Written Answers Nos. 39-51
39. Deputy Denise Mitchell asked the Minister for Health if data exist on the cost to the Exchequer of operating a private system of health care; if so, the details of same; and if he will make a statement on the matter. [37865/16]
View answerMy Department does not collect data specifically on the cost to the exchequer of operating a private system of healthcare. However, the System of Health Accounts provides data on current health expenditure in Ireland and other EU and OECD countries, both public and private. It is collected by the CSO in Ireland for the purpose of estimating health care expenditure according to the international standard of the System of Health Accounts 2011. It sets out health care expenditure broken down into 3 main sources – “Government and Compulsory”, “Voluntary Health Care Payment Schemes” and “Household Out-of-Pocket Payments". It also breaks the figures down into 10 different types of Health Care Provider. This information is published on the CSO’s website.
As the Deputy will be aware, there are a number of tax reliefs available for certain health-related expenditure. My officials are in contact with the Revenue Commissioners to obtain details on this which will be forwarded to the Deputy separately. However, it is important to note in order to avoid double counting, that all these sources of expenditure are included in the System of Health Accounts data.
40. Deputy Anne Rabbitte asked the Minister for Health the reason 3,635 persons were waiting more than a year for inpatient and day-case treatment in University Hospital Galway in October 2016; and the reason the numbers waiting more than a year have increased by 5,000% since April 2014. [38042/16]
View answerThis Government is committed to improving waiting times for patients. While recognising that demand for acute hospital services has increased this year with a 4% increase in inpatient and day case activity nationally to end October compared with the same period last year, the important issue for patients is how long they wait.
Under the HSE Service Plan 2016 targets, 95% of people should be waiting less than 15 months for their inpatient or daycase appointment. The latest NTPF inpatient/daycase waiting list figures indicate that the total number of people on the inpatient/daycase waiting list for Galway University Hospital is 11,822 and that 78% of people at the hospital are waiting less than 15 months for their inpatient or daycase appointment. 8,187 or 69% of people are waiting less than 12 months for their inpatient or day case appointment.
There are a number of ongoing and planned construction projects at Galway University Hospital that will increase capacity in the future.
In August, I asked the HSE to develop a Waiting List Action Plan for 2016 to reduce by year end the number of patients waiting over 18 months on the inpatient/daycase waiting list. Since then, approximately 6,500 patients have been removed from the waiting list nationally. Additional funding of €11.25m has been allocated under the Winter Initiative in order to support patient treatment under this Action Plan.
Budget 2017 provides for the treatment of our longest-waiting patients. €20m is being allocated to the NTPF in 2017, rising to €55m in 2018. Planning of these initiatives is currently being finalised. I will shortly be asking the HSE to develop a Waiting List Action Plan for 2017 working collaboratively with the NTPF to address inpatient, daycase and outpatient waiting times.
41. Deputy Eoin Ó Broin asked the Minister for Health the private hospitals and health providers that are under contract with the NTPF, National Treatment Purchase Fund, and his Department and the HSE with respect to the provision of services and surgeries that are not being met publicly or where there are extensive waiting lists; and if he will make a statement on the matter. [37857/16]
View answer65. Deputy Aengus Ó Snodaigh asked the Minister for Health the types of contracts that exist between his Department, the HSE, the NTPF and private hospitals for treatments commissioned by the private sector; if contracts are awarded en bloc, either in terms of funding allocated, speciality and so on or on a case-by-case basis; and if he will make a statement on the matter. [37861/16]
View answerI propose to take Questions Nos. 41 and 65 together.
The NTPF was established on a statutory basis in 2004 and previously arranged for the provision of hospital treatment to classes of persons determined by the Minister. Since 2011 this function has been suspended.
Budget 2017 provides for the treatment of our longest waiting patients. €20m is being allocated to the NTPF, rising to €55m in 2018.
On foot of this allocation the NTPF recently issued a Prior Information Notice stating that commissioning will recommence and they will be engaging with suppliers through competitive dialogue on the required optimum approach for future outsourcing of public patients. Controls to ensure quality patient treatment, value for money and efficient processes will be determined by this process. No formal contracts have been signed to date.
The NTPF launched the 2016 Endoscopy Initiative in June which includes outsourcing from a list of approved private providers. These are Clane General Hospital, Galway Clinic, Aut Even Hospital, Bon Secours Hospital, Beacon Hospital, Hermitage Medical Clinic, Whitfield Clinic, St Vincent's Private Clinic, Blackrock Clinic and St Francis Private Hospital.
In relation to contracts entered into by the HSE, as this is a service matter I have asked the HSE to respond to you directly.
42. Deputy Darragh O'Brien asked the Minister for Health the measures that will be put in place to assist the 6,989 persons waiting more than a year for an outpatient appointment in Beaumont Hospital; and if he will make a statement on the matter. [38056/16]
View answerThis Government is committed to improving waiting times for patients. While recognising that demand for acute hospital services has increased, the important issue for patients is how long they wait.
Under the HSE Service Plan 2016 targets, 85% of people should wait less than 52 weeks for their first outpatient appointment. The latest NTPF Outpatient Waiting List figures indicate that 75% of people in Beaumont Hospital are waiting less than 52 weeks for their first outpatient appointment.
In August, I asked the HSE to develop a Waiting List Action Plan for 2016 to reduce by year end the number of patients waiting over 18 months for an inpatient or daycase procedure. Since then, approximately 6,500 patients have been removed from the waiting list nationally.
Regarding outpatient waiting lists in particular, the HSE recently launched the Strategy for the design of Integrated Outpatient Services 2016-2020. It seeks to improve waiting times for outpatient services by enhancing patient referral pathways and utilising technology to enable better planning.
Budget 2017 provides for the treatment of our longest-waiting patients. €20m is being allocated to the NTPF in 2017, rising to €55m in 2018. Planning of these initiatives is currently being finalised. I will shortly be asking the HSE to develop a Waiting List Action Plan for 2017, working collaboratively with the NTPF, to address inpatient, daycase and also outpatient waiting times.
43. Deputy Denise Mitchell asked the Minister for Health if data are being collected on the type of treatment, the cost of treatment and the patient outcome for services commissioned from the private sector by the NTPF, National Treatment Purchase Fund; if so, the details of same; and if he will make a statement on the matter. [37866/16]
View answerThe NTPF was established on a statutory basis in 2004 and previously arranged for the provision of hospital treatment to classes of persons determined by the Minister. Since 2011 this function has been suspended.
I include with the official report a tabular statement setting out details of the annual budget of the NTPF and the number of patients treated per annum since its inception.
Budget 2017 provides for the treatment of our longest-waiting patients. €20m is being allocated to the NTPF, rising to €55m in 2018. Planning for these initiatives is currently being finalised with the NTPF. As part of this process, I have requested that the NTPF put in place a robust monitoring and evaluation process of the outputs and outcomes to ensure that the learning gleaned informs future initiatives.
Finally, the NTPF launched the 2016 Endoscopy Initiative in June and I receive monthly reports on the overall progress of this initiative, which is on track to achieve its target of no patients waiting more than 12 months for a routine scope by the end of the year. The NTPF will be submitting a final report to me by the end of January 2017 which will set out the overall performance of the initiative including: number of patients referred. number of patients who received a procedure, a total cost of procedures and a breakdown of where these procedures were provided.
44. Deputy Louise O'Reilly asked the Minister for Health the status of an initiative he is reported to be taking with a European bloc of countries to negotiate collectively to lower prices of drugs; the status of meetings that he and officials from his Department have had with their European counterparts on this; the way in which he will proceed on this; if targets have been set; and if he will make a statement on the matter. [37855/16]
View answerDecisions on pricing and reimbursement of pharmaceutical products within public health systems are a national competence for EU Member States. However, the issue of pricing and reimbursement of medicines and patient access to affordable medicines has been addressed at European level. In June of this year the EU Council adopted conclusions on strengthening the balance in the pharmaceutical systems in the EU and its Member States. Those conclusions invited Member States to explore opportunities for cooperation on pricing and reimbursement of medicines and to identify areas for cooperation which could contribute to higher affordability and better access to medicines. I have indicated my support for these measures and I welcome the opportunity for Member States to cooperate by sharing information so that we can achieve affordable and sustainable access to medicines.
I intend to travel to Lisbon on 7 December to attend the Round Table Meeting of European Ministers of Health and Pharmaceutical Companies and my officials continue to engage with their counterparts in other Member States.
45. Deputy Bernard J. Durkan asked the Minister for Health the extent to which hospitals have begun to cope with hospital bugs; and if he will make a statement on the matter. [37970/16]
View answerMultidrug-resistant infections and resistance to antibiotics are an ongoing and evolving international risk for all healthcare providers. I can assure the Deputy that the prevention and control of healthcare associated infections (HCAIs) and antimicrobial resistance (AMR) is a significant patient safety and public health priority for the Government.
I am aware of the challenges in relation to tackling multidrug-resistant superbug infection rates in Irish hospitals. I am advised that Irish hospitals, like other hospitals internationally, are taking steps to reduce HCAIs and AMR including the prudent use of antibiotics. A wide range of initiatives has been put in place in the Irish health system over several years to tackle HCAIs and AMR, including improved surveillance of infections and prescribing and infection prevention and control processes. Also included are antimicrobial stewardship initiatives and public and professional awareness-raising with a significant emphasis on the education and training of healthcare professionals. The HIQA National Standards for the Prevention and Control of Healthcare Associated Infections (2009) are being updated.
In addition, on foot of concerns about outbreaks of Multi-Drug resistant Organisms (MDROs) in recent years a National Taskforce on AMR to address the issues of managing and reducing AMR and HCAI was established by the HSE in 2015. The Taskforce's remit is to direct and coordinate an effective system-wide response to the issue of HCAI/AMR.
The Taskforce is a multi-disciplinary high-level group that supports and advises HSE Divisions on reducing incidences of MDRO through ensuring rational antimicrobial use across all healthcare settings, providing effective diagnostic support for infection, improving professional education, training and public engagement to promote wider understanding of the need for appropriate use of antibiotics, ensuring compliance with the National Standards for the Prevention and Control of HCAI across all healthcare settings and ensuring implementation of national guidelines across all healthcare settings.
Ireland is also developing a National Action Plan on Antimicrobial Resistance in line with the World Health Organisation’s 2015 Global Action Plan on AMR and the European Council’s 2016 Conclusions: ‘The next steps under a ‘One Health’ approach to combat antimicrobial resistance’. The National Action Plan is being developed with the oversight and guidance of the Interdepartmental AMR Consultative Committee. The Committee was established in 2014 by my Department’s Chief Medical Officer and the Chief Veterinary Officer of the Department of Agriculture, Food and the Marine in recognition of the need for a ‘whole of Government’ approach to tackling the issue of AMR. This intersectoral approach crosses the health, veterinary and environmental spheres to encompass all stakeholders’ efforts to address what is a world-wide concern. This work will continue in 2017 and it is intended that the National Action Plan will be published in 2017.
Nationally, I expect that the HSE will place particular emphasis on prevention and management of healthcare associated infections and antimicrobial resistance in its service planning for 2017.
Tackling AMR will require the whole system to prioritise key initiatives, working with our international colleagues. 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.
46. Deputy Louise O'Reilly asked the Minister for Health the action his Department will take to increase capacity in acute hospitals and their emergency departments in view of the fact that the full capacity protocol was deployed 2,300 times across a 321-day period in 2016; if the full capacity protocol is the last escalation step in the national system-wide escalation framework and is now being used with concerning frequency; the actions he will take to review the framework, capacity and departmental and HSE responses to excess demand in the acute hospital system; and if he will make a statement on the matter. [37856/16]
View answerIncreased demand for health services is evident across acute hospital services this year with a 5% increase in ED attendances and a 4% increase in inpatient and day-case activity to end October 2016, in comparison with the same period in 2015.
Trolley numbers have been high in November due to increased ED attendances, greater incidence of infection in several hospitals and a high rate of elective activity in hospitals to address waiting lists. It is unacceptable that patients wait on trolleys for long periods especially elderly and vulnerable patients.
The National ED Congestion Escalation Framework sets out procedures for hospitals to use during periods of high demand for emergency care, to ensure that safe care is provided to patients. The HSE intends to undertake a review of the Escalation Framework in the coming months to ensure its effectiveness.
Following the formation of Government an additional €40 million was provided to assist in the management of winter pressures. Utilising this additional funding the HSE developed the Winter Initiative Plan 2016 – 2017 which was published in September. Key aspects of this plan are being implemented at hospital and community services level across the country.
At present approximately 200 additional beds which opened in 2015 under the “Winter Beds Initiative” remain open. Work is under way to open further acute and step-down beds under the 2016 Winter Initiative.
47. Deputy Declan Breathnach asked the Minister for Health the action that will be taken to address the fact that 441 persons have been waiting over 18 months for an outpatient appointment at Our Lady of Lourdes Hospital, Drogheda; and if he will make a statement on the matter. [38054/16]
View answerThis Government is committed to improving waiting times for patients. While recognising that demand for acute hospital services has increased, the important issue for patients is how long they wait.
Under the HSE Service Plan 2016 targets, 85% of people should wait less than 52 weeks for their first outpatient appointment. The latest NTPF Outpatient Waiting List figures indicate that 86% of people in Our Lady of Lourdes Hospital, Drogheda are waiting less than 52 weeks for their first outpatient appointment. Only 3.6% of people are waiting over 18 months for access to Outpatient services.
In August, I asked the HSE to develop a Waiting List Action Plan for 2016 to reduce by year end the number of patients waiting over 18 months for an inpatient or day case procedure. Since then, approximately 6,500 patients have been removed from the waiting list nationally.
Regarding outpatient waiting lists in particular, the HSE recently launched the Strategy for the design of Integrated Outpatient Services 2016-2020. It seeks to improve waiting times for outpatient services by enhancing patient referral pathways and utilising technology to enable better planning.
Budget 2017 provides for the treatment of our longest-waiting patients. €20m is being allocated to the NTPF in 2017, rising to €55m in 2018. Planning of these initiatives is currently being finalised. I will shortly be asking the HSE to develop a Waiting List Action Plan for 2017, working collaboratively with the NTPF, to address inpatient, day case and also outpatient waiting times.
48. Deputy Richard Boyd Barrett asked the Minister for Health further to Question No. 453 of 5 July 2016, if home help will be provided as a matter of urgency; and if he will make a statement on the matter. [37963/16]
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) again for investigation and for direct reply to the Deputy.
49. Deputy Brian Stanley asked the Minister for Health his medium and long-term proposals to enhance services and secure the future of Abbeyleix and Shaen nursing hospitals in County Laois. [37778/16]
View answer70. Deputy Brian Stanley asked the Minister for Health the planned level of investment and timeframe for renovations and capital works at both Abbeyleix and Shaen nursing hospitals in County Laois. [37779/16]
View answerI propose to take Questions Nos. 49 and 70 together.
As these are service matters they have been referred to the Health Service Executive for direct reply.
50. Deputy Mary Butler asked the Minister for Health the number of intensive home care packages currently being provided to persons with dementia for each local health office in tabular form; and if he will make a statement on the matter. [38024/16]
View answerAs this is a service matter it has been referred to the Health Service Executive for direct reply.
51. Deputy Billy Kelleher asked the Minister for Health the status of the review of bed capacity in the acute hospital sector; and if he will make a statement on the matter. [38010/16]
View answer80. Deputy Louise O'Reilly asked the Minister for Health further to Question No. 558 of 15 November 2016, if the parameters and terms of reference for the bed capacity review have been set; the status of the bed capacity review; the person or body that will undertake this review; the timeframe for the review; when this will conclude; the definition of a bed in this regard; and if he will make a statement on the matter. [37854/16]
View answerI propose to take Questions Nos. 51 and 80 together.
The Programme for a Partnership Government commits to the undertaking of a national hospital bed capacity review "to establish the number, type and location of beds required into the future recognising the need for a range of beds including critical care, palliative and day case bed stock", with the intention that this would form part of the preparations for the Government's review of the Capital Plan 2016-2021.
This is an important piece of work which will enable the determination of future capacity requirements and will provide a basis for planning our health and social care services and assist in informing investment decisions over the coming period.
While the Programme for a Partnership Government explicitly commits to a review of hospital bed capacity, I believe that this presents us with an opportunity to consider capacity requirements across the health service more generally. I do appreciate that there are immediate strains within our acute hospital system. But I am also conscious that our growing and ageing population is going to drive demand for health and social care services more broadly. We know that the overall population increased by 6.8% over the period 2007 – 2016, while the numbers over the age of 65 increased by nearly 33%. This demographic pattern is going to continue in the coming years.
A comprehensive review which will assess current capacity and future capacity requirements across our primary, social and acute care services will allow us to properly examine and determine how the system as a whole can respond to these challenges. My Department has commenced work on an overall model of care which will inform the assessment of future capacity requirements across the different parts of the health sector. This model of care will be informed by international best practice and the work underway has included engagement with experts from the European Observatory on Health Systems and Policies in this regard.
My intention is that the capacity review will be undertaken by my Department, with suitable external expert inputs as required. Initial work on scoping the project is already underway. I envisage that the review itself will commence early in the New Year and will be advanced sufficiently to enable it to contribute to next year’s mid-term review of the current Capital Plan (2016 – 2021).
