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Wednesday, 3 May 2017

Written Answers Nos. 24-32

Hospital Appointments Administration

Questions (24)

Brendan Griffin

Question:

24. Deputy Brendan Griffin asked the Minister for Health the measures he is taking to reduce the number of persons not presenting for outpatient appointments in the public health system; the annual cost of those who did not attend, DNA, nationally; the number of no shows per annum nationally; if he will consider a deposit system to ensure persons who no longer need an appointment will inform the service provider; the methodology used to ensure that deceased persons are removed from waiting lists; and if he will make a statement on the matter. [20449/17]

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Written answers

In order to ensure that outpatient services are used to best effect, it is important that the HSE progresses initiatives to reduce the number of people not presenting for outpatient appointments. Consequently, the HSE is investing in digital and technological systems to ensure that patients are appropriately reminded.

One of the solutions eHealth Ireland has proposed is to provide a standardised national patient reminder service using SMS or email. This solution has the potential to reduce the number of people who do not show up for appointments and reallocate those appointment slots to other patients. This standardised national text reminder service project has already been initiated.

In addition, under the new Outpatient Reform Programme, the hospital system will be moving to advanced booking systems which will allow patients two choices of appointment time. This process has been shown internationally to dramatically reduce patient failure to attend.

A waiting list validation service has also been proposed. The proposal is to validate waiting lists using SMS reminder messages which will quicken the validation process and increase efficiency. A pilot is to be initiated shortly for both inpatient and outpatient services.

These initiatives are being progressed in conjunction with the HSE's Outpatient Waiting List Action Plan 2017 which will be communicated shortly.

The cost of patients who "Did Not Attend" (DNA) is difficult to ascertain. In order to ensure that outpatient clinics, and the time of clinical staff, are used to best effect, hospitals usually schedule a greater number of patients so that the clinic is fully utilised in the event that some patients fail to attend. There is an administrative cost associated with DNAs, which is approximately €25 per patient visit. According to the latest HSE data, current ‘Did Not Attend’ rates are at approximately 13%. This translates into a cost of approximately €12 million.

With respect to a deposit system, I am not sure it would be effective having regard to the administrative overheads involved and the requirement for a legislative basis for charges.

With regard to deceased persons, during routine validation of waiting lists by hospitals, deceased patients are removed from waiting lists. The waiting list validation service mentioned above will also assist in relation to this issue in the future.

Question No. 25 answered with Question No. 20.

Medical Conditions

Questions (26)

Mary Butler

Question:

26. Deputy Mary Butler asked the Minister for Health his views on the findings of the recent TILDA wave report that the prevalence of untreated treatable conditions has not changed in four years. [20752/17]

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Written answers

TILDA, the Irish Longitudinal Study on Ageing, examines the social, economic, and health circumstances of a representative sample of around 8,000 community-dwelling adults aged 50 years and older, resident in the Republic of Ireland. It provides a valuable source of research on the current and future needs of an ageing population to inform policy responses to population ageing. Every two years TILDA researchers undertake very detailed interviews with the participants in their home and every four years TILDA undertakes a very comprehensive health assessment with the majority of the participants. During each wave of research, new areas of data are added bringing new issues to light and building up a more comprehensive picture of older people in Ireland.

The TILDA Wave 3 report which was published on 7 March and launched by my colleague Minister Corcoran Kennedy highlighted that the prevalence of untreated "treatable" conditions has not changed in four years. These conditions include hypertension, high cholesterol, osteoporosis, osteopenia and atrial fibrillation which are the key risk factors for stroke, heart failure, kidney failure and injurious falls. The report highlights that innovative policy interventions to raise awareness of these common and treatable disorders are critical.

It is disappointing that the prevalence of untreated treatable conditions has not reduced since Wave 1 of TILDA. It is therefore vital that this and other evidence emerging from TILDA is disseminated widely to inform policy and practice responses to ageing. With that in mind the latest TILDA findings have been disseminated throughout the Department of Health.

The Department of Health is strongly supportive of TILDA's work in building an evidence base for health policy and practice and has committed to funding the study for a further five years. To ensure optimal transfer of the knowledge generated by TILDA, the Health Research Board, which is managing the TILDA contract on behalf of the Department, will set up a Knowledge Translation Group to raise awareness of TILDA among policymakers across Government Departments and solicit suggestions for future evidence needs, as well as optimise the use of TILDA data and inform future waves.

The 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 care.

There have been significant developments in general practice service in recent years, with more services being made available to our citizens. Developments include a universal GP service for all persons over 70 years, the introduction of a Diabetes Cycle of Care for adult GMS patients with Type 2 Diabetes as well as an enhanced support framework for rural GPs and a revised list of special items of service to encourage the provision of more services in the primary care setting.

The next phase of discussions on a new GP contract is underway and I look forward to positive and constructive engagements with GP representatives in the months ahead.

Hospital Services

Questions (27, 236)

Martin Heydon

Question:

27. Deputy Martin Heydon asked the Minister for Health the position regarding the proposed new endoscopy unit at Naas hospital; and if he will make a statement on the matter. [20737/17]

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Joan Burton

Question:

236. Deputy Joan Burton asked the Minister for Health if he will provide the capital funding for the new endoscopy unit under the review of the capital plan following his meeting in April 2017 with management from Naas General Hospital, County Kildare and the Dublin Midlands Hospital Group in connection with funding for the new endoscopy unit at the hospital. [20976/17]

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Written answers

I propose to take Questions Nos. 27 and 236 together.

The project to be delivered at Naas General Hospital is more extensive than the endoscopy services department referred to. It also includes accommodation and ancillary services to support the new physical medicine, physical therapy, oncology services and day procedures departments, a duplex (rather than simplex) reverse osmosis filtration system and two lifts. All stages of capital projects, including the design and tendering processes, are subject to review to ensure that the projects deliver value for money. This includes, where possible, 'future proofing' to ensure that capital developments meet not just current standards but that provision is made for additional capacity and / or improved equipping and that these are addressed appropriately. This has resulted in a significant increase in the scope of the project and as a consequence its estimated cost.

I recently met with management of Naas Hospital to discuss their plans for increased endoscopy services facilitated by the development of a new Endoscopy Unit. Funding will be considered in the context of the future capital envelope for the health service and the overall priorities for future service development in the Dublin Midlands Hospital Group. It is proposed that there will be a mid-term review of the State’s capital envelope, which will assess progress, review emerging pressures and demands. It is expected that this mid-term review will be completed in 2017.

HSE Investigations

Questions (28)

Thomas P. Broughan

Question:

28. Deputy Thomas P. Broughan asked the Minister for Health further to parliamentary Question No. 91 of 8 March 2017, replied to by the HSE on 31 March 2017 (details supplied), the number of investigations into the care of vulnerable adults in either foster care, residential settings or other State care setting in each of the years from 2013 to 2016; the liaison his Department officials have with the HSE's national safeguarding office regarding the approximate 7,500 safeguarding concerns reported during 2016; and if he will make a statement on the matter. [20202/17]

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Written answers

I understand that the Health Service Executive (HSE) has already responded to the Deputy in respect of his enquires regarding the number of investigations into the care of vulnerable adults in either foster care, residential settings or other State care setting in each of the years 2013 to 2016. In its response of 31 March 2017 to the Deputy, the HSE advised that there were 5,278 safeguarding concerns reported in Q1-Q3 2016, which was anticipated to rise to over 7,500 concerns by the end of Q4 2016. The HSE has also advised that 2016 represents the first year it collected national data in respect of safeguarding concerns pertaining to older persons and persons with disabilities.

I will now set out the position in respect of the second element of the Deputy’s question, namely the liaison my Departmental officials have had to date with the HSE’s National Safeguarding Office regarding the approximate 7,500 safeguarding concerns reported during 2016.

The safety and protection of vulnerable people in the care of the State is paramount. This Government’s primary concern is that the needs of the residents are being prioritised and addressed. As the Deputy will be aware, a number of important steps have been taken in recent years to strengthen the protection afforded to vulnerable children and adults in the State’s day care and residential care settings. Some of these measures, such as the establishment in early 2014 of the Child and Family Agency, TUSLA, for example, are outside the remit of my Department.

Within the health sector specifically, the HSE published its national safeguarding policy and procedures, Safeguarding Vulnerable People at Risk of Abuse, in December 2014. This safeguarding policy was the first such HSE policy to encompass both elder abuse and concerns of abuse relating to people availing of disability services.

A number of important steps have been taken to progress implementation of this policy, including the establishment by the HSE of a National Safeguarding Office, and the establishment of Safeguarding and Protection Teams in each of the Executive’s CHO areas. In addition, a National Safeguarding Committee was formally established in December 2015. The Committee has multi-agency and inter-sectoral representation, including representation from the Department of Health. The Committee is independently chaired by Ms. Patricia T Rickard-Clarke. It has agreed Terms of Reference but its overarching remit is to support the development of a societal and organisational culture, which promotes the rights of persons who may be vulnerable and safeguards them from abuse. Its remit extends beyond abuse of elderly and disabled persons and recognises that any vulnerable adult can be subject to abuse. Vulnerability can be a transient or permanent state depending on many influences.

The Safeguarding Committee published its Strategic Plan for 2017 – 2021 on 20 December 2016. One of its strategic objectives is the initiation of conversations with Government and Oireachtas Committees on the development of legislation on adult safeguarding. The work to date of the National Safeguarding Committee has confirmed that the scope of the issues around the safeguarding of vulnerable adults goes far beyond the area of health and that a much broader, cross-sectoral approach is needed. I fully support the principle of providing a legislative basis for the safeguarding of vulnerable adults and I am committed to working with my Government colleagues across all the relevant Government Departments to this end.

My Departmental officials liaise with their HSE counterparts on a regular basis, both in respect of safeguarding policy and in respect of specific individual safeguarding concerns.

Question No. 29 answered with Question No. 9.
Question No. 30 answered with Question No. 20.

Speech and Language Therapy

Questions (31)

Bríd Smith

Question:

31. Deputy Bríd Smith asked the Minister for Health if he will examine delays in parents accessing speech and language therapy for their children in the Crumlin area of the HSE, specifically in the case of a person (details supplied); and his plans to ensure vulnerable children at a key developmental age are not left without key services such as these. [20803/17]

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Written answers

As this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply.

Maternity Services

Questions (32, 61)

Louise O'Reilly

Question:

32. Deputy Louise O'Reilly asked the Minister for Health the reason detailed 20 week scans for pregnant women are not provided routinely and offered to all patients; his plans to extend this facility from the current six maternity units where it is available to all 19 maternity units; the status of the development of the clinical guidelines for the provision of 20 week scans; when this will be completed; and if he will make a statement on the matter. [20212/17]

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Aengus Ó Snodaigh

Question:

61. Deputy Aengus Ó Snodaigh asked the Minister for Health if he will ring-fence funding specifically for the necessary investment requirement in terms of equipment and personnel for providing 20 week routine scans for pregnant women; and if he will make a statement on the matter. [20215/17]

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Written answers

I propose to take Questions Nos. 32 and 61 together.

I am advised that foetal anomaly scans are available in all Hospital Groups. Those hospitals/maternity units currently providing anomaly scans accept referrals from other maternity units, if requested. This occurs where the medical team in the referring maternity unit consider that an anomaly scan is clinically indicated.

The National Maternity Strategy is very clear that all women must have equal access to standardised ultrasound services and, consequently, the issue of anomaly scanning is a priority issue for the newly established HSE National Women and Infants Health Programme. An early priority for the Programme will be to develop clinical guidance regarding routine detailed scans at 20 weeks. In the meantime, the Programme will continue to work with the six Hospital Groups to assist in increasing access to anomaly scans for those units with limited availability.

One of the current challenges to increase access to anomaly scans is the recruitment of ultrasonographers. In this context it is expected that the establishment of maternity networks across hospital groups will assist in developing a sustainable model that ensures that all women within each hospital group can access anomaly scans. The Programme has advised that there is some resource available to support this initiative in 2017, and a submission will be made to the estimates process for 2018 for the additional funding.

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