Written Answers Nos. 1-41
34. Deputy Brian Stanley asked the Minister for Health the documents and the nature of the documents that he has received from HSE management over the past two years regarding the future of the emergency department in Portlaoise hospital. [47980/17]
View answerThe most important issue in relation to consideration of services at the Midlands Regional Hospital Portlaoise is that patient safety and outcomes must come first. Reports on Portlaoise hospital in recent years have pointed to the need for reconfiguration of some services to ensure that patients are treated in the most appropriate setting by specialist staff that can safely meet their needs. Since 2014, the focus has been on supporting the hospital to develop and enhance management capability, implementing changes required to address clinical service deficiencies, and incorporating the hospital into the governance structures within the Dublin Midlands Hospital Group. Significant work has been undertaken to strengthen and stabilise current arrangements for services at the hospital to ensure that services currently provided that are not sustainable are discontinued and those that are, are safety assured and adequately resourced.
The Dublin Midlands Hospital Group has been working for some time on a draft plan for a new model of clinical service delivery at Portlaoise Hospital. A draft plan was submitted to my Department in December 2016. This draft report was reviewed in detail and was the subject of detailed engagement between Department officials and the HSE. Significant additional work was undertaken by the HSE on foot of this engagement resulting in a revised draft plan that was submitted to my Department in September 2017.
The report is currently under detailed consideration in my Department. Once there is an agreed position on the draft plan, it is intended that there will be further engagement with all interested parties, to ensure that the needs of patients, staff, the local and wider community are addressed. Any future changes to services at Portlaoise, will have to take account of existing patient flows and demands in other hospitals, as well as the need to develop particular services at Portlaoise in the context of the overall service configuration in the Dublin Midlands Hospital Group.
35. Deputy Brendan Smith asked the Minister for Health the action being taken to address the long waiting times for orthodontic services in the north east. [48199/17]
View answerThe HSE provides orthodontic treatment to those who have the greatest level of need and have been assessed and referred for treatment before their 16th birthday. Patients with greatest clinical need are prioritised for treatment.
The Programme for a Partnership Government contains a commitment to providing timely access to orthodontic care. In order to address long waiting times, the HSE has procured orthodontic services in primary care from a number of private service providers and a budget of €1 million per annum is being dedicated to this initiative which commenced in 2016. Approximately 400 patients from the north east are being treated under this programme. The HSE is also working on a programme to up-skill dental hygienists and dental nurses to become orthodontic therapists and facilitate a greater throughput of patients. Four orthodontic therapists are now in place, including three in the north east.
Under EU Directive 201/24/EU, now commonly referred to as the Cross Border Directive, it is open to persons entitled to public patient healthcare in Ireland to choose to avail of that healthcare in another EU or EEA country or Switzerland. Assistance is provided by the Cross-Border Healthcare Directive Department of the HSE on the operation of scheme. In 2016, 92 patients were approved by the HSE for orthodontic treatment.
The national approach to future oral health service provision will be informed by the National Oral Health Policy which is currently being finalised.
36. Deputy Louise O'Reilly asked the Minister for Health the position regarding the possibility of a strike by workers in section 39 agencies; the steps that he has taken to address the underlying issues which may lead to a strike; his plans to unwind the FEMPI cuts imposed on section 39 agencies; and if he will make a statement on the matter. [48113/17]
View answer83. Deputy Billy Kelleher asked the Minister for Health the action he will take to alleviate the difficulties being experienced by section 39 organisations; and if he will make a statement on the matter. [48185/17]
View answerI propose to take Questions Nos. 36 and 83 together.
I am advised that notice of industrial action has not been served on any Section 39 employer. In any event, as the HSE is not the employer, the Executive would not have a direct role in any such industrial action. I understand that a number of Section 39 agencies have been before the Workplace Relations Commission and some have or are currently in the process of going to the Labour Court. The HSE is not party to any such proceedings.
Under Section 39 of the Health Act 2004, the HSE has in place Service Level Agreements with voluntary providers which set out the level of service to be provided for the grant to the individual organisation. Any individuals employed by these Section 39 organisations are not HSE employees, therefore neither the HSE nor my Department has a role in determining the salaries or other terms and conditions applying to these staff.
The staff of these Section 39 organisations are not public servants and therefore were not subject to the FEMPI legislation which imposed pay reductions. It follows then that the staff of the Section 39 bodies will not be eligible for any pay restoration associated with the unwinding of this legislation and provided for under the more recent Public Service Agreements. It is a matter for Section 39 organisations to negotiate salaries with their staff as part of their employment relationship and within the overall funding available for the delivery of agreed services.
As I understand it, pay cuts were imposed on Section 39 employees but it is not clear that these cuts were applied in a universally consistent manner across all the Section 39 agencies. It is also important to recognise that this group of organisations within the health sector is just one element of a larger complex issue which could have significant cost implications for the Exchequer across the public services as a whole.
In this regard, I have had discussions with my colleague Minister Donohoe and will continue to engage with him on this matter.
37. Deputy Marc MacSharry asked the Minister for Health the action being taken to address the long waiting times for orthodontic services in the north west. [48214/17]
View answerThe HSE provides orthodontic treatment to those who have the greatest level of need and have been assessed and referred for treatment before their 16th birthday. Patients with greatest clinical need are prioritised for treatment.
The HSE has addressed concerns about facilities and staff at the Orthodontic Department in Letterkenny University Hospital, including the filling of a dental nurse vacancy. The HSE is also working on a programme to up-skill dental hygienists and dental nurses to become orthodontic therapists and facilitate a greater throughput of patients. Four orthodontic therapists are now in place nationally, including one in Galway.
Under EU Directive 201/24/EU, now commonly referred to as the Cross Border Directive, it is open to persons entitled to public patient healthcare in Ireland to choose to avail of that healthcare in another EU or EEA country or Switzerland. Assistance is provided by the Cross-Border Healthcare Directive Department of the HSE on the operation of scheme. In 2016, 92 patients were approved by the HSE for orthodontic treatment.
The Programme for a Partnership Government contains a commitment to providing timely access to orthodontic care. In order to address long waiting times, the HSE has procured orthodontic services in primary care nationally from a number of private service providers and a budget of €1 million per annum is being dedicated to this initiative which commenced in 2016. The national approach to future oral health service provision will be informed by the National Oral Health Policy which is currently being finalised.
38. Deputy Stephen S. Donnelly asked the Minister for Health the position regarding Ireland’s bid to host the European Medicines Agency. [44897/17]
View answerThe European Medicines Agency, which is currently located in London, will have to move to another location within the EU when the UK leaves the Union.
On 31 July 2017, Ireland officially submitted its proposals for Dublin to be the new host city of the EMA to the European Council and Commission. The bid was developed by a cross-sectoral working group, led by my Department, with colleagues from the Department of the Taoiseach and Department of Foreign Affairs and Trade, as well as representatives from the Health Products Regulatory Authority, IDA Ireland and other Government Departments and agencies.
Since its submission, promotion of the Dublin bid has continued at political and diplomatic levels. Our bid has been promoted by our EU missions as well as at Ministerial level by myself and my colleagues. In addition, officials from my Department have held a series of bilateral engagements to promote our bid with different Member States over the last number of weeks to discuss and promote the respective bids.
There is strong competition from 18 other Member States to act as host, which reflects the prestige and opportunity provided by becoming the new home of the EMA.
The vote on the agency’s new location will be taken at the General Affairs Council (Art. 50) on 20 November. My colleague, the Minister for Foreign Affairs, will represent Ireland at this meeting.
40. Deputy Gino Kenny asked the Minister for Health if his attention has been drawn to the fact that returning nurses who have trained elsewhere must complete an adaption course to become fully registered to work here but that the number of hospitals offering the course has reduced leading to some nurses having to pay approximately €2,800 to do it privately; the way in which this impacts on their job choices to work in the private sector to try to recoup this expense; the implications for staffing of public hospitals; and if he will make a statement on the matter. [48175/17]
View answerThe Nursing and Midwifery Board of Ireland (NMBI) has advised that all applications for registration on a division or divisions of the register of nurses and midwives are individually assessed. If the applicant has obtained his or her nurse or midwife qualification in an EU/EEA country, they are entitled to have their qualifications assessed pursuant to the Recognition of Professional Qualifications Directive 2005/36/EC. If their qualifications fall under this Directive, they are entitled to have qualifications automatically recognised.
With regard to other applicants, if the theoretical or clinical components of their training programme show deficits not compensated for by professional experience, then the applicant will have to successfully complete an adaptation and assessment period of 6-12 weeks or an aptitude test. There is no aptitude test available for midwifery, psychiatry, children’s and intellectual disability nursing.
Where the NMBI determines that a period of adaptation is required, and the nurse has a conditional offer of employment in the Irish health service, they will then undertake adaptation and assessment at a hospital, in order to register and take up the post - 7 such programmes have been run with respect to nursing homes since July 2016 and a further 2 are scheduled for April & June 2018. The Dublin Academic Teaching Hospitals (DATHs) have been recruiting and providing clinical adaptation and assessment on an ongoing basis since 2015.
At present 21 public sector acute hospitals are listed on the NMBI website as approved to provide periods of adaptation and assessment to candidate nurses seeking registration on the general division of the nurses register held by the NMBI. These hospitals provide adaptation and assessment to candidate nurses - many of these hospitals and all DATHs have provided these programmes in 2017. The provision of such programmes is driven by service need and availability of appropriate candidates – it is not provided routinely as with other academic programmes.
The Royal College of Surgeons Ireland offer a 2 day assessment process for registration and all details are on their website which provides information on this aptitude test. The fee is €2,800. It is understood that payment of fees for candidates who have undertaken the test has been predominantly by their employer. The HSE pays this fee for candidates who have been given a provisional offer of employment. The aptitude test that is currently open will be held on 28 January 2018, a further five tests have been held in the interim. Since the two day assessment process commenced less than two years ago, the RCSI have had 1,700 applicants and have been able to respond in a positive and proactive way to the needs of the Irish health service and the applicants concerned.
To attend either the clinical adaptation and assessment programme or the aptitude test, candidates should ensure to allow sufficient time to obtain immigration authorisations.
41. Deputy Dara Calleary asked the Minister for Health when he expects the number of community CAMHS posts in CHO 2 to reach the level recommended under A Vision for Change. [48219/17]
View answerThe Government is committed to increasing the Mental Health budget annually, as shown by the substantial additional funding of some €200m provided for mental health from 2012 to 2018. The implementation of 'A Vision for Change' has been given specific priority in recent years with the additional ring-fenced funding, specifically aimed at modernising mental health services in line with the Programme for Government commitments. A key focus has been approval of some 1,550 additional posts to strengthen Community Mental Health Teams; enhancing specialist community mental health and forensic services, increasing access to counselling and psychotherapy; and developing suicide prevention initiatives. These posts are directly facilitating the policy of moving away from traditional institutional based care to a patient-centred, flexible and community based mental health service. Staff recruitment and retention has been a challenge for the HSE for various reasons, with approximately two thirds of these posts filled so far in certain CHO areas.
CHO 2 serves a population of 109,784 people aged 0-18 years. Adjusted for population changes, A Vision for Change recommendations would result in a total of 114 Whole Time Equivalents (WTEs) required across all CAMHS teams. Currently, there are 66 WTEs in post, and a further 3 approved and funded posts under recruitment, i.e. nearly 61% of the recommended level. CHO2 works closely with the HSE Mental Health Division to prioritise additional funding for continued investment in CAMHS. Continuing Programme for Government funding will support the implementation of Vision for Change recommendations.
The HSE National Service Plans of recent years also highlight the broad range of ongoing reforms in mental health services including CAMHS. The Department of Health is currently advancing a review of 'A Vision for Change' . Having commissioned an Expert Evidence Review (completed in February 2017), an Oversight Committee has been established to begin the process of updating our mental health policy.
