Written Answers Nos. 563-576
563. Deputy Mary Butler asked the Minister for Health his plans to provide extra bed capacity in nursing homes going forward in view of the fact the State has an ageing population (details supplied); and if he will make a statement on the matter. [17946/17]
View answerResidential care in Ireland is provided through a mix of public, voluntary and private provision. It is worth highlighting that the net budget for long-term residential care in 2017 is €940m and the Nursing Homes Support Scheme will support 23,603 clients by the end of the year.
Public Nursing Units are an essential part of our national nursing home infrastructure. They provide 5,000 long stay residential care beds i.e. approximately 20% of the total stock of nursing home beds. They also provide about 2,000 short stay beds. Many public units are housed in buildings that are less than ideal in the modern context, but notwithstanding this, the standard of care delivered to residents is generally of a very high standard. It is important therefore that we consolidate our existing stock and this is the aim of the five-year Capital programme for Community Nursing Units which was announced last year. This provides the framework to allow for an enhanced programme to replace, upgrade and refurbish these care facilities which will consolidate our existing public stock and is expected to provide 250 additional beds.
With regard to private facilities, in Budget 2016 the Minister for Finance announced changes to the Employment and Investment Incentive Scheme to allow for investment in the expansion, management and operation of nursing homes. The inclusion of nursing home expansion works in the Scheme was influenced by an analysis submitted by the Department of Health on measures, including tax measures, to support targeted development in nursing homes and primary care centres.
I would like to reiterate that it is Government policy that long-term nursing home care should be a last resort and we want to develop home and community care services to provide a more viable alternative to nursing home care for a greater number of people. In that context, I am prioritising the development of a regulatory and funding model for home care services.
564. Deputy Clare Daly asked the Minister for Health if, in view of the fact that the maternity and infant care scheme last had a full review in 1994 when the reported costs of the general practitioner element of this combined care scheme was listed as nearly €17 million annually, when the scheme will be reviewed again in respect of its adherence to the current evidence base on antenatal care and value for money [17966/17]
View answerThe Maternity and Infant Care Scheme provides an agreed programme of care, free of charge, to an expectant mother arising out of her pregnancy and to her new born baby for six weeks after birth. All expectant mothers who are ordinarily resident in Ireland are eligible to avail of services under the scheme. Women who choose to avail of these services are under the care of both a general practitioner of their choice and a hospital obstetrician. Care can be obtained from any general practitioner who has a contract for the provision of services under the scheme.
The scheme provides for 12 ante-natal visits – six to the general practitioner and six to the chosen maternity unit/hospital in the case of a first pregnancy. In subsequent pregnancies, there are seven visits to the general practitioner and five to the maternity unit/hospital. There are also two post-natal visits to the general practitioner – at two weeks for the baby and at six weeks for mother and baby. There are currently no plans by my Department to carry out a review of the scheme.
565. Deputy Clare Daly asked the Minister for Health if a review will be conducted of the CPD obligations of general practitioners that are providing combined care under the maternity and infant care scheme in respect of the current evidence base on antenatal care [17967/17]
View answerThe Medical Council is designated as the regulatory body for all registered medical practitioners under the Medical Practitioners Act 2007. It has a statutory role in protecting the public by promoting the highest professional standards among medical practitioners practising in the Republic of Ireland.
The Medical Council has advised that all doctors are responsible for maintaining professional competence relevant to their scope of practice. Practitioners will be enrolled in Continuous Professional Development (CPD) activities as defined by the training body for that specialty and will be required to submit evidence of their participation in educational activities.
The Irish College of General Practitioners (ICGP) operates a professional competence scheme for General Practitioners (GPs) under arrangement with the Medical Council. Under this arrangement the ICGP is required to undertake an annual review of 3% of its enrolees to ascertain that they are completing and recording Continuous Professional Development (CPD) relevant to the professional competence requirements and provides advice accordingly to the Council.
Under the MPA 2007 any doctor who refuses to co-operate, fails to co-operate or ceases to co-operate with requirements under the Act to participate in Professional Competence Schemes will be the subject of a complaint to the Medical Council's Preliminary Proceedings Committee.
566. Deputy Clare Daly asked the Minister for Health the number of general practitioners that are receiving HSE payments for employing practice nurses to carry out antenatal care, including routine checks. [17968/17]
View answerUnder the GMS scheme, subsidies are payable to GPs towards the cost of employing support staff, including practice nurses.
Practice nurses carry out a wide range of patient care under the direction of the GP. Services provided may include, for example: vaccinations; women’s health services; antenatal and postnatal care; skin and wound care; health promotion and lifestyle advice; general nursing duties; practice administrative and policy work; specialist services in a particular disease area such as diabetes or cardiology.
The HSE can provide information on the number of GPs receiving subsidies towards the employment of practice nurses, therefore I have arranged for the question to be transferred to the HSE for direct reply to the Deputy. However, these subsidies are not specific to particular services being provided by practice nurses and the HSE would not hold information on the number of these GPs who employ a practice nurse for the purpose of carrying out antenatal care.
567. Deputy Clare Daly asked the Minister for Health if all practice nurses employed by general practitioners to carry out antenatal care, including routine checks, are registered midwives; and if he will make a statement on the matter. [17969/17]
View answerPractice nurses carry out a wide range of patient care under the direction of the GP, which can vary depending on the qualifications and skills of individual nurses. Services provided may include, for example: vaccinations; women’s health services; skin and wound care; health promotion and lifestyle advice; general nursing duties; practice administrative and policy work; specialist services in a particular disease area such as diabetes or cardiology.
Practice nurses who are also registered midwives are able within their scope of practice to undertake antenatal care, provided they are competent to do so, i.e. their knowledge and skills in midwifery practice are up to date.
The scope of practice of midwives, which is different to the scope of practice of nurses, as set out in The Scope of Nursing and Midwifery Practice Framework 2015 is underpinned by EU Directive 2005/36/EC (as amended). Article 42 of the Directive states that midwives shall ‘diagnose and monitor normal pregnancies; carrying out the examinations necessary to do this.’
While a routine antenatal check-up will include tasks which a nurse is trained to undertake (e.g. recording blood pressure) a nurse cannot take accountability for interpretation of the observations whereas a midwife is educated and trained to do so. Fragmented task-orientated care is not the best approach to care for pregnant women.
As practice nurses are employed directly by GPs, who are private contractors, details of the number of practice nurses who are registered midwives and who carry out antenatal care are not available to my Department or the HSE.
568. Deputy Clare Daly asked the Minister for Health the exact location of the proposed site for the first new midwifery led unit to be built as part of the national maternity strategy; and when it is due to be opened [17970/17]
View answer570. Deputy Clare Daly asked the Minister for Health when as part of efforts to bring down unnecessary interventions all women attending hospital antenatal clinics under the maternity and infant care scheme will attend wholly midwifery led antenatal clinics [17972/17]
View answerI propose to take Questions Nos. 568 and 570 together.
Ireland's first National Maternity Strategy - Creating A Better Future Together 2016 - 2026 - recognises pregnancy and birth as a normal physiological process. It aims to ensure appropriate care pathways are in place in order that mothers, babies and families get the right care, at the right time, by the right team and in the right place. Similarly, it recognises that, while all pregnant women need a certain level of support, some will require more specialised care. Accordingly, it proposes an integrated model of care that encompasses all the necessary safety nets in line with patient safety principles. The model consists of three care pathways - Supported, Assisted and Specialised. The Strategy also proposes the development of Alongside Birth Centres across each Maternity Network.
The Strategy will be implemented on a phased basis and this work will be led by the newly established National Women & Infants Health Programme. The Programme is drawing up a detailed action plan to inform this process, which will include plans to roll out the new care pathways and birth centres. This work will also include the identification of both capital and revenue funding requirements, which will in turn inform the annual Estimates process over the lifetime of the Strategy. The Strategy states that intrapartum guidelines will be developed through the National Clinical Effectiveness Committee (NCEC) process. To that end, Professor Michael Turner is the Chair of the guideline development group and work has commenced.
569. Deputy Clare Daly asked the Minister for Health when all 19 maternity units will have a whole time or whole time equivalent perinatal mental health midwife specialist in place in view of the fact that the national maternity strategy set out a commitment to improve perinatal mental health services [17971/17]
View answerIreland's first National Maternity Strategy - Creating A Better Future Together 2016 - 2026 - aims to ensure appropriate care pathways are in place in order that mothers, babies and families get the right care, at the right time, by the right team and in the right place. Similarly, it recognises that, while all pregnant women need a certain level of support, some will require more specialised care. Accordingly it proposes an integrated model of care that will be provided by a multidisciplinary team.
The National Women & Infants Health Programme will lead the management, organisation and delivery of maternity, gynaecology and neonatal services, strengthening such services by bringing together work that is currently undertaken across primary, community and acute care. The Programme will also lead the implementation of the Strategy, which will take place on a phased basis. To this end, the Programme will draw up a detailed action plan that will inform the full implementation of the Strategy on a phased basis; this work will include the identification of both capital and revenue funding requirements which will in turn inform the annual Estimates process over the lifetime of the Strategy.
I am advised that perinatal mental health is recognised as a priority by the HSE Mental Health Division. In 2016, work commenced on scoping the need for perinatal mental health services nationally, and, in 2017, this prioritisation has continued. Indeed, one of the priority aims of HSE National Service Plan 2017 is the design and development of perinatal mental health services capacity. I have asked the HSE to provide you with further information on that work.
571. Deputy Clare Daly asked the Minister for Health when the HSE will publish as part of its monthly maternity safety statements a metric on the monthly use of admission CTGs, in view of the fact that the current HSE monthly maternity safety statements for each of the 19 maternity units include figures on rates of induction of labour and on rates of caesareans. [17973/17]
View answerMaternity hospitals began publishing Maternity Patient Safety Statements in March 2016, with the first reports detailing data from December 2015. They have since been produced on a monthly basis, being published on the basis of a two month time lag. The Statement currently consists of 17 metrics, including, as the Deputy notes, figures for rates of induction and also for Caesarean sections. The introduction of Maternity Patient Statements was among the recommendations made by the Chief Medical Officer of my Department in his Report on Perinatal Deaths at Portlaoise Hospital, which was published in February 2014. The information contained in the Statements provides hospitals and Hospital Groups with a snapshot of key information which can serve to provide an immediate indication of whether there is any cause for concern in relation to the safety and quality of the maternity services being delivered.
The HSE has established a governance mechanism to provide oversight of the process, including the metrics in use. However, I understand that the HSE does not intend to alter the metrics at this time, primarily as it is desired to establish a consistent series of data in order to establish trends across the health service.
572. Deputy Clare Daly asked the Minister for Health the average cost of an emergency caesarean and of an elective caesarean as paid for under the maternity and infant care scheme. [17974/17]
View answerIn relation to your query regarding the average cost of an emergency caesarean section and of an elective caesarean section, I have asked the HSE to respond to you directly.
573. Deputy Clare Daly asked the Minister for Health if there are top-up payments still being paid to senior management staff in the country’s four largest maternity units; and if so, the breakdown of those top-up payments. [17975/17]
View answerI have asked the HSE to respond to the Deputy directly on this matter.
574. Deputy Clare Daly asked the Minister for Health the number of new contracts that have been issued to fill posts of CMM1, CMM2 and CMM3 since the removal of the existing embargo in May 2016. [17976/17]
View answerI have asked the HSE to respond to the Deputy directly on this matter.
575. Deputy Clare Daly asked the Minister for Health the number of agency midwives and agency midwifery care assistants being employed in each of the four largest maternity units since January 2017 to date. [17977/17]
View answerIn relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to you directly.
576. Deputy Clare Daly asked the Minister for Health if he will confirm the existence of and explain the purpose of so-called confidentiality, non-disclosure or gagging clauses in HSE contracts issued to midwifery students in their final internship year before qualifying and in the contracts issued to newly qualified midwives. [17978/17]
View answerI have asked the HSE to respond to the Deputy directly on this matter.
