Written Answers Nos 57-80
57. Deputy Niamh Smyth asked the Minister for Health the position regarding introducing the 20-week maternity scan to Cavan General Hospital; the work which has been carried out to date; the timeframe for its introduction; and if he will make a statement on the matter. [40765/17]
View answerI 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. The Strategy will be implemented on a phased basis and this work will be led by the HSE National Women and Infants Health Programme. Indeed, the issue of anomaly scanning is a priority issue for the Programme and, accordingly, it will 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.
In relation to your specific query regarding Cavan General Hospital, I have asked the HSE to reply to you directly.
58. Deputy Billy Kelleher asked the Minister for Health if reports that the HSE is facing a projected €300 million financial deficit this year are accurate; and the action that will be taken to address this. [40942/17]
View answerTo end June the HSE is reporting net expenditure of €6,959.1m, which is €132.9m (1.95%) over profile. This variance includes €33m for the central pay decision on the early payment of the Lansdowne Road Agreement (LRA) which is not yet funded by Government. Excluding this issue, the variance is €99.8m.
While made up of offsetting surpluses and deficits, a large proportion of the overall reported deficit arises in Acutes (€104m) and Disability (€15m) Services. The underlying deficit in Acutes division is substantially reflected in non-pay categories and comprises increased volume and complexity of activity, non-achievement of savings targets, and a shortfall in income, while the deficit in the Disability division is predominantly a result of regulatory compliance, emergency placements and the non-achievement of targeted savings.
In addition, payments in relation to the State Claims Agency, spending on which is always difficult to predict, account for €24m of the deficit at the end of June.
The non-achievement to date of targeted savings is under examination. There will always be a requirement for effective management of overall resources particularly since health care demands continue to rise due to our growing and ageing population, the increasing incidence of chronic conditions, and advances in medical technologies and treatments. The HSE has used its Performance and Accountability Framework to identify actions to be undertaken, at both the centre and local level, to reduce the overspend. These include the issuance of performance notices, an examination of the drivers the overspend, and the mandated production of savings plans and targets.
The high level of variance against profile to end June is of significant concern and my Department is engaging closely with the HSE to ensure that every effort is made to maximise cost containment and cost avoidance measures and identify a series of mitigating actions that do not impact on the ability of the HSE to deliver on the planned activity levels set out in the NSP 2017.
While it is anticipated that there may be some areas that will experience overruns in 2017, it is too early yet to be definitive in terms of the final outturn for the health services at year end.
59. Deputy Gino Kenny asked the Minister for Health the circumstances in which the drug Vimizim, a treatment for those that suffer from the rare disease Morquio, has been refused funding by the HSE; and if he will make a statement on the matter. [40922/17]
View answerThe HSE has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drug schemes, in accordance with the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013.
The HSE issued a Notice of Proposal not to support reimbursement of Elosulfase alfa (Vimizim) to the manufacturer BioMarin in June 2017.
The Health (Pricing and Supply of Medical Goods) Act 2013 allows suppliers at least 28 days in which to make representations on any proposed decision.
Those representations have been received and are being considered carefully by the HSE.
Until such time as the process has concluded and a formal decision has been communicated to BioMarin, the application for reimbursement remains under consideration.
60. Deputy Martin Heydon asked the Minister for Health the position regarding an application (details supplied) for an extension at Naas General Hospital in view of the need for these services in the Kildare and west Wicklow region and the support of the hospital group; and if he will make a statement on the matter. [40999/17]
View answerMy Department's mid-term review submission includes this project and many others. Funding for this project 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.
62. Deputy Thomas P. Broughan asked the Minister for Health the measures he is taking to address the waiting lists for eye procedures; and if he will make a statement on the matter. [40790/17]
View answerI acknowledge that ophthalmology waiting times are often unacceptably long and I am conscious of the burden that this places on patients and their families.
Reducing waiting times for the longest waiting patients is one of this Government's key priorities. Consequently, Budget 2017 allocated €20 million to the NTPF, rising to €55 million in 2018.
In order to reduce the numbers of long-waiting patients, I asked the HSE to develop Waiting List Action Plans for 2017 in the areas of Inpatient/Daycase, Scoliosis and Outpatient Services. The Inpatient/Daycase Action Plan is being delivered through a combination of normal hospital activity, as well as insourcing and outsourcing initiatives utilising NTPF funding. Under the Inpatient/Daycase Plan, since early February, over 23,800 patients have come off the Inpatient/Daycase Waiting List.
The NTPF has advised that to date 5,901 patients have been authorised for treatment in private hospitals under its Initiatives, 2,235 patients have accepted an offer of treatment in a private hospital and that 1,112 patients have received their procedure. The NTPF has also indicated that 2,841 patients have been authorised for treatment in public hospitals under the Plan’s insourcing initiatives, 910 offers of treatment have been accepted and 285 patients have been treated. Long-waiting Ophthalmology patients are a core group who are receiving treatment under these Initiatives.
Under the Oupatient Plan, since early February, more than 84,200 patients have come off the Outpatient Waiting List.
The Report of the HSE-led Primary Care Eye Services Review Group was published in June 2017. The Review Group determined that there is a need to move from community ophthalmic physicians managing all primary care referrals to a model centred on a multi-disciplinary Primary Eye Care Team and also for the Primary Care Eye Team to liaise closely with the local hospital ophthalmic service to ensure that all patients are managed within the most appropriate clinical service and location.
63. Deputy Eugene Murphy asked the Minister for Health when the FreeStyle Libre system will be made available under the LTI scheme for persons with diabetes; if availability will not be restricted only to persons with type 1 diabetes but will be made available to all persons on multi-daily insulin injections based on clinical need; and if he will make a statement on the matter. [40776/17]
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.
64. Deputy Bríd Smith asked the Minister for Health the way in which he plans to ensure that staffing levels in public hospitals are adequate in view of the fact that existing pay and conditions are failing to retain the necessary numbers; and if he will make a statement on the matter. [40919/17]
View answerThe recruitment and retention of hospital staff is a priority for the HSE, my Department, and for me. As set out in its Statement of Strategy 2016-2019, my Department has committed to developing a national strategic framework for health workforce planning, in collaboration with Government Departments and agencies. During 2016, my Department convened a Cross-sectoral Steering Group to develop a national strategic framework for health workforce planning. A consultation draft of the framework was completed in mid-2017 and was subject to a stakeholder consultation process over the summer. Submissions received as part of this consultation process have been considered by the Steering Group and the draft Framework has been updated accordingly. I expect to receive the final version of the Framework shortly, accompanied by a high-level implementation plan.
It is Government policy to move to a consultant delivered service. While there are difficulties in filling posts in certain specialties and locations, the number of consultants employed in the public health system continues to increase year on year. At the end of July 2017 there were 2,892 whole time equivalents, an increase of 105 compared with the end July 2016 number and an increase of over 700 in the past decade. The HSE has been focused on addressing issues associated with the creation and approval of consultant posts and successful recruitment. It is now giving effect to the report 'Towards Successful Consultant Recruitment, Appointment and Retention', completed in December 2016. The number of NCHDs has also increased significantly given service demands and the need to progress compliance with the provisions of the European Working Time Directive. Similar to consultants, recruitment to certain specialties, e.g. surgery and paediatrics, is challenging. At the end of July 2017 there were 5,962 whole time equivalent NCHDs, an increase of 178 compared with the end of July 2016 number and an increase of over 1,100 in the past decade.
Recruitment of nurses and midwives is a key priority this year. The HSE has been focused on increasing nursing numbers over the past two years as the budgetary position has improved. The number of nursing and midwifery staff stood at 36,278 in August 2017; this is an increase of 739 whole time equivalents in the past 12 months, notwithstanding intense global competition for our nurses and midwives. The HSE has developed a fully funded workforce plan for an additional 1,224 nursing/midwifery posts in 2017 as provided for in the agreement reached with the nursing unions last February on recruitment and retention. These posts are being filled through a broad range of initiatives including the conversion of agency employed staff into HSE direct employees, national recruitment campaigns and offering all graduating nurses and midwives full time contracts. Key measures to retain nursing and midwifery staff include the creation of new development specialist posts, a unified approach to recruitment across hospitals and offering nurses and midwives improved educational opportunities and career pathways.
The Report of the Public Service Pay Commission identified problems in recruitment and retention in specific and specialist groups that are internationally in demand particularly in the health sector Following the ratification of the Public Service Stability Agreement, the Commission will now carry out a more comprehensive examination of underlying difficulties in recruitment and retention in those sectors and employment streams where difficulties are clearly evident. The Commission is committed to reporting on medical and nursing grades in 2018. The outcome of its assessment will be subject to discussions between the relevant parties.
65. Deputy Mick Wallace asked the Minister for Health if his attention has been drawn to the recently published scorecard on the national carers' strategy, which classified respite care as regressive meaning that the situation has worsened since the national carers' strategy was launched, in view of the commitments outlined in the programme for partnership Government to the principle of equality of opportunity and improving the quality of life for persons with disabilities; if his attention has been further drawn to issues with the provision of respite care and residential care in County Wexford; and if he will make a statement on the matter. [40772/17]
View answerThe National Carers’ Strategy was published in 2012, and includes 42 action areas under four national goals. One of these goals is to empower carers to participate as fully as possible in economic and social life and an objective under this goal is to enable carers to have access to respite breaks. The Department of Health collates an annual report on the progress made by all Government Departments and their Agencies in implementing the Strategy, which is to be implemented on a cost neutral basis. The fourth progress report, for the period September 2015 to December 2016, was published earlier this year.
In relation to respite, the report notes that “Respite service needs are addressed on an individualised case by case basis and can include planned and emergency respite care options in the home, community and residential settings including services provided by non-statutory organisations. The respite service is not a demand led scheme and the HSE must deliver services within budget.” The HSE has established a respite review group to establish the levels of respite services provided and to consider future performance indicators for the services.
The National Carers Strategy Monitoring Group, established by Family Carers Ireland publishes an annual scorecard on the impact that implementation of the 42 actions in the Strategy is having on family carers’ lives. Its most recently published Scorecard and, in relation to respite, it continues to report the situation as regressive. The report points out that the 2016 HSE Annual Report confirms a reduction of over 4,000 respite overnights delivered.
In the context of disability services, there are a number of factors impacting on capacity. A significant number of respite beds have to be utilised where admission is unplanned leading to the number of available respite nights being down against planned activity. In addition, within the regulatory and policy context, the manner in which residential and respite services is provided has also changed, as Agencies comply with regulatory standards. Capacity has generally decreased with requirements for personal and appropriate space. In some situations beds are no longer available. For instance, they may be vacated by residents who go home at weekends or for holidays and can no longer be used for respite. Implementation of the national policy on congregated settings is also affecting available capacity.
In the HSE's Social Care Operational Plan for 2017, 6,320 people with a Disability are expected to avail of centre based respite services totalling 182,506 overnights. Based on existing levels of service and in addition to the centre-based respite service, it’s planned that between 2,000 and 2,500 persons will avail of respite services such as holiday respite or occasional respite with a host family. It is also planned that based on existing levels of service, a further 41,100 day only respite sessions will be accessed by people with a disability.
In addition, the HSE has been funded to provide 185 new emergency residential placements and new home support and in-home respite for 210 additional people who require emergency supports has been allocated. This marks a significant change in the way that respite services are delivered.
The HSE continues to work with agencies to explore various ways of responding to this need in line with the budget available. As the Deputy's question concerning services in Co Wexford are a service matter, I have asked the HSE to respond directly to him.
66. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he is monitoring the waiting lists throughout the health services with particular reference to specific procedures such as miscellaneous orthopaedic, cardiac, neurological or other procedures, thereby alleviating pain and suffering for persons; if the utilisation of the treatment purchase scheme can be used to clear backlogs in the first instance, thereby facilitating smoothness and efficiency throughout the service; and if he will make a statement on the matter. [40912/17]
View answerI acknowledge that waiting times are often unacceptably long and I am conscious of the burden that this places on patients and their families.
Reducing waiting times for the longest waiting patients is one of this Government's key priorities. Consequently, Budget 2017 allocated €20 million to the NTPF, rising to €55 million in 2018.
In order to reduce the numbers of long-waiting patients, I asked the HSE to develop Waiting List Action Plans for 2017 in the areas of Inpatient/Daycase, Scoliosis and Outpatient Services. The Inpatient/Daycase Action Plan is being delivered through a combination of normal hospital activity, as well as insourcing and outsourcing initiatives utilising NTPF funding. Under the Inpatient/Daycase Plan, since early February, over 23,800 patients have come off the Inpatient/Daycase Waiting List.
The NTPF has advised that to date 5,901 patients have been authorised for treatment in private hospitals under its Initiatives, 2,235 patients have accepted an offer of treatment in a private hospital and that 1,112 patients have received their procedure. The NTPF has also indicated that 2,841 patients have been authorised for treatment in public hospitals under the Plan’s insourcing initiatives, 910 offers of treatment have been accepted and 285 patients have been treated.
Under the Outpatient Plan, more that 84,200 patients have come off the Outpatient Waiting List.
67. Deputy Louise O'Reilly asked the Minister for Health the steps he is taking regarding allegations by ambulance drivers that precious time is being lost by ambulances travelling to accidents and other emergencies due to the fact they are not fitted with satellite navigation equipment, and advanced paramedics are instead having to use ordnance survey maps on their personal mobile phones due to the lack of an onboard navigation system. [40779/17]
View answerAs this is a service matter, I have asked the HSE to respond directly to you.
68. Deputy Billy Kelleher asked the Minister for Health when he expects to bring forward proposals on changing the nursing home support scheme. [40943/17]
View answerThe Nursing Homes Support Scheme (NHSS) is a system of financial support for those in need of long-term nursing home care. Participants contribute to the cost of their care according to their income and assets while the State pays the balance of the cost. The Scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings.
When the NHSS commenced in 2009, a commitment was made that it would be reviewed after three years. The Report of the Review was published in July 2015. Arising out of the Review, a number of key issues have been identified for more detailed consideration across Departments and Agencies.
An Interdepartmental/Agency Working Group has been established to progress the recommendations contained in the Review. This Group is chaired by the Department of Health and includes representatives from the Department of the Taoiseach, the Department of Public Expenditure and Reform, the HSE, the Revenue Commissioners, and when required, the National Treatment Purchase Fund (NTPF). These recommendations include examining the treatment of business and farm assets for the purposes of the financial assessment element of the Scheme. The programme for a Partnership Government has also committed to reviewing the NHSS to remove any discrimination against small businesses and family farms. It is important to remember that the NHSS is largely underpinned by primary legislation and changes to the NHSS will require legislative implementation.
On this basis, I have requested legal advice from the office of the Attorney General regarding potential changes to the legislation that will address this matter. I have met with representatives from the I.F.A to discuss this matter and have apprised them of the current progress. I am committed to this review of the position with regard to family farms and small businesses for the purposes of the financial assessment of the scheme.
69. Deputy Michael McGrath asked the Minister for Health the position regarding the future of the health centre in Passage West, County Cork; and if services will continue to be provided in the local community. [40769/17]
View answerAs the HSE has responsibility for the provision, along with the maintenance and operation of Primary Care Centres and other Primary Care facilities, the Executive has been asked to reply directly to the Deputy.
70. Deputy Martin Heydon asked the Minister for Health the position regarding the work of the interdepartmental agency working group established to oversee the implementation of certain recommendations contained in the review of the fair deal scheme from July 2015, with specific reference to the recommendations relating to the financial assessment of family farms and small businesses; the expected timeframe for the completion of the work; and if he will make a statement on the matter. [40937/17]
View answerThe Nursing Homes Support Scheme (NHSS) is a system of financial support for those in need of long-term nursing home care. Participants contribute to the cost of their care according to their income and assets while the State pays the balance of the cost. The Scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings.
When the NHSS commenced in 2009, a commitment was made that it would be reviewed after three years. The Report of the Review was published in July 2015. Arising out of the Review, a number of key issues have been identified for more detailed consideration across Departments and Agencies.
An Interdepartmental/Agency Working Group has been established to progress the recommendations contained in the Review. This Group is chaired by the Department of Health and includes representatives from the Department of the Taoiseach, the Department of Public Expenditure and Reform, the HSE, the Revenue Commissioners, and when required, the National Treatment Purchase Fund (NTPF). These recommendations include examining the treatment of business and farm assets for the purposes of the financial assessment element of the Scheme. The programme for a Partnership Government has also committed to reviewing the NHSS to remove any discrimination against small businesses and family farms. It is important to remember that the NHSS is largely underpinned by primary legislation and changes to the NHSS will require legislative implementation.
On this basis, I have requested legal advice from the office of the Attorney General regarding potential changes to the legislation that will address this matter. I have met with representatives from the I.F.A. yesterday evening to discuss various strategies that may assist with addressing their members concerns and have apprised them of the current progress. We agreed to meet again in the near future for further discussions. I am committed to this review of the position with regard to family farms and small businesses for the purposes of the financial assessment of the scheme.
71. Deputy Billy Kelleher asked the Minister for Health the position regarding the bed capacity review. [40939/17]
View answer72. Deputy Thomas P. Broughan asked the Minister for Health if he will report on the Health Service Capacity Review 2017; if the review is on course to be completed by the end of 2017; if the capacity review steering group has provided an interim report; and if he will make a statement on the matter. [40789/17]
View answerI propose to take Questions Nos. 71 and 72 together.
Work on the Health Service Capacity Review is ongoing. The review is examining key elements of primary and community care capacity in addition to hospital capacity. As part of the review process, the Department has commissioned independent external consultants to provide technical, analytical and engagement expertise. A Steering Group is overseeing the project and an independent international peer review group is involved in ongoing review and validation of the methodology and approach. My Department has also undertaken a public consultation process to ensure that stakeholder views feed into the process and work is now underway in relation to analysing the submissions received.
The findings from the review will provide a basis for determining both the extent of capacity requirements over the next 15 years and the type of capacity that is needed at a national and regional level. It is expected that the review will be advanced sufficiently to inform the mid-term review of the capital programme and the development of a new 10 year capital plan later this year. A final report will be published before the end of the year. An interim report is not expected.
73. Deputy Maureen O'Sullivan asked the Minister for Health the number of persons being prescribed methadone in 2017; the number that have been prescribed methadone for more than ten years; and if, since the introduction of methadone in 1971, longitudinal research has been carried out to examine its effectiveness [41001/17]
View answerMethadone maintenance treatment is a critical stabilising treatment that enables people involved to counter their problem drug use and to rebuild their lives. In conjunction with other services and supports such as counselling, after-care and training, methadone maintenance treatment provides a pathway to recovery for the individual affected by problem substance use.
In their 2014 annual report, the European Monitoring Centre for Drugs and Drug Addiction note that in Europe an estimated 734,000 opioid users received substitution treatment in 2012 with methadone being the most commonly prescribed substitution medication, received by up to two-thirds of substitution clients, while buprenorphine is prescribed to most of the remaining clients (about 20 %). Methadone is the principal substitution medication in six countries within the EU, including in Ireland.
As this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
74. Deputy Aindrias Moynihan asked the Minister for Health the steps he will take to reduce waiting times for persons waiting for ophthalmology services in Cork; and if he will make a statement on the matter. [40898/17]
View answerIn relation to the specific case raised, I have asked the HSE to respond to you directly.
75. Deputy Louise O'Reilly asked the Minister for Health if primary care centres (details supplied) will receive additional new staff; if there will be no new hires, if staff will instead be moved from areas in the locality to the centre; the locations they will be moved from, in tabular form; and if he will make a statement on the matter. [40781/17]
View answerAs the HSE has responsibility for the provision, along with the maintenance and operation of Primary Care Centres and other Primary Care facilities, the Executive has been asked to reply directly to the Deputy.
76. Deputy Catherine Connolly asked the Minister for Health the status of the plans in respect of a new building, in view of the decision of HSE west to ring-fence the insurance payment for the construction of a new building following the burning down of the addiction counselling service building at Merlin Park hospital, Galway; and if he will make a statement on the matter. [40767/17]
View answerAs this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
77. Deputy Bobby Aylward asked the Minister for Health if additional resources will be allocated to the existing cardiac catheterisation laboratory at University Hospital Waterford to increase the laboratory's current capacity (details supplied); and if he will make a statement on the matter. [40787/17]
View answerFurther investment to enhance cardiology services at Waterford and to provide an additional 8 hours cath lab activity per week to address waiting times was recommended by the Herity Report. This was identified as a priority in the HSE National Service Plan for 2017 and €500,000 was allocated.
In June, the HSE issued a tender for a mobile cath lab, which arrived on site on 25 September and is scheduled to provide services to patients from Monday 2 October 2017, for a period of 20 weeks. This is expected to assist on an interim basis to addressing elective cardiology waiting lists in UHW.
78. Deputy Joan Collins asked the Minister for Health if he will address a matter (details supplied) regarding the service provision at Chamber House, Tallaght; and if he will make a statement on the matter. [40915/17]
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) for direct reply to the Deputy.
79. Deputy Aindrias Moynihan asked the Minister for Health the steps he will take to reduce waiting times for persons waiting for gynaecological services in Cork University Maternity Hospital; and if he will make a statement on the matter. [40897/17]
View answerI acknowledge that waiting times are often unacceptably long, including for gynaecology services at Cork University Maternity Hospital, and I am conscious of the burden that this places on patients and their families. Reducing waiting times for the longest waiting patients is one of this Government's key priorities. Consequently, Budget 2017 allocated €20 million to the NTPF, rising to €55 million in 2018.
In order to reduce the numbers of long-waiting patients, I asked the HSE to develop Waiting List Action Plans for 2017 in the areas of Inpatient/Daycase, Scoliosis and Outpatient Services. The Inpatient/Daycase Action Plan is being delivered through a combination of normal hospital activity, as well as insourcing and outsourcing initiatives utilising NTPF funding. Under the Inpatient/Daycase Plan, since early February, over 23,800 patients have come off the Inpatient/Daycase Waiting List, including at Cork University Maternity Hospital.
The NTPF has advised that to date 5,901 patients have been authorised for treatment in private hospitals under its Initiatives, 2,235 patients have accepted an offer of treatment in a private hospital and that 1,112 patients have received their procedure. The NTPF has also indicated that 2,841 patients have been authorised for treatment in public hospitals under the Plan’s insourcing initiatives, 910 offers of treatment have been accepted and 285 patients have been treated. Under the Outpatient Plan, since early February, more than 84,200 patients have come off the Outpatient Waiting List.
In relation to Cork University Maternity Hospital specifically, the South/South West Hospital Group (SSWHG) has developed a phased approach to improve waiting times for gynaecology services there. This includes the establishment of the SSWHG Women and Children Services Directorate earlier this year, which, I expect, will ensure better coordination and utilisation of maternity gynaecological resources across the group.
