Written Answers Nos. 1-23
14. Deputy Louise O'Reilly asked the Minister for Health the exact initial work that has taken place on the 2017 capacity review; the exact arrangements being put in place for the review to date; the timeline of the work of the review for 2017; the reporting as part of the bed capacity review which will be due for the Estimates process; if this will be published; and if he will make a statement on the matter. [20210/17]
View answerMy Department has commenced the Health Service Capacity Review over recent weeks. My officials have been progressing work on the Review process, including putting in place the Review structures, drawing up the Terms of Reference, assessing external expertise requirements, and considering options for stakeholder consultation.
The review is being led by my Department and will be overseen by a Steering Group. The Steering Group is in place and includes senior officials from my Department and the Departments of the Taoiseach and Public Expenditure and Reform, the HSE, and experts with a clinical and academic background. The Steering Group met for the first time in March, and is meeting again this month. Also, an independent peer group of international health experts has been established to review and validate the review methodology and findings.
The Terms of Reference for the review are as follows:
a) To determine and review current capacity, both public and private, in the health system and benchmark with international comparators;
b) To determine drivers of future demand and estimate impact on capacity requirements to 2030;
c) To consider and analyse how key reforms to the model of care will impact on future capacity requirements across the system; and
d) To provide an overall assessment, including prioritisation and sequencing, of future capacity requirements on a phased basis for the period 2017 – 2030 at a national and regional level, cognisant of resource availability.
My Department has recently gone out to tender for technical, analytical and engagement expertise to assist in the Review process.
It is essential that this review is progressed sufficiently to enable it to feed into the mid-term review of the capital programme, which will take place later in the year. While the review will consider capacity requirements over the next decade or so, I am also anxious that it also provides a short-term focus and determine how capital and other investment over the coming years can be best targeted, given the current pressures being experienced within our hospital services.
I look forward to the emerging findings later in the year.
15. Deputy Aindrias Moynihan asked the Minister for Health the reason more than 1,000 Cork children under 18 years of age were waiting more than a year for occupational therapy assessment in January 2017. [20780/17]
View answerPrimary Care Paediatric Occupational Therapists undertake a standardised and clinical assessment with the child, parent and or school, as appropriate. Referrals are accepted from G.P’s, Public Health Nurses, Senior Medical Officers, Teachers and Parents and urgent cases are prioritised.
I have been informed by the HSE that there continues to be an increase in referral rates to the Primary Care Occupational Therapy Services in the Cork and Kerry Community Healthcare Organisation area. The number of referrals for the months January to March 2017 has increased by 20% on the same period last year which is impacting on the numbers waiting more than a year for occupational therapy services.
To address the waiting list issue, a pilot initiative to deal with children aged 3 to 5 years, which will have the effect of reducing the waiting lists overall in an 8 month period, is currently under consideration. If approved, this pilot initiative will get under way later this year.
This initiative is in addition to the current work of the HSE National Therapy Service Review Group established to address therapy waiting times, including those for access to Occupational Therapies. This joint Primary Care and Social Care project will include a detailed analysis of waiting times and resource deployment across the country. It will seek to make the services more responsive to people's needs and also to put in place a standardised approach to the delivery of Occupational Therapy services across the country.
16. Deputy Ruth Coppinger asked the Minister for Health his views on the ownership of hospitals by religious organisations; if he will review this situation, in view of the extensive public funding over decades of these hospitals; and if he will make a statement on the matter. [20687/17]
View answer106. Deputy Michael Moynihan asked the Minister for Health his plans to review and separate the church ownership of health services across the State. [20408/17]
View answerI propose to take Questions Nos. 16 and 106 together.
As the Deputy is aware and will appreciate, voluntary and non-statutory providers, including religious bodies, have historically played an important role in the provision of health and personal social services in Ireland. Many of our largest and most developed health service providers are voluntary organisations, some with religious involvement.
Ireland is not unique in the participation of voluntary organisations, including those with religious involvement, in the delivery of publicly funded healthcare. However, it is proper that the frameworks within which service providers operate in delivering publicly funded health services are subject to ongoing consideration.
In recent years, the nature of the relationship between voluntary organisations and the State has been clarified in a number of ways. The HSE operates a robust Governance Framework which governs grant-funding provided to all Non-Statutory Service Providers and provides for detailed service level agreements. In the voluntary sector, it is required practice for public capital investment to be accompanied by a lien which protects the State's interest. All public hospitals are regulated by HIQA and are subject to national clinical standards and guidelines. Moreover, as part of the establishment of hospital groups, voluntary hospitals will be required to plan and deliver services in a manner which integrates service provision with HSE-owned hospitals in the region. These arrangements and controls are what are paramount in ensuring high quality care and patient safety, robust operational and clinical governance, and value for State investments.
I am open to giving further consideration to these relationships and the statutory and other controls which support the use of public funds to deliver health policy.
17. Deputy Eamon Scanlon asked the Minister for Health the reason behind the 40% increase in trolley numbers in Sligo University Hospital in March 2017 relative to March 2016. [20785/17]
View answerIn September the HSE launched its Winter Initiative Plan which provided €40 million of additional funding for winter preparedness. The Initiative concluded at the end of March.
A range of practical measures to address ED overcrowding were implemented, including 90 additional beds, aids and appliances for over 4,450 patients, around 1,000 extra homecare packages and 615 additional transitional care bed approvals.
During the Winter Initiative delayed discharges reduced from 638 in September 2016 to 434 in December and were maintained below 500 from mid-December through to end February. This had a positive impact on trolley numbers and freed-up beds for use by patients awaiting admission. Further, since the start of 2017 there have been approximately 5% less patients waiting on trolleys nationally compared to the same period last year.
However, since the start of 2017, there has been an increase of around 20% in trolley numbers at Sligo University Hospital. During March, Sligo ED experienced an increase of nearly 9% in attendances, on March 2016.
Following the Winter Initiative my Department and the HSE are currently engaged in a process to commence winter planning for next year and to achieve an improvement trajectory in ED performance. A key learning from this year's Initiative has been the need to put in place measures to support capacity and process improvement in Model 3 hospitals.
As such, the HSE's Special Delivery Unit will be working closely with Sligo University Hospital to identify improvements that can be made to support patient flow through the Hospital, reduce trolley numbers and improve patients' ED experience.
18. Deputy Margaret Murphy O'Mahony asked the Minister for Health the number of children awaiting a first assessment from the HSE under the Disability Act 2005; and the number of assessments that are overdue for each local health office area, in tabular form. [20750/17]
View answerThe Disability Act 2005 provides for an assessment of the needs of eligible applicants occasioned by their disability. The assessment of need must commence within three months of receipt of a completed application and must be completed within a further three months.
There were a total of 3,960 applications overdue for completion at the end of 2016.
The HSE recognises that it faces significant challenges in respect of meeting the statutory time-frames which apply to the assessment of need process. Targeted action plans have been in place since early 2011 and measures have included prioritising assessments, holding additional clinics, using therapist in private practices and reconfiguring resources to target areas of greatest need.
In accordance with the Social Care Operational Plan 2017, the HSE has committed to improving Disability Act compliance for assessment of need with a particular emphasis on putting in place improvement plans for CHOs that have substantial compliance challenges.
The above measures will have a positive impact on the provision of clinical services for all children requiring access to health related supports. It is expected that the reconfiguration of services under Progressing Disability Services for Children and Young People (0-18s) Programme will have a significant impact on our ability to comply with the statutory time-frames set out in the Disability Act and the accompanying regulations
The requested breakdown in tabular format will be forwarded to the Deputy.
19. Deputy Fiona O'Loughlin asked the Minister for Health if asthma sufferers that have to cease medication during pregnancy can rejoin their medication programme without being penalised in any manner; and if he will make a statement on the matter. [20800/17]
View answerI understand that the medication in question relates to Omalizumab (Xolair), a drug used to treat asthma. The provision of treatment to patients is based on clinical criteria and is a matter for the treating Consultant. Individual patients should consult their GP or treating consultant in relation to their participation in a medication programme.
20. Deputy Eamon Ryan asked the Minister for Health the assurances he can provide that the proposed agreement between the National Maternity Hospital and St. Vincent's Hospital will not restrict the provision of medical procedures in the new facility. [20741/17]
View answer25. Deputy Mick Barry asked the Minister for Health if he will report on his discussions with a group (details supplied) and the National Maternity Hospital regarding the ownership and governance of the National Maternity Hospital following its move to Elm Park, Dublin. [20688/17]
View answer30. Deputy Ruth Coppinger asked the Minister for Health his views on the governance arrangements for the National Maternity Hospital upon moving to Elm Park, Dublin; and if he will make a statement on the matter. [20686/17]
View answer55. Deputy Richard Boyd Barrett asked the Minister for Health if he will reconsider plans to have an organisation (details supplied) as owners of the new maternity hospital at St. Vincent's Hospital and instead ensure that it is fully owned by the State; and if he will make a statement on the matter. [20690/17]
View answer73. Deputy Catherine Connolly asked the Minister for Health the position regarding the situation in relation to the proposed maternity hospital in Elm Park and the independence of its clinical governance, in view of the involvement of an organisation (details supplied); the safeguards in place to ensure future State ownership of the hospital; and if he will make a statement on the matter. [20732/17]
View answer74. Deputy Eamon Ryan asked the Minister for Health if there are other ownership models in which the ownership of the National Maternity Hospital would not accrue to those owning the land at which the hospital is to be located. [20740/17]
View answer89. Deputy Mick Barry asked the Minister for Health the steps he will take to guarantee that women will be able to access all services at the National Maternity Hospital following its move to Elm Park, Dublin; and if he will make a statement on the matter. [20689/17]
View answer105. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he remains satisfied regarding the proposals for the new maternity hospital co located with St. Vincent's Hospital; if he remains assured regarding the independence of the maternity hospital and the ability of its master and staff to deliver the services as they see fit independently and without restriction; and if he will make a statement on the matter. [20710/17]
View answerI propose to take Questions Nos. 20, 25, 30, 55, 73, 74, 89 and 105 together.
Following extensive mediation discussions, agreement was reached late last year between the St. Vincent’s Healthcare Group and the National Maternity Hospital (NMH) on the relocation of the NMH to the Elm Park campus. The terms of the agreement, which has now been published, provides for the establishment of a new company - "The National Maternity Hospital at Elm Park DAC (limited by shares)”.
The new company will have clinical and operational, as well as financial and budgetary independence in the provision of maternity, gynaecology and neonatal services. This independence will be assured by the reserved powers which are set out in the agreement and will be copperfastened by the golden share which will be held by the Minister for Health of the day. These reserved powers can only be amended with the unanimous written approval of the Directors and with the approval of the Minister for Health. The Board of the new NMH will comprise nine directors; four nominated by St. Vincent’s Healthcare Group, four by NMH, including the Master, and one will be an international expert in obstetrics and gynaecology. Two of the NMH Directors will also sit on the St. Vincent’s Board.
The agreement ensures that a full range of health services will be available at the NMH at Elm Park without religious, ethnic or other distinction. In that regard, I welcome the confirmation by the Board of St. Vincent’s Healthcare Group that any medical procedure, which is in accordance with the laws of this State, will be carried out at the new hospital. I should also acknowledge that the St. Vincent’s Healthcare Group is making valuable land available, at no cost to the State, to facilitate the new NMH. In doing so, they have foregone the opportunity to put this land to alternative use.
Now that the planning application for the development has been submitted we must now turn our focus to the legal mechanisms necessary to complete the project. The hospital will be publicly funded, built on lands in the ownership of the St. Vincent’s and operated by the new company. Over the next few weeks I will meet with both hospitals and will consider further the legal mechanisms necessary to absolutely protect the State's considerable investment in the hospital, including the issue of ownership of the new facility. I have indicated that, prior to the HSE entering into any construction contract, I will formally sanction the necessary arrangements to ensure that the facilities are legally secured on an on-going basis for the delivery of publicly funded maternity, gynaecology and neonatal services commitments. I should add that over the years we have made very significant capital investment in voluntary hospitals, and such facilities have always continued to be used for the delivery of publicly funded healthcare as intended.
I intend to report to Government on this project at the end of May. At that stage I expect to have further details on the legal and other arrangements envisaged and will make this information available publicly. This will allow for the necessary clarity well in advance of contractual or other commitments being entered into in respect of this project.
Finally, I would like reaffirm my commitment to this hugely important project. The facilities at Holles St. are no longer fit for purpose. It is also acknowledged that for optimal clinical outcomes, maternity services should be co-located with adult acute services. We need to move on with this project and provide women and infants with modern healthcare facilities. I look forward to working with all stakeholders to deliver this new NMH.
21. Deputy Clare Daly asked the Minister for Health if he will provide the detail of the information held by his Department after November 2009 regarding the safety profile of the Pandemrix vaccine compared to other vaccines for swine flu; and if his Department was briefed by the Irish Medicines Board as to the heightened risk of serious adverse drug reactions associated with the drug. [20206/17]
View answerAs you are aware this matter is the subject of litigation in which plaintiffs allege personal injury in which they claim the development of narcolepsy (cataplexy) resulted from the administration of the H1N1 pandemic vaccine. An Order requiring the defendants to make Discovery was made in the High Court on 28 November 2016 in the most advanced case. Discovery is a legal process which must be carried out in accordance with Orders made by the Courts and both the Department of Health and the HSE are working to comply with the Order made in this case. However, the size and complexity of the Discovery means that this is not a trivial or quick process and, to date, the HSE has identified 300,000 records, and the Department over 465,000 records, all which must be examined and scheduled by Counsel. Consequently, I am currently not in a position to provide the detailed information requested in this question.
Nevertheless, it is important to remember the context in which vaccination against influenza type A (H1N1) was introduced. On 11 June 2009, following consideration by its Emergency Committee, the WHO raised the Influenza type A (H1N1) alert to Pandemic level 6 which officially declares a pandemic. My Department activated the National Plan for pandemic influenza and, based on the advices of the National Immunisation Advisory Committee, ‘at risk’ groups were prioritised for vaccination. Vaccination of children was prioritised as the rates of influenza were highest in those groups at that time. The public pandemic vaccination campaign ended on 31 March 2010.
The first reports of a link between pandemic influenza vaccination and narcolepsy came in the second half of 2010. In August 2010, the Swedish pharmacovigilance authority reported that it was investigating six cases of narcolepsy reported by health care professionals as a possible adverse event following the use of Pandemrix vaccine during the pandemic. This was followed later that month by reports from the Finnish National Institute for Health and Welfare noting there had been a more than expected number of cases of narcolepsy in children and adolescents that year. On 23 September 2010, the Committee on Human Medicinal Products of the European Medicines Agency concluded in its initial review of available data that the available evidence did not confirm a link but that more research was needed. By the end of March 2011 the Irish Medicines Board, now the Health Products Regulatory Authority, had received reports of two confirmed cases of narcolepsy following vaccination with pandemic vaccines. My Department and the HSE agreed that the Health Protection Surveillance Centre would work with the Irish Medicines Board and Irish clinical experts in narcolepsy to examine the Irish data and report back the findings. The Final Report of National Narcolepsy Study Steering Committee was published on 19 April 2012. It found a 13-fold higher risk of narcolepsy in vaccinated compared to unvaccinated individuals and the absolute increased risk associated with the vaccine was five narcolepsy cases per 100,000 vaccinated children and adolescents.
22. Deputy Brendan Griffin asked the Minister for Health the position regarding the provision of a dedicated obstetrics theatre at University Hospital Kerry; and if he will make a statement on the matter. [20448/17]
View answerI can assure the Deputy that the Government is committed to the progressive development of maternity services. In 2016, Ireland's first National Maternity Strategy was published along with the HSE's National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death and HIQA's National Standards for Safer Better Maternity Services. Since December 2015, each maternity unit has published a monthly Maternity Patient Safety Statement as recommended by the Chief Medical Officer. These developments represent key building blocks to facilitate the provision of a consistently safe and high quality service.
In addition, a National Women & Infants Health Programme has now been established within the HSE to lead the management, organisation and delivery of maternity, gynaecological and neonatal services. The Programme will ensure the consistent delivery of high quality care and oversee the development of Maternity Networks.
In relation to the Deputy's query regarding University Hospital Kerry, I understand that the provision of a dedicated Obstetric Theatre forms part of a capital submission that is due for consideration by the South South/West Hospital Group (SSWHG). If approved, this proposal would then be referred to the Acute Hospital Division for consideration in the national context.
My Department has been assured by the SSWHG that arrangements are in place to mitigate any risk to patients. In that regard it is understood that theatre scheduling ensures the availability of an Emergency Theatre every day. In addition, the Consultant teams have worked successfully to date to ensure emergency access is provided if required. While, occasionally, this can lead to delays for scheduled procedures, the hospital has advised that, to date, no such procedures have been cancelled to accommodate an obstetric emergency.
23. Deputy Dessie Ellis asked the Minister for Health if he will fund a properly resourced stroke register in addition to a rolling audit cycle incorporating acute, rehabilitation and community services every three years to ensure that service deficits are identified and addressed; if his attention has been drawn to the fact that the current stroke register receives no dedicated funding and operates in only two thirds of hospitals; and if he will make a statement on the matter. [20220/17]
View answerThe National Clinical Programme for Stroke has been in place since early 2010. The vision of the programme is to design standardised models of integrated care pathways for the delivery of clinical care to ensure sustained quality clinical operational management. Overall, the programme aims to improve quality, access and cost-effectiveness of stroke services in Ireland.
The programme can point to many improvements in Stroke care since its inception. The HSE has previously advised my Department that emergency thrombolysis is provided now to patients in all regions of the country by improved hospital and ambulance protocols, health professional training and the appointment of new physicians.
There is national 24/7 access to safe stroke thrombolysis, the rate of which has increased from 1% in 2006 to a current rate of 13%. This exceeds the national target of 9%.
Access to stroke unit care has been shown to improve stroke patient outcomes through reduced mortality rates, reduced dependency and shorter lengths of stay in hospital by patients. Since the commencement of the National Clinical Programme for Stroke, nine new stroke units have been opened, bringing the total number of stroke units in acute hospitals to twenty-two. This is a major improvement from the first national stroke care audit report in 2008 which reported one stroke unit in the country.
The programme has also developed a range of care pathways to assist the streamlining and standardisation of stroke care delivery.
The cost objectives of the programme have also been met with more stroke patients experiencing improved clinical outcomes. Examples include:
- Less stroke patients are dying in hospital: The rate has dropped from 16.2% in 2009 to 14.1% in 2014 – an overall percentage reduction of 12.9%;
- Less stroke patients are discharged to nursing homes – and therefore with improved disability outcomes: This has reduced from 17.7% in 2009 to 13.8% in 2014 – an overall percentage reduction of 22.1%;
- More stroke patients are discharged directly to home from acute hospitals: The rate has increased from 50.7% in 2009 to 51.6% in 2014;
- The median acute hospital length of stay for stroke has fallen from 10 days in 2009 to 9 days in 2014, with an estimated 19,000 bed days saved in the 2011-2014 period.
This is all good news for stroke patients.
The HSE has advised my Department that funding for developments are considered annually and submitted to the Department of Health as part of the service planning process. The HSE will be starting this process in the coming weeks for 2018. Requests for allocation of dedicated funding for the Stroke Register will be considered in the context of the Estimates Process for 2018.
