Written Answers Nos. 81-92
81. Deputy Anne Rabbitte asked the Minister for Health the proportion of mothers who breastfeed their babies; the action the HSE is taking to increase the level of breastfeeding; and if he will make a statement on the matter. [20754/17]
View answerThe latest NPRS (HSE, 2016) reported a rate of 56.9% of babies breastfeeding, and 46.3% exclusively breastfeeding on discharge from maternity hospitals in 2014.
The breastfeeding figures at first PHN visit and at three months are reported quarterly in the HSE Performance reports. The figures for 2016 were 56.8% at first PHN visit and 38.8% at 3 months.
The Breastfeeding in a Healthy Ireland Health Service Breastfeeding Action Plan 2016 – 2021 (HSE, 2016) sets out the priority areas to be addressed over the next 5 years to support more mothers in Ireland to breastfeed and to contribute to increases in breastfeeding rates.
82. Deputy Dessie Ellis asked the Minister for Health the number of elective surgeries cancelled in each month to March 2017 inclusive; the number of persons whose elective surgery was cancelled or rescheduled more than once in the past year to March 2017; and if he will make a statement on the matter. [20219/17]
View answerCancellation of elective procedures can occur for a variety of exceptional reasons including cancellations because a bed or the clinical team are not available, cancellations by the patient or because the patient may not be fit for surgery at the time.
Maintaining scheduled care access for all patients and managing emergency demand at times is challenging, however all efforts are made to limit cancellations particularly for clinically urgent procedures.
Based on data provided by the NTPF, collated from reports by hospitals, approximately 3,400 elective procedures, on average, are cancelled per month. In 2016, typically in a month, there were approximately 53,000 admissions to acute hospitals on a daycase and an inpatient basis.
The National ED Escalation Framework sets out procedures to be followed in hospitals during periods of high demand for emergency care, to ensure that safe care is provided to all patients. In order to respond to surges in ED demand, under the Framework, hospital managers may, in consultation with the relevant clinical leads, review and cancel non-urgent planned electives, where appropriate. This allows both beds and staff to be redeployed to alleviate pressure in the ED.
It is essential that hospitals continue to improve how they manage, and balance, the demand for emergency care with the planning of elective procedures to minimise the impact on patients. In addition, it is important that the HSE continues to improve its processes to minimise the number sessions lost when patients cancel or do not attend for their procedures.
Over recent years activity in acute hospitals has increased, with the total number of discharges of inpatients and daycases rising around 34% between 2006 and 2015. Our hospitals are now carrying out four times more procedures in patients aged 65 years and over, and twice as many in the under 65 age group since 2000. Last year alone there was a 4% increase in inpatient and daycase activity over 2015, and in 2016 almost 1.69 million patients received inpatient or daycase treatment in our hospitals, an increase of almost 40,000 on the previous year.
In response to the particular query raised, I have asked the HSE to provide the specific details and I will forward these on to the deputy when they are received.
Question No. 83 withdrawn.
84. Deputy Clare Daly asked the Minister for Health his views on the failure of Portiuncula Hospital to inform the parents of a baby who died in the maternity unit there (details supplied) of either the existence of a review into the care given to the mother and baby in the hospital or the conclusions of that review. [20627/17]
View answerIn November 2014 a quality and risk management process highlighted a potential problem in maternity services in Portiuncula Hospital, on the basis of a higher than expected rate of newborn babies requiring head cooling. In early 2015 an Expert Review Team chaired by Professor Jimmy Walker, Professor of Obstetrics and Gynaecology, University of Leeds was established. After the review was made public further examination of cases and contact from further families, 18 cases (that is, 16 families) met the Terms of Reference for the review.
The family, to which you refer in your question, were unaware of the 2011 review that had taken place in to the death of their daughter. They should have been previously informed and given an opportunity to be involved in the review. My Department notes that both Portiuncula Hospital and the Saolta Hospital Group have apologised unreservedly and fully to the family for the failures of care delivered that contributed to the likely preventable deaths of their two daughters.
Safeguards are now in place in Portiuncula Hospital with regular and on-going audits in the maternity unit and Saolta Hospital Group have advised that there are no continuing patient safety concerns. I am advised that the Final Report of the Review Group is due to be published in the next few weeks.
My Department is continuing to progress an ambitious programme of patient safety reforms. The new National Patient Safety Office, located in my Department, was launched by me in December 2016. I have directed this office to work on a range of initiatives, including new legislation, the establishment of a national patient advocacy service, the measurement of patient experience, the introduction of a patient safety surveillance system and extending the clinical effectiveness agenda. Within the programme of legislation, it is intended to progress the licensing of our public and private hospitals.
As the Deputy will be aware provision to support Open Disclosure which is included in the Department of Justice and Equality's Civil Liabilities (Amendment) Bill 2017 was recently accepted at Report Stage by Seanad Eireann. The provision which is designed to give legal protection/privilege for the information and apology made to a patient is in line with the legislation. This is intended to create a positive voluntary climate for open disclosure and will support the National Policy on Open Disclosure which was developed jointly by the HSE and the State Claims Agency.
The main provisions of the Open Disclosure legislation are to:
- ensure patients are informed when adverse events happen as soon as is practicable;
- assist in supporting appropriate patient care;
- increase trust between patients and their clinicians;
- create a safe space for staff to conduct open disclosure;
- support staff in managing adverse events; and
- improve patient safety and quality of care through organisational learning.
Open Disclosure and a strong culture of reporting of adverse events provide opportunities to learn, improve, address errors that have happened and apply the lessons to make the service safer for all patients.
The Health Information and Patient Safety Bill will include a provision that public and private health care providers must notify serious patient incidents (Serious Reportable Events (SREs)) occurring in their services to their relevant regulatory body i.e. the State Claims Agency, HIQA, the Mental Health Commission or the Chief Inspector of Social Services as appropriate. The provisions intended for patient safety incident reporting and clinical audit in the Bill will provide a comprehensive patient-centred approach to preventing, managing and learning from incidents. HIQA and the Mental Health Commission are at an advanced stage of development of Standards on the Conduct of reviews of Patient Safety Incidents which expand on the National Standards for Safer Better Healthcare.
The Health Information and Patient Safety Bill is currently the subject of Pre-Legislative Scrutiny by the Oireachtas Committee on Health and I understand that they, following a public consultation exercise, may report in May.
My Department is committed to introducing a national licensing system in hospitals which will provide a mandatory system of licensing for public and private healthcare providers. The Patient Safety Licensing Bill is focused on governance and accountability and will ensure that providers do not operate below core standards. Licensing is part of a phased approach to better regulation in the health service.
The Government is committed to the progressive development of our maternity services. Key building blocks are now in place to facilitate the provision of a consistently safe and high quality service; these include:
- The National Maternity Strategy;
- HSE National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death;
- HIQA National Standards for Safer, Better 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, the newly established 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 drive implementation of the Strategy and oversee the establishment of maternity networks in each hospital group.
85. Deputy Billy Kelleher asked the Minister for Health his plans to address the ongoing difficulties in emergency departments in the south/south west hospital group. [20742/17]
View answerSince the start of 2017 there have been approximately 5% less patients waiting on trolleys nationally compared to the same period last year.
As the Deputy will be aware, in September the HSE launched its ‘Winter Initiative Plan 2016-2017’ which provided €40 million of additional funding for winter preparedness. This Initiative was developed to manage the expected winter surge in demand for hospital care in an integrated way across Primary, Acute and Social Care.
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 a low of 434 at the end of December and were maintained below 500 from mid-December through to end February. This had a positive impact on ED overcrowding and trolley numbers, in freeing up beds for use by patients awaiting admission to hospital.
Under the Winter Initiative, three hospitals from the South/South West Hospital Group, (Cork University Hospital, South Tipperary General Hospital and University Hospital Waterford) were identified as focus sites in terms of ED congestion and as such Improvement Plans have been put in place setting out specific mitigating actions to support patient flow and improve processes in these EDs. The Mercy University Hospital in Cork also benefited from 18 new step-down acute beds under the Winter Initiative this year which has increased capacity within the South/South West Hospital Group and within the Cork area.
I can assure the Deputy that there continues to be a very strong focus on reducing ED overcrowding. 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.
The HSE's Special Delivery Unit continues to work closely with hospitals in the South/South West Hospital Group to identify improvements that can be made to support patient flow, reduce trolley numbers and improve patients' ED experience.
87. Deputy Billy Kelleher asked the Minister for Health if his Department or the HSE will undertake a comprehensive review of the use of the drug valproate by pregnant women here. [20745/17]
View answerSodium valproate is among a number of medicines licensed in Ireland for the treatment of epilepsy. Valproate medicines have been authorised via national procedures in all EU Member States and in Norway and Iceland; valproate-containing medicines are also approved nationally in Ireland to treat bipolar disorder.
In March of this year, the Pharmacovigilance Risk Assesssment Committee of the European Medicine Agency (EMA) initiated a new review of the use of valproate-containing medicines in the treatment of women and girls who are pregnant or of childbearing age. A previous EMA review of valproate, in 2014, resulted in measures to strengthen the warnings and restrictions on the use of valproate medicines in women and girls, due to the risk of malformations and developmental problems in babies who are exposed to valproate in the womb.
The Health Products Regulatory Authority (HPRA) is the competent authority for the regulation of medicines in Ireland. The HPRA has highlighted the results of previous reviews of valproate to Irish healthcare professionals and provided revised educational materials for both healthcare professionals and patients. The HPRA has already informed healthcare professionals and relevant patient groups that the new EMA review is underway, and will disseminate the results of the review to Irish patients and healthcare professionals as soon as they become available.
In October 2016, the HSE's Medicines Management Programme (MMP) launched its Valproate Toolkit, an online resource consisting of a patient information booklet, summary guide for prescribers and a patient/prescriber checklist. This information highlights that sodium valproate should not be prescribed to girls or women of childbearing age or pregnant women unless other treatments are ineffective or not tolerated. The MMP is in contact with the HPRA regarding the EMA's current review of valproate, and any further recommendations will be considered.
Neither my Department nor the HSE has plans to conduct a separate review of the use of valproate by pregnant women in Ireland.
90. Deputy Aengus Ó Snodaigh asked the Minister for Health if his attention has been drawn to the fact that reductions in death and disability achieved under the national stroke programme may be compromised by the inability of stroke care teams, whose resources fall below minimum international standards in every hospital, to cope with the expected increase of 50% in the number of strokes in the next five to eight years; and if he will make a statement on the matter. [20216/17]
View answerAs the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive for direct reply to the Deputy.
91. Deputy Billy Kelleher asked the Minister for Health if Respreeza will be approved for persons with alpha-1 lung disorder. [20744/17]
View answerUnder the Health (Pricing and Supply of Medical Goods) Act 2013, the HSE has statutory responsibility for the administration of the community drug schemes; therefore, the matter has been referred to the HSE for attention and direct reply to the Deputy.
92. Deputy Darragh O'Brien asked the Minister for Health the status of the provision of new primary care centres in Dublin Fingal. [20796/17]
View answerAs this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply.
