical Healthcare Association (IPHA) in recent months with a view to securing an agreement that would:
- significantly reduce the price of medicines to the Irish taxpayer;
- reduce growth in the drugs and medicines bill to an affordable level; and
- allow the HSE to invest in new and innovative medicines over the next four years.
The Minister for Public Expenditure and Reform and I have formally briefed Government on these negotiations. The State team concluded that the potential of the current negotiation process had been exhausted and that the value of the best offer from the IPHA fell substantially short of what would be needed to satisfy the State's strategic requirements.
In the absence of an agreement with IPHA, the Health (Pricing and Supply of Medical Goods) Act 2013 is available to the HSE to determine reimbursement prices.
72. Deputy John Brady asked the Minister for Health when the pilot for the minor ailments scheme will commence; the geographic spread of the pilot; the timeline for reporting and recommendations; if recommendations will be binding; and if he will make a statement on the matter. [13701/16]
View answerI am informed by the HSE that the target date for commencement of the pilot Minor Ailments Scheme developed between the HSE and the Irish Pharmacy Union is 1 July. The four locations chosen for the pilot scheme are Edenderry, Roscommon, Macroom and Kells.
The pilot scheme will run for a period of three months, and a review of its effectiveness will then be conducted. The objective of the pilot is to inform policy decisions and recommendations regarding the future of such schemes.
73. Deputy Imelda Munster asked the Minister for Health his plans to review the outdated Traveller health strategy and to develop a new strategy with a particular focus on mental health. [13723/16]
View answerConnecting for Life, Ireland’s National Strategy to reduce Suicide 2015 - 2020, sets out a vision where fewer lives are lost through suicide, and where communities and individuals are empowered to improve their mental health and well-being. Connecting for Life involves preventive and awareness-raising work with the population as a whole, supportive work with local communities and targeted approaches to priority groups. Members of the Traveller community are identified as a priority group. The two objectives of the strategy are:
- Reduced suicide rate in the whole population and amongst specified priority groups; and
- Reduced rate of presentations of self-harm in the whole population and amongst specified priority groups.
There are no current plans to update the All Ireland Traveller Health survey. The Deputy will be aware that the Department of Justice and Equality is leading on the development of a new National Traveller and Roma Inclusion Strategy. The Strategy aims to provide a set of specific actions that need to be taken to bring about a real improvement in quality of life for Travellers and Roma. A number of cross-cutting themes have emerged in the consultation process for the Strategy such as accommodation, employment, health and education. It is intended that the Strategy will include agreed actions in relation to improving the health of travellers. The Strategy is expected to be completed in 2016 and will cover the period up to 2020.
74. Deputy Eamon Ryan asked the Minister for Health the status of negotiations on general practitioner contracts; the timeframe envisaged; and his vision for the revised general practitioner contract. [13769/16]
View answerUnder a Framework Agreement, signed in 2014, the HSE, the Department of Health and the Irish Medical Organisation (IMO) are currently engaged in a comprehensive review of the General Medical Services (GMS) and other publicly funded health sector contracts involving GPs.
As a first step in this process, universal GP care without fees for all children under the age of 6 years was successfully introduced in 2015. Shortly afterwards, the second phase implemented universal GP care without fees for 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 GP service contract also included age-based preventive checks focused on health and well-being and also introduced a cycle of care for children with asthma. In October 2015, a specific Diabetes Cycle of Care provided by GPs for adult patients with Type 2 diabetes who hold a medical card or GP visit card was launched.
Earlier this year, an enhanced supports package for rural GP practices was agreed between the IMO, the HSE and the Department of Health. The enhanced package included improved qualifying criteria for rural support and an increase in the financial allowance from €16,216 to €20,000 per annum. In order to support additional services being provided by GPs, the IMO, the HSE and the Department of Health also agreed to revisions to the list of special items of GP service. The revised special items include increased rates of payment for suturing and bladder catheterisation, reflecting the costs and time associated with these services, and the introduction of a 24-hour blood pressure monitoring service by GPs.
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 expected 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. This will also be subject to on-going negotiation with the IMO in relation to the scope of the service to be provided and the fee arrangements to apply. The Programme for Partnership Government also commits to extending in phases, and subject to negotiation with GPs, the introduction of universal GP care to all children under 18 years of age. The roll-out of free GP care to under-18s and other cohorts of the population will be considered in the context of the funding available and the capacity of GPs to undertake this additional work.
Discussions on other aspects of a new GP contract are ongoing. These will address the changing role of the GP in delivering chronic care within the community, the further development of universal GP care, and how general practice can play its part in addressing the challenges facing the health service.
75. Deputy Barry Cowen asked the Minister for Health if he is aware of the huge demand for home help and home care packages and that there are waiting lists developing for these services; how many home care packages and home help hours it is intended to introduce under the new programme for Government; and if he will make a statement on the matter. [13788/16]
View answerIn 2016, the Health Service Executive has a core provision of €324m for home supports.
The HSE’s National Service Plan for this year provides for a target of:
- 10.4 million Home Help Hours to support about 47,800 people;
- 15,450 Home Care Packages; and
- 130 Intensive Home Care Packages for clients with very complex needs.
- A further 60 clients with dementia will be supported with co-funding from Atlantic Philanthropies under the Irish National Dementia Strategy.
Prudent management of available resources is needed as demand for services increases and the HSE is working to most effectively target those with the greatest need, and to provide the best possible contribution to the system as a whole. Services are being stretched by demands from more people, and for more hours at times outside of core hours, in the evenings and at weekends, all of which cost more. Decisions on resource allocations are made and reviewed by front line staff who are familiar with the client’s individual needs and circumstances. All relevant factors are carefully balanced so that as many people as possible can viably stay at home and enjoy the best possible quality of life. Those who cannot be provided with a service immediately are risk-assessed and placed on a waiting list for resources as they become available.
Notwithstanding the significant improvements in the overall economic position that we have seen in recent times, pressures continue to apply across the health service. There is no doubt that home care needs more resources than are currently available, and for this reason the Programme for a Partnership Government commits to increasing funding for Home Care Packages and Home Help. The planning and management of future health expenditure will be considered as part of the annual estimates and budgetary process which seeks to balance available funding across all of the various service areas to achieve the best possible outcomes for the greatest number of service users and prioritise areas of greatest need. The Minister for Health has already stated that he will seek additional resources for home support services in the next Budget.
76. Deputy Bríd Smith asked the Minister for Health the number of patients per month who register at emergency departments for treatment but who leave before being discharged; and if he will make a statement on the matter. [13768/16]
View answerPressures on Emergency Departments have been rising, given an ageing and growing population.
ED attendances have been significantly higher this year, particularly in Quarter 1. To date, the HSE has reported an average increase in attendances of nearly 6% compared with the same period last year. Despite attendance increases, TrolleyGAR numbers in Quarter 1 2016 are similar to those for 2015. Furthermore, figures for May 2016 show total numbers of patients on trolleys are approximately 18% lower than in May 2015, with numbers waiting over 9 hours approximately 24% lower.
The HSE maintains records on service users who register at an ED and choose to leave without actively discharging themselves. Figures for March 2016 indicate that 3.9% of ED patients ‘did not wait’ to complete their episode of care, which is within the internationally accepted safe target of less than 5%.
It is important to note that patient experience times have improved in April 2016 with 67.6% of patients being admitted or discharged within 6 hours and 81.7% within 9 hours.
Reducing the wait times for patients attending EDs is a priority for this Government. Investments in capital expansion are ongoing (new EDs have been completed in the Mater and Wexford Hospitals and are planned in Beaumont and Galway). 366 extra beds have been opened or re-opened. A review of bed capacity in our health service, coupled with a review of Medical Assessment Unit hours are further key commitments intended to alleviate ED overcrowding.
77. Deputy Jonathan O'Brien asked the Minister for Health the progress made in the preparation of the 2016 pay and numbers strategy; when the strategy will be submitted; and if he will make a statement on the matter. [13703/16]
View answerArising from Budget 2015, the Minister for Public Expenditure and Reform announced an easing of restrictions on the employment of additional staff. Submission of a Pay and Numbers Strategy, outlining planned staffing levels and pay/pensions expenditure was required to obtain sanction for the lifting of the moratorium and Employment Control Framework arrangements.
This change allows for greater autonomy to be delegated to Departments and Agencies to manage their own staffing levels within allocated pay frameworks. It also provides for further recruitment flexibility, for example where it is determined that offering permanent contracts can achieve more economical service delivery than agency usage.
The HSE are currently working with my Department on the preparation of their 2016 Pay and Numbers Strategy. This has involved the development of ‘bottom up’ workforce plans at hospital and community service level. Recent measures taken in relation to service areas in the HSE remaining within budget have been portrayed, incorrectly, as a recruitment freeze.
These measures do not impact on a hospital’s ability to recruit where funding exists to facilitate that recruitment; for example in the case of replacement posts or where funding has been allocated for particular roles under the HSE service plan. Recruitment can also take place in areas of critical care and emergency services.
A draft Pay and Numbers Strategy has recently been submitted by the HSE and the details of this submission are currently being examined by officials within my Department.
I want to assure you that this government is fully aware of the difficulties and challenges that are currently faced by health service staff, in delivering care and there is a real focus within our health service on recruitment and retention of staff.
Finally I would take the opportunity to confirm my intention to continue to grow the health budget as the economy improves and to obtain the resources necessary to improve working conditions for front line staff and to enable us deliver the level of service that we all want to provide to our patients.
78. Deputy Bernard J. Durkan asked the Minister for Health the extent to which comparisons have been made with staffing levels at various grades including nurses, doctors, consultants and administrators in this jurisdiction with other European Union countries; whether the staffing levels here compare favourably or otherwise with those applicable in other countries; if other forms of expenditure per capita here have been measured against those elsewhere with a view to achieving a comparable delivery of services; and if he will make a statement on the matter. [13751/16]
View answerMy Department has committed, in its Statement of Strategy 2015-2017, to developing a national integrated strategic framework for health workforce planning, in collaboration with Government Departments and agencies. Workforce Planning models in other countries will be assessed and analysed as part of this development process. This will provide an overarching framework for strategic, discipline-specific workforce planning and development, including the work of the Taskforce on Staffing and Skill Mix for Nursing and work currently underway in the HSE's National Doctors Training and Planning Unit on medical workforce planning. The framework is intended to support the stability and sustainability of the health workforce in Ireland into the future.
The ability to provide high quality health and social care services depends on having a sufficient level of and appropriately trained health and social care workforce in place.
There has been a significant increase in the number of consultants working in the public health service since the establishment of the HSE reflecting the policy outlined in the 'Hanly Report' of moving to a consultant delivered service. That study recognised that the number of consultants in Ireland were low when compared to international standards. Numbers have increased by over 850 from the end of 2004 to the end of April 2016 and the HSE is committed to growing the consultant workforce into the future.
The work of the Taskforce on Staffing and Skill Mix for Nursing will inform policy on the appropriate level of nurse staffing, taking account of factors unique to the Irish health system, in the first instance within the acute hospital sector.
The HSE's National Doctors Training and Planning Unit is working on a series of medical workforce reports addressing the manpower needs of all medical specialties. It produced its first report in September 2015 on medical workforce for General Practice in Ireland in which projected the future demand for GPs taking account of a range of factors such as population ageing, Government policies on Primary Care, part-time working and expected retirements and other exits from the workforce. It is currently working on medical workforce reports for Anaesthesia and Critical Care services.
79. Deputy Gino Kenny asked the Minister for Health if he is aware that the impending retirement of a consultant who specialises in a number of rare eye disorders in children is causing an extreme amount of concern and stress among the families affected; and if he will make a statement on the matter. [13748/16]
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.
80. Deputy Joan Burton asked the Minister for Health if he will confirm that the allocation of €5 million in funding to recruit up to 100 psychologists and counsellors to develop psychological services for persons under 18 years of age will be spent; and the timeframe for the delivery of these services. [13739/16]
View answerThe HSE National Service Plan 2016 envisages the development of early intervention and counselling for young people, similar to the service provided for adults, and that this will be developed collaboratively by the Primary Care and Mental Health services. This initiative will be funded from the €5 million of the held back Development funds provided in this years National Service Plan for Mental Health. The Department of Health will shortly conclude discussions with the HSE on how this initiative should be progressed over the remainder of this year and beyond, as part of the approval of development funding set aside for mental health in 2016.
In regard to the recruitment of specific posts for this initiative as this is a service matter, I have referred the Deputy's question to the HSE for direct reply.
81. Deputy James Lawless asked the Minister for Health the status of the nurse in the diabetes clinic in Tallaght Hospital, Dublin 24, who specialises in assisting those with insulin pumps; if the specialist nurse who is on long-term sick leave will be replaced; if it is intended to ever provide the same service in Naas Hospital, County Kildare; and if he will make a statement on the matter. [13756/16]
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.
82. Deputy Alan Kelly asked the Minister for Health his plans to roll out free general practitioner care for the entire population, given the success of the programme for children under six years of age and adults over 70 years of age; if he will confirm that he has not abandoned the roll-out of free general practitioner care to other cohorts of the population; and the estimated timeline for this programme. [13737/16]
View answerAs set out in the Programme for Partnership Government, the Government is committed to the goal of universal healthcare. One of the key proposals in the Programme is the establishment of an Oireachtas Committee to develop cross-party consensus on the future of the health service. I believe the health service would benefit enormously from a single unifying vision that can help to drive reform and development of the system over the next ten years.
The Programme for Government 2011-2016 committed to the phased introduction of a universal GP service for the entire population. The first two phases of universal GP care without fees have been successfully introduced in 2015, firstly, for children under the age of 6 years and, secondly, for 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 GP service includes age-based preventive checks focused on health and well-being and a cycle of care for children with asthma.
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 expected 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. This will also be subject to on-going negotiation with the Irish Medical Organisation (IMO) in relation to the scope of the service to be provided and the fee arrangements to apply. The Programme for Partnership Government also commits to extending in phases, and subject to negotiation with GPs, the introduction of universal GP care to all children under 18 years of age. The roll-out of free GP care to under-18s and other cohorts of the population will be considered in the context of the funding available and the capacity of GPs to undertake this additional work.
83. Deputy John Brady asked the Minister for Health when the memorandum for information to Government relating to the children’s hospital capital project will be completed; the timeframe for the commencement of the enabling works contracts; when the general scheme of a Bill to establish a new children’s hospital body will be brought to Government; and if he will make a statement on the matter. [13700/16]
View answerThe decision to locate the new children's hospital at the St James's campus was based on the over-riding priority of best clinical outcomes for our children and, in particular, the sickest of these. The planned new facilities will provide us with the means to deliver on improved health outcomes for children, especially the sickest children in Ireland. I am delighted at the unanimous decision of An Bord Pleanála to grant planning permission for these vital new facilities as designed.
The National Paediatric Hospital Development Board (NPHDB) is the statutory body responsible for planning, designing, building and equipping the new children's hospital. The NPHDB has commenced the tender process for enabling works contractors for the St James’s site and tender returns have been received. It is expected that the enabling works contractor will be appointed in the coming weeks, for commencement on site in July. It is expected that the satellite centres can open in 2018, significantly enhancing access to urgent care and outpatient services for children from the Greater Dublin Area. Building work on the main site will be completed in 2020. I intend to bring a Memorandum for Information to Government in the coming weeks, advising of the progress of the project.
My Department is currently working on the General Scheme of a Bill to establish a single entity, bringing together the existing hospitals, to govern and manage the new hospital, and I intend to bring this to Government as soon as possible.
