Written Answers Nos. 54-68
54. Deputy Thomas P. Broughan asked the Minister for Health when he will provide full local day services for young school leavers on the autistim spectrum disorder who graduated in 2015 and are due to graduate in 2016 in Dublin Bay North and Fingal; and if he will make a statement on the matter. [13677/16]
View answerThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. The commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities. With regard to the provision of day services for school-leavers with disabilities, the Programme for Partnership Government says that the Government is committed to ensuring that all 18 year old school leavers with intellectual and physical disabilities have continued education or training opportunities.
The process of planning for the needs of around 1,500 young people with disabilities and autism who will require continuing health-funded supports on leaving school or rehabilitative (life-skills) training this year commenced in September 2015. To ensure these needs are met, funding of €7.25m is being allocated by the HSE to provide appropriate services and supports. Once off funding of €2 million is also being provided for the refurbishment and fit-out of buildings to provide suitable service locations by September, based on an assessment of the physical capacity within existing services to accommodate the additional numbers. A standardised process for the identification of support needs has been put in place and a profiling exercise has now been completed with each individual in order to ascertain their needs and preferences.
As the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply 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.
55. Deputy Alan Kelly asked the Minister for Health the reason there is no commitment on delivering an extended range of general practitioner services in the new programme for Government; and how he will develop the delivery of key health services at general practitioner and primary care level, including direct access for general practitioners to ultrasound and X-ray services, enhanced minor surgery services, and community-based clinical programmes, targeting the most prevalent chronic diseases. [13740/16]
View answerThe Programme for Partnership Government emphasises the priority of increasing access to safe, timely care, as close to patients' homes as possible, and it recognises that general practice needs a new contract to address its changing role in delivering chronic care with the community and to allow it play its part in addressing the challenges that face the health system. Under a Framework Agreement, signed in 2014, the HSE, the Department of Health, and Irish Medical Organisation are currently engaged in a comprehensive review of the General Medical Services (GMS) and other publicly funded health sector contracts involving GPs. A priority of these discussions will be the inclusion of chronic disease management for patients.
Funding of €13.5 million from the 2016 HSE Primary Care budget was held within the Department of Health for GP contract developments, which includes rural practices, access to diagnostics and minor surgery, and extending GP care without fees to all children aged between 6 years and 11 years. It is expected that the full €13.5 million in hold-back funding will be fully utilised during 2016 in accordance with the HSE 2016 National Service Plan.
The HSE has recently developed a pilot service whereby a GP can refer adult medical card and GP visit card holders for ultrasound scans. Patients deemed to be urgent are seen within 5 working days and routine patients are seen within 10 working days. The service is currently available in 10 primary care centres and the plan is to improve GP access to ultrasound in other areas of the country throughout 2016 - 2017.
In addition, the HSE in collaboration with the Irish College of General Practitioners is completing a pilot research project involving 23 GPs in 20 practices who are delivering a range of minor surgery procedures in general practice. Subject to analysis of the results, the pilot will be extended to a further 40 GP practices. This will allow in the region of 10,000 procedures on hospital waiting lists to be fast-tracked in General Practice.
The HSE's 2016 Operational Plan sets out a number of the 2016 planned initiatives on chronic disease management in primary care, including:
- improve integrated pathways across all Community Healthcare Organisations (CHOs) in collaboration with the Integrated Programme for Prevention and Management of Chronic Disease for patients with COPD, Asthma, Ischaemic Heart Disease and Diabetes;
- provide structured education programmes for patients with Diabetes;
- implement the Integrated Model of Care for Prevention and Management of Chronic Disease in identified areas and implementing the Chronic Disease Demonstrator Projects; and
- develop and recruit new clinical roles and structures to support integrated care implementation in CHOs.
56. Deputy Paul Murphy asked the Minister for Health his views on the cutting of facilities in Cheeverstown Hospital for severely disabled children; if he will restore funding to allow for a full restoration of these services and to meet the needs of the local population; and if he will make a statement on the matter. [13689/16]
View answerThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
As the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply 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.
57. Deputy Donnchadh Ó Laoghaire asked the Minister for Health his plans to introduce measures to allow mental health nurses who have taken early retirement to return to work for a period to address the shortage in qualified staff. [13721/16]
View answerThe HSE's Mental Health Division is experiencing significant challenges in recruiting suitably qualified nurses for the mental health services. Given this, it sought from the National Director, Human Resources, and was granted a derogation from the policy which did not allow for the rehiring of retired staff.
Following this decision some retired mental health nurses have been rehired to work reduced hours in services with critical shortages of staff. Currently these staff are paid at the first point of the staff nurse scale in accordance with general pay policy. However, retired mental health nurses who return to work through an agency are paid at a higher rate. A business case on this issue is awaited by my Department and will receive early consideration.
58. Deputy Eugene Murphy asked the Minister for Health for an update on the scheduled appointments of consultants at Portiuncula Hospital, Ballinasloe, County Galway. [13758/16]
View answerConsiderable efforts have been made by the Saolta Healthcare Group to improve the staffing levels at Portiuncula Hospital. In March 2016, the Hospital hired one extra ED consultant, an increase from one consultant to two.
In the area of Medicine, the Hospital has five consultants in post; two permanent, three locum and two vacancies. The three locum posts are being filled on a permanent basis with a Consultant General Physician and a Consultant Respiratory Physician commencing in September and a Consultant Cardiologist who will commence in October 2016. The two vacant posts, namely a Consultant in Geriatrics and a Consultant Gastroenterologist are to be advertised.
In the area of Obstetrics, the Hospital has five consultant posts. A Consultant Obstetrician, who will fill a post vacated due to a recent retirement, will commence in July 2016.
In Anaesthesia, there are currently four Consultants in post. A new Consultant Anaesthetist/Intensivist,with responsibility for the Intensive Care Unit, has recently been secured and is a joint appointment with Galway University Hospital. Also, an additional Consultant Anaesthetist is due to commence in early January 2017.
Finally in Radiology, there are two permanent Consultants, one locum and one vacancy. Two Consultant Radiologist posts are in clearance stage. The first is to commence later in 2016, the second is due to take up post in 2017.
All of these new posts demonstrate commitment to the care of patients at Portiuncula Hospital.
59. Deputy Brendan Smith asked the Minister for Health the proposals he has to progress co-operation on a North-South basis with the delivery of health services, particularly for Border counties; and if he will make a statement on the matter. [13772/16]
View answerCross-border cooperation on health makes sense, allowing us to pool our resources to provide better health care for all our citizens. North-South cooperation on health matters takes place through the North South Ministerial Council as well as joint departmental projects. There has been significant activity in cross-border health and social care activity over the last decade. Collaboration takes place on a wide range of health and social care issues including, for example, health promotion (tobacco and obesity), cancer research, food safety, suicide prevention and GP out of hours services. Future work to deepen cooperation between both jurisdictions on rare diseases is anticipated. Further cooperation on organ transplantation is also currently being explored.
A new Radiotherapy Unit at Altnagelvin Hospital, Derry, is being developed by the Western Health and Social Care Trust (Northern Ireland). The Radiotherapy Unit, which is due to open in autumn 2016, will provide access to radiotherapy services to people in the northwest of the island, including patients from this jurisdiction. A Service Level Agreement between the Trust and the Health Service Executive has been agreed for the provision of services to patients from this jurisdiction. The HSE will pay the trust for the provision of these services. The Irish Government has committed capital funding of one third of the cost (up to €19m) of the project.
There is continued engagement between my Department and the Department of Health in Northern Ireland on progressing co-operation in the area of Congenital Heart Disease. Significant progress has been made in respect of establishing an all-island model of care for Congenital Heart Disease (CHD). The CHD Network Board, which was jointly established in 2015, has submitted a full business case for the implementation of this model of care, and that business case is currently under consideration in both Departments.
A significant milestone in the development of a cross border cardiology service was announced in April and has been operational since last month which sees Donegal patients having access to 24/7 primary Percutaneous Coronary Invention (pPCI Services) at Altnagelvin hospital in Derry. I am delighted that this service will be available to the wider population of the Northwest.
€30 million was allocated under the European Regional Development Fund INTERREG IVA programme to Cooperation and Working Together (CAWT Partnership) for cross-border health and social care initiatives. CAWT delivered the project on behalf of the two health departments North and South across 12 strands of activity with a strong focus on improving access to services, promoting health and well-being, reducing health inequalities and promoting social inclusion. The latest European Regional Development Fund programme INTERREG V 2014-2020 has four priority areas, one of which is health. For the health priority, the funding available for the duration of the Programme is €62m, i.e. €53m EU funding and €9.35m match funding from the two member states. Projects which will receive funding under this programme will aim, like previous INTERREG programmes, to benefit the health and wellbeing of border communities.
I am committed to continuing to work together with my Northern colleagues on issues of common concern and benefit.
60. Deputy Eamon Ryan asked the Minister for Health the measures taken to reduce the amount of unnecessary antibiotic prescriptions; and if he will consider the creation of a special task force to assess and mitigate the growing threat of antibiotic resistant infections. [13770/16]
View answerThe rise in antimicrobial resistance (AMR) is recognised at global, European and national levels, including Ireland, as one of the greatest potential threats to human and animal health with possible serious consequences for public health, animal welfare and the agriculture and food sectors.
The emergence of resistance is a normal biological phenomenon but is increased through the overuse and misuse of antimicrobials in human and animal medicine. The spread of these resistant strains is further increased, however, through poor hygiene practices and increased global travel and trade. There are also increasing concerns about the potential for spread of antimicrobial resistance in food and environmental pollution with antimicrobials e.g. through water contamination and agricultural run-off.
In recognition of the serious and increasing threat of antimicrobial resistance and the requirement for a ‘whole of Government’ approach to health issues, a high level National Interdepartmental AMR Consultative Committee was established in November 2014 to address this issue. The Committee is co-chaired by the Department of Health’s Chief Medical Officer (CMO) and the Department of Agriculture, Food and the Marine’s Chief Veterinary Officer (CVO).
The Committee also functions as Ireland’s Intersectoral co-ordinating mechanism for addressing AMR at European level.
The Committee was launched, with Ministerial approval, on European Antibiotic Awareness Day in November 2014 and has a clear role and mandate across the human and animal health sectors. Committee membership consists of representatives of both Departments and of the relevant HSE and veterinary specialist agencies, including other relevant bodies with a remit across the two sectors; membership is representative of major stakeholders. The Committee meets bi-annually and its most recent meeting took place on 13 April 2016.
Ireland is fully committed to and engaged in addressing resolution of the problem of AMR and will continue to collaborate at international, EU and national levels to this end. Through membership of the World Health Organisation, Ireland is part of the international effort aimed at tackling the global public health threat of AMR, which requires action across human and animal health sectors, agriculture and the wider environment.
In May 2015 at the WHO 68th World Health Assembly the final WHO Global Action Plan was endorsed; it sets out five strategic objectives:
1. to improve awareness and understanding of antimicrobial resistance;
2. to strengthen knowledge through surveillance and research;
3. to reduce the incidence of infection;
4. to optimize the use of antimicrobial agents; and
5. develop the economic case for sustainable investment that takes account of the needs of all countries, and increase investment in new medicines, diagnostic tools, vaccines and other interventions.
Through adoption of the Global Action Plan, governments committed to have in place, by May 2017, a national action plan on antimicrobial resistance that is aligned with the global action plan. This national plan will cover the use of antimicrobial medicines in animal health and agriculture, as well as for human health. The WHO is working with countries to support the development and implementation of their national plans, and will report progress to the Health Assembly in 2017.
The National Interdepartmental AMR Consultative Committee, at its meeting on 13 April last, agreed as a key action for 2016 the development of Ireland’s AMR national action plan.
I would also note that the prevention and control of healthcare associated infections (HCAIs) and AMR has in any case been a significant, long-standing patient safety and public health priority for the Department of Health for many years.
A wide range of initiatives have been put in place in the Irish health system over several years in response to the rising incidence of AMRs. These include:
- improved surveillance of infections and prescribing;
- infection prevention and control processes;
- antimicrobial stewardship initiatives; and
- public and professional awareness raising, with a significant emphasis on the education and training of healthcare professionals.
61. Deputy Catherine Murphy asked the Minister for Health how he will ensure the Health Service Executive recruitment embargo does not impact detrimentally on critical services; what oversight he has on the provision of services impacted by the embargo; and if he will make a statement on the matter. [13667/16]
View answerAn easing of restrictions on the employment of additional staff was announced in Budget 2015. Under this new approach public sector organisations can obtain delegated sanction to recruit within the parameters of their pay budget once they obtain approval for their Pay and Numbers Strategy from their parent Department and from the Department of Public Expenditure and Reform.
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.
Recent measures taken in relation to service areas in the HSE remaining within budget have been portrayed, incorrectly, as a recruitment freeze. The HSE is currently working with the Department of Health on the finalisation of its 2016 Pay and Numbers Strategy. This has involved the development of detailed workforce plans at hospital and community service level.
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 funded replacement posts or where additional funding has been allocated for new positions under the HSE service plan. Recruitment can also take place in areas of critical care and emergency services.
The HSE has continuously increased staffing levels since the beginning of 2015. By the end of April this year, overall health service employee numbers had increased by over 6,000 whole time equivalents since the start of last year, with an extra 1,600 WTEs in the first four months of 2016 alone. The vast majority of these employees are in front line positions. Numbers in the Medical and Dental category increased by almost 600 WTEs or 6.5% since the start of 2015 while nursing figures rose by over 1,700 or 5% during the same timeframe.
It is this government’s intention to continue to grow the health budget as the economy improves and to obtain further resources to deliver the level of service that we all want to provide to our patients.
62. Deputy Denise Mitchell asked the Minister for Health his plans to support the provision of a full complement of suicide crisis assessment nurses, as recommended under A Vision for Change. [13719/16]
View answerThe Suicide Crisis Assessment Nurse (SCAN) Initiative was first set up in 2008 in line with A Vision for Change's proposed shift towards community-based provision of multidisciplinary services. Under this initiative, GPs can refer directly to SCAN Nurses for assessment and advice on management of their patients who attend their surgeries with suicidal ideation. In each of these settings, a comprehensive biopsychosocial assessment is carried out together with an assessment of mental state and a risk assessment for suicide. On the basis of this, a care plan is drawn up and the next steps depend on the psychosocial stresses identified together with the presence or absence of a mental illness such as depression.
At present there are 15 SCAN nurses providing service nationwide. A number of new sites have expressed interest in developing SCAN and are being considered at present.
63. Deputy Dessie Ellis asked the Minister for Health the progress made to date in the establishment of a bed bureau for the greater Dublin area on the availability of residential care beds; the areas being covered in this bureau; his plans to roll this out in other areas; and if he will make a statement on the matter. [13694/16]
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.
64. Deputy Micheál Martin asked the Minister for Health his Department’s projection of the number of medical cards in 2016; the number of such cards projected to be issued on a discretionary basis this year; the number of medical cards in circulation as of 31 May 2016, or latest date available; the number issued on a discretionary basis; the number of over 70s with medical cards on that date, or latest date available; and if he will make a statement on the matter. [13775/16]
View answerThe HSE estimate that the projected number of persons covered by Medical Card eligibility on 31 December 2016, as outlined in the HSE Service Plan will be 1,675,767.
On 1 May 2016, the number of people with Medical Card eligibility was 1,731,406, which included 104,671 persons granted eligibility on the basis of the exercise of discretion.
It is not possible to forecast the number of persons that will be issued Medical Cards by end 2016, based on the exercise of discretion, as each application assessment is based on the individual circumstances applicable to the applicant and/or the applicant’s dependants.
On 1 May 2016, the number of persons aged 70 years and older with Medical Card eligibility was 333,825.
65. Deputy Mick Wallace asked the Minister for Health his plans to open a 24-hour acute mental health unit in County Wexford; if he is aware of issues arising, whereby currently persons must travel to Counties Waterford or Wicklow to access such services; and if he will make a statement on the matter. [13671/16]
View answerAs this is a service issue, this question has been referred to the HSE for direct reply. If you have not received a reply within 15 working days, please contact my Private Office and they will follow up the matter with them.
66. Deputy Tony McLoughlin asked the Minister for Health the status of the implementation of the Health Service Executive's neuro-rehabilitation policy published in 2011; if he is aware that organisations such as Spinal Injuries Ireland do not believe this policy has been implemented; when he will adhere to this policy; and if he will make a statement on the matter. [13673/16]
View answerThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
The National Policy & Strategy for the Provision of Neuro-rehabilitation Services in Ireland Report made a number of recommendations for services for people with rehabilitation needs which covered clinical, therapeutic, social, vocational and community supports. Following the development of the Neuro-rehabilitation Policy & Strategy, the Health Service Executive established the Rehabilitation Medicine Programme, to ensure the optimal care pathway for different clinical needs. The scope of the Rehabilitation Medicine Programme covers the whole of the patient journey from self-management and prevention through primary, secondary and tertiary care. These Programmes provide a national, strategic and coordinated approach to a wide range of clinical services. They include the standardization of access to and delivery of, high quality, safe and efficient hospital services nationally, as well as better linkages with primary care services. The Rehabilitation Medicine Programme has almost completed the Model of Care for the provision of specialist rehabilitation services in Ireland, which will be the basis for the delivery of services.
At the same time, the HSE Disability Services Division has a role in the provision of Neuro-rehabilitation services, primarily the provision of community based therapy services and personal social services. As part of the Transforming Lives programme, the programme to implement the recommendations of the Value for Money & Policy Review of Disability Services, the HSE is focusing on disability funded rehabilitation services to encourage reconfiguration of existing provision through the establishment of demonstration sites. Close links are being maintained with the Rehabilitation Medicine Programme to ensure that there is no duplication of effort and that all initiatives receive optimal support.
Alongside these developments, the Government announced a major development of the National Rehabilitation Hospital with a commitment of around €40 million. The new development will deliver a 120 bed ward capacity, including support therapies, paediatric and acquired brain injury wards, a hydrotherapy unit and a sports hall.
With regard to Neuro-rehabilitation services, the Programme for Partnership Government places a particular focus on publishing a plan for advancing Neuro-rehabilitation services in the community. Currently a steering group led by the Health Service Executive Social Care Division with representation from the National Clinical Programmes for Rehabilitation Medicine and Neurology, Department of Health, Primary Care, Therapy Professions and the Neurological Alliance of Ireland, has drafted an implementation framework for the National Policy & Strategy for Neuro-rehabilitation services, which has been circulated to members of the steering group and stakeholder agencies for consultation. Following feedback, the implementation framework will be revised and will guide and oversee the reconfiguration and development of Neuro-rehabilitation structures and services at national and local level.
67. Deputy Clare Daly asked the Minister for Health if due consideration was given to the impact on the health service and on nursing and midwifery services in particular of the Health Service Executive's effective recruitment freeze before it was implemented; and if he will make a statement on the matter. [13687/16]
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. The HSE has introduced interim recruitment measures to ensure that service providers operate within their pay budgets. 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 are 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.
68. Deputy Maurice Quinlivan asked the Minister for Health the progress being made to date on a review of international advocacy models and advocacy services, with a view to developing a national advocacy service for patients; and if he will make a statement on the matter. [13708/16]
View answerWork on a new independent national model for patient advocacy as recommended by the HIQA Report into Portlaoise Report has commenced. This advocacy service will be external to the Department and the HSE and will be in line with international best practice. The Department has begun the examination of the most appropriate patient advocacy model for Ireland having requested the Health Research Board Evidence Centre to undertake a brief research review of international best practice models. The HRB has now presented my Department with its findings relating to models of advocacy and my officials are currently reviewing this Report. A scoping exercise of the current national models will also be commissioned by my Department.
Following this exercise officials of my Department will then define and oversee the implementation of the national advocacy model for Ireland.
