Written Answers Nos. 63-82
63. Deputy Brian Stanley asked the Minister for Health if his attention has been drawn to the improvements in maternity services in Portlaoise hospital since more staff were provided and that the unit is now being linked to networks within the Coombe university hospital; and his plans to use the same model to enhance and secure the future of the emergency department at Portlaoise hospital in view of same. [47981/17]
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.
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.
64. Deputy John McGuinness asked the Minister for Health the action being taken to address the long waiting times for orthodontic services in the south east. [48207/17]
View answerAs this is a service matter, it has been referred to the Health Service Executive for direct reply to the Deputy.
65. Deputy Pat The Cope Gallagher asked the Minister for Health his strategy for dealing with the ongoing capacity difficulties at Letterkenny University Hospital whereby full capacity protocols have been exercised throughout 2017; his winter strategy for the hospital and the expected increase in demand for services; the way in which his Department plans to deal with these issues; the additional resources he plans to provide; the extra bed capacity he plans to introduce in order to deal with this ongoing crisis at Letterkenny University Hospital; and if he will make a statement on the matter. [48094/17]
View answerI wish to acknowledge the distress for patients and their families, and the impact on staff, caused by cramped and overcrowded conditions in some of our hospital Emergency Departments (EDs). ED overcrowding, and long patient waiting times for emergency care, are of critical concern within the health service and tackling this issue remains a key priority for my Department. As such I am delighted that €40 million in additional funding in 2017 has been made available as part of the 2018 Budget to address winter pressures and waiting lists over the rest of this year.
In relation to these particular queries raised in relation to Letterkenny University Hospital, as they are service matters, I have asked the HSE to respond to you directly.
66. Deputy John Curran asked the Minister for Health his plans to significantly increase capacity at Tallaght Hospital to meet the increase in population and the increase in the age of the population in the catchment area of Tallaght Hospital over the next five years; and if he will make a statement on the matter. [47975/17]
View answerTallaght Hospital recently provided my Department with an overview of the major capital projects that are in progress and the major capital projects that are planned at the hospital.
Future capital investment in hospitals must be considered within the overall acute hospital sector infrastructure programme, the prioritised needs of the hospital groups and within the overall capital envelope available to the health service. The HSE will continue to apply the available funding for infrastructure development in the most effective way possible to meet current and future needs, having regard to the level of commitments and the costs to completion already in place.
In addition, work on the Health Service Capacity Review is progressing. The review will have a wider scope than previous exercises and will examine key elements of primary and community care infrastructure in addition to hospital facilities including Tallaght Hospital. As part of the review process, my Department has commissioned 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 are fed into the process.
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. The emerging findings from the review will inform the development of a new 10 year national capital plan later this year. The final report will be published before the end of the year.
67. Deputy Michael McGrath asked the Minister for Health when he expects the number of community CAMHS posts in CHO 4 to reach the level recommended under A Vision for Change. [48220/17]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
68. Deputy Niall Collins asked the Minister for Health the action being taken to address the long waiting times for orthodontic services in the mid-west. [48210/17]
View answerAs this is a service matter, it has been referred to the Health Service Executive for direct reply to the Deputy.
69. Deputy Mick Wallace asked the Minister for Health if he is satisfied with the overall level of support provided by the HSE to persons in County Wexford with intellectual disabilities and complex needs, including autism; if he is satisfied that the transition from child to adult services is functioning to the highest standard; and if he will make a statement on the matter. [48146/17]
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 issues in the Wexford area, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
70. Deputy Richard Boyd Barrett asked the Minister for Health the way in which he will fulfil the commitment in budget 2018 for 1,800 extra staff in the health service in view of the fact that the campaign to recruit 500 nurses commenced in 2015 has only delivered 88 new nurses and is reported to have cost €250,000; and if he will make a statement on the matter. [48130/17]
View answerThe need to increase the numbers of consultants, doctors, nurses and midwives in the public health service is a priority for this Government despite a backdrop of global shortages in health professionals. The Government has allocated an additional €646 million in current expenditure to Health in Budget 2018, including funds for an additional 1,800 front line staff. The overall Health budget for 2018 is almost €15.3 billion. The HSE is currently finalising the 2018 Service Plan and will allocate the additional posts in accordance with service demands.
The HSE has been focused on increasing the number of frontline staff over the past three years as the budgetary position has improved and progress has been made. At the end of September 2017 there were 2,951 whole time equivalent consultants in the public health services. This is 126 more than the end September 2016 figure and an increase of 666 in the past decade. The number of NCHDs has also increased significantly. At the end of September 2017 there were 6,286 whole time equivalent NCHDs, an increase of 311 compared with the end of September 2016 number and an increase of over 1,394 in the past decade.
Nursing and midwifery numbers at the end of September 2017 stood at 36,170 whole time equivalents. The number of nursing posts has increased by 632 in the 12 months from end September 2016 and by over 2,000 in the four years from end September 2013 to end September 2017. The Nursing Recruitment and Retention Agreement concluded with the INMO and SIPTU Nursing earlier this year committed to increasing the number of nurses and midwives by 1,224 additional permanent posts in 2017. The recent quarterly progress report on the Agreement from the HSE (30th Sept 2017) states that the HSE has filled 20% of the target posts. It is important to bear in mind however that most student nurses graduate in the autumn. The HSE is currently concluding the process of offering all graduating nurses and midwives permanent contracts. This is expected to deliver a significant increase in staff nurse numbers between now and year-end, given that most students who complete their training at the end of August are recruited in the 4th quarter, following registration.
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.
71. Deputy Mary Butler asked the Minister for Health if the FreeStyle Libre system will be made available under the long term illness scheme for persons with diabetes. [48191/17]
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.
72. Deputy Paul Murphy asked the Minister for Health if the waiting time for treatment by the school age team for a person (details supplied) will be adjusted to take into account their appeal; if he will reply to questions on this matter not addressed by the HSE in correspondence; and if he will make a statement on the matter. [47982/17]
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.
73. Deputy Michael Harty asked the Minister for Health the legislative proposals he plans to bring forward in collaboration with other Departments to protect vulnerable adults from abuse; and if he will make a statement on the matter. [44410/17]
View answerThe safety and protection of vulnerable people in the care of the State is paramount. As the Deputy is aware, at the recent meetings of the Joint Oireachtas Committee on Health, the issue of adult safeguarding was extensively discussed. The Department outlined its intention to the Committee, subject to Government approval, to explore the development of an appropriate adult safeguarding policy for the health sector underpinned with such legislation as may be required.
The scope and content of a health sector policy on safeguarding and any legislation required will be informed by a major review by the HSE of its safeguarding policy, comprehensive policy and legal research, consultation with other Government Departments, key stakeholders and the public, and extensive evidence based policy analysis. However, I am hopeful that preliminary proposals on a high level approach can be brought to Government shortly. The development of health policy and legislation in this area is a complex undertaking and will, of necessity, take time and it is important that such proposals are built on the foundations of a clear, carefully considered, coherent and implementable policy.
74. Deputy Charlie McConalogue asked the Minister for Health if approval will be forthcoming for a request for additional funding of €1.8 million for Letterkenny University Hospital in order to enable it to open an additional 20-bed ward and staff it appropriately to address an issue with persons having to wait on trolleys for hospital admission. [47979/17]
View answerIn relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to you directly.
75. Deputy Éamon Ó Cuív asked the Minister for Health his policy in relation to provision of health services through Irish in Gaeltacht areas; and if he will make a statement on the matter. [48193/17]
View answerAs this is a service matter, I have asked the HSE to reply to you directly.
76. Deputy Kate O'Connell asked the Minister for Health the number of persons under various schemes in receipt of contraceptives over the past ten years, in tabular form; the cost to the State; and if he will make a statement on the matter. [47983/17]
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.
77. Deputy Niamh Smyth asked the Minister for Health the increase in items (details supplied) to date in counties Cavan and Monaghan; and the way in which response times have improved in the counties. [48261/17]
View answerIn relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to you directly.
78. Deputy Seán Haughey asked the Minister for Health the action being taken to address the long waiting times for orthodontic services in north Dublin. [48201/17]
View answerAs this is a service matter, it has been referred to the Health Service Executive for direct reply to the Deputy.
79. Deputy Clare Daly asked the Minister for Health the status of the implementation of the perinatal mental health strategy; and if he will make a statement on the matter. [48155/17]
View answerThe Specialist Perinatal Mental Health Services - Model of Care for Ireland document has been approved by the National Mental Health Clinical Advisor Group Lead and the Senior Management Team in the HSE's Mental Health Division. It is currently at design and final proof stage, and it is hoped to launch the document at the end of November 2017.
This Model of Care specifically addresses the needs of women with moderate to severe mental health problems/illnesses through the provision of specialist hub teams, one based in each Hospital Group. The HSE's Mental Health Division, in recognition of the importance of the issue, included in its 2016 Service Plan the development of a model of care for the specialist component of perinatal mental health services. The Maternity Strategy also includes seven actions on mental health to be implemented by the HSE's National Women & Infants Health Programme which is charged with implementing the Strategy, these are addressed in the Model of Care. The National Clinical Lead for Specialist Perinatal Mental Health is working closely with the Women and Infants Health Programme Office to implement services in line with the agreed Model of Care.
The Clinical Lead and Programme Manager of the Working Group have provided an Implementation Plan and will continue to work closely with the National Women & Infants Health Programme on the additional resources required in each of the 6 hub sites to build the specialist perinatal specialist teams. In the meantime, the National Clinical Lead and the Programme Manager have completed 3 of 6 site visits to hub hospitals as recommended in the Model of Care. The remaining 3 hospital site visits (Maternity Hospitals in Dublin) are scheduled to take place in the week of 13 of November.
80. Deputy Billy Kelleher asked the Minister for Health his views on concerns being raised regarding access to orphan and high-tech drugs due to the process of reimbursement assessment; if Ireland is in line with EU norms; and if he will make a statement on the matter. [48186/17]
View answer99. Deputy Louise O'Reilly asked the Minister for Health his views on the need for a dedicated policy for the approval and reimbursement of orphan drugs for rare diseases, which is separate to the current policy, in view of the fact that the national rare disease plan for Ireland 2014-2018 recommended the bringing forward of appropriate decision criteria for the reimbursement of orphan rare medicines and technologies; and if he will make a statement on the matter. [48114/17]
View answerI propose to take Questions Nos. 80 and 99 together.
The Health Service Executive (HSE) has statutory responsibility for decisions on the pricing and reimbursement of medicines, under the Health (Pricing and Supply of Medical Goods) Act 2013. The 2013 Act specifies the criteria to be applied in making decisions on the reimbursement of medicines.
The issue of orphan medicines, with very small patient populations, and the price barriers for health systems in supplying them to patients, is world-wide. Orphan product manufacturers have exclusive patents and are monopoly suppliers. They can, and frequently do, seek very high prices for these products.
The HSE seeks, where possible, to give patients early access to new treatments. However, it must work within the budget provided by the Oireachtas. In the statutory reimbursement process, supported by the 2016 Framework Agreement with industry, the HSE makes decisions on objective scientific and economic grounds. Criteria which must be considered include the population’s health needs, the product’s cost and clinical effectiveness, opportunity costs, the budget impact and available resources.
HSE decisions are supported by health technology assessments (HTAs), which systematically assess whether a drug is a cost-effective health intervention. Currently, most new medicines, including orphan products, undergo HTAs. However, not all applications have sufficient information for assessment and in such cases this must be sought. Also, as HTAs frequently cannot demonstrate value for money for items at the price sought by the company, lengthy price negotiations between the HSE and the manufacturer may be needed. These factors contribute significantly to the length of the reimbursement decision making process.
With the potential costs involved and the competing demands across the health service, every effort must be made to secure the best outcome for the health service and the taxpayer. This includes seeking realistic and sustainable pricing and supply models for new treatments.
81. Deputy Catherine Connolly asked the Minister for Health the position regarding staffing and facilities at the maternity ultrasound department at Galway University Hospital; the complement of staff necessary to provide the services; the vacancies which exist and the recruitment process under way; if women are not receiving scans as a result of staffing issues; if so, the number of women affected; and if he will make a statement on the matter. [48092/17]
View answerThe National Maternity Strategy is very clear that all women must have equal access to standardised ultrasound services, including anomaly scans. The Strategy will be implemented on a phased basis over the coming years and this work will be led by the HSE National Women & Infants Health Programme. Last month, I was pleased to launch the Programme’s detailed Implementation Plan for the Strategy.
I am advised that anomaly scans are available in each hospital group. I am also advised that those maternity hospitals/units that currently provide anomaly scans accept referrals from other maternity units, if requested. This occurs where the medical team in the referring maternity unit consider that such a scan is clinically indicated. I am assured that the Programme will continue to work with the maternity networks to assist in increasing access to anomaly scans for those hospitals and units with limited availability.
In relation to University Hospital Galway, I understand that the maternity unit currently provides pregnant women with access to an anomaly scan. The HSE has advised that, while the hospital has experienced staffing changes in recent weeks, the anomaly scanning service remains in place. It has also advised that every effort is being made to recruit additional staff to support the anomaly scanning service into the future. I have asked the HSE to respond directly to the detailed queries concerning the staffing complement, vacancies and recruitment process.
In conclusion, and in demonstration of the Government's commitment to improve maternity care, I can confirm that additional funding will be provided for anomaly scanning in 2018, the detail of which will be set out in the National Service Plan 2018.
82. Deputy Jack Chambers asked the Minister for Health the number of primary care psychologists recruited to date in 2017; and if he will make a statement on the matter. [48229/17]
View answerI have asked the HSE to respond to the Deputy directly on this matter.
