Stephen Donnelly
Question:434. Deputy Stephen S. Donnelly asked the Minister for Health when the 2019 HSE service plan will be published; and if he will make a statement on the matter. [43647/18]
View answerHSE National Service Plan
Questions (434)
Written answers
As provided for under legislation (Health Act 2004 as amended), my Department must write to the Health Service Executive to notify it of its allocation for 2019 not later than 21 days after the publication by the Government of the Estimates for Public Services. The legislation further provides that, on receipt of the letter of determination, the Executive has 21 days to prepare and submit its Service Plan for 2019 for my approval. The Health Act allows me to extend the period provided to the HSE to prepare, adopt and submit its Service Plan, if required. I understand that work is already underway within the HSE on the 2019 National Service Plan and I can state that the letter of determination issued from my Department on 17th October, 2018.
Following the submission of the draft National Service Plan, the legislation provides 21 days for me to examine the proposed plan and where necessary to seek amendment to, or approve, the plan. The National Service Plan must be laid before the Houses of the Oireachtas within 21 days of its approval. Once the Service Plan is laid before the Houses of the Oireachtas the HSE will ensure it is published at the earliest possible time.
Health Services Staff Remuneration
Questions (435)
Stephen Donnelly
Question:435. Deputy Stephen S. Donnelly asked the Minister for Health his views on whether the provision of health care is being undermined by reduced salaries for those recruited since 2012; and if he will make a statement on the matter. [43648/18]
View answerWritten answers
The Government remains committed to the recruitment and retention of health service personnel. Notwithstanding recruitment and retention challenges, the number of consultants and nurses employed in the public health services have increased overall.
The Public Service Pay Commission recently concluded a review in respect of key health service grades, including nurses and midwives and consultants and its Report was published on 4 September. For consultants, in terms of pay, it identified the two-tier pay system as being one of number of factors affecting recruitment and found that the differential in pay between pre-existing and new entrant consultants is greater than that for other categories of public servants. The Commission proposed that the Parties to the Public Service Stability Agreement jointly consider what further measures could be taken, over time, to address this difficulty.
In terms of nurses and midwives, it found the recruitment and retention issues to be multi-factorial and not solely due to pay. It recommended increases to a number of allowances and reducing the time to progress to senior staff nurse. These will benefit approximately 18,000 nurses.
Separate to this, agreement has also been reached on the new entrant salary scale for those recruited into the public service since 2012. This will benefit all health care staff who are signed up to the Public Service Stability Agreement. It is hoped that this range of measures will ultimately assist in improving recruitment to the public health service.
Disability Services Data
Questions (436)
Stephen Donnelly
Question:436. Deputy Stephen S. Donnelly asked the Minister for Health the waiting time to assessment and to access therapies for children with special needs by county or by the smallest available geographic breakdown if county level data is not available; and if he will make a statement on the matter. [43649/18]
View answerWritten answers
The 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 a service issue, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
General Practitioner Services
Questions (437)
Joan Collins
Question:437. Deputy Joan Collins asked the Minister for Health his plans in relation to general practitioner recruitment and retention over the next five years (details supplied). [43308/18]
View answerWritten answers
The Government is aware of workforce issues facing general practice, including the influence of demographic factors, and has implemented a number of measures to improve recruitment and retention in general practice.
GPs play a crucial role in the provision of primary care services. The number of GPs on the specialist register continues to increase – up from 2,270 in 2010 to 3,668 in 2018 and the number of GPs with a GMS contract has also risen from 2,098 in 2008 to 2,494 as at 1 July 2018.
GP training places have been increased from 120 in 2009 to 193 in 2018 and the Government's objective is to continue to achieve annual increases in the number of training places available while ensuring that all of the places are filled.
Entry provisions to the GMS scheme have been changed to accommodate more flexible GMS contracts and the retirement age has been extended to 72. An enhanced support package for rural practices has been introduced with improved qualifying criteria and an increased financial allowance of €20,000 per annum.
The Government remains committed to the continued development of GP capacity to ensure that patients across the country continue to have access to GP services and that general practice remains an attractive career option.
Health Services Reports
Questions (438)
Éamon Ó Cuív
Question:438. Deputy Éamon Ó Cuív asked the Minister for Health the reason the Central Island Healthcare review has still not been published; and if he will make a statement on the matter. [43574/18]
View answerWritten 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.
Autism Support Services
Questions (439)
Maureen O'Sullivan
Question:439. Deputy Maureen O'Sullivan asked the Minister for Health if appropriate funding will be provided for autism assistance dogs in view of the fact that at present they receive no HSE funding; and if he will make a statement on the matter. [43531/18]
View answerWritten answers
The 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 a service issue, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
Mobility Allowance
Questions (440)
Richard Boyd Barrett
Question:440. Deputy Richard Boyd Barrett asked the Minister for Health his plans to replace the mobility allowance and motorised transport grant withdrawn in 2013; and if he will make a statement on the matter. [38836/18]
View answerWritten answers
The Deputy will be familiar with the background to the closure of both the Mobility Allowance and Motorised Transport Grant schemes in February 2013.
My colleague, the Minister for Health and I brought a Memorandum to Government on proposals for a new Transport Support Payment Scheme towards the end of the last Dáil session. Following consideration of the matter, it was decided to withdraw the Memorandum from the Cabinet Agenda at the time. A new Transport Support Payment Scheme remains a priority and we intend to revert to Government with revised proposals to reflect the discussions at that Cabinet meeting and further discussions between ourselves, in due course.
With regard to the Motorised Transport Grant, this scheme operated as a means-tested grant to assist persons with severe disabilities with the purchase or adaptation of a car, where that car was essential to retain employment. The maximum Motorised Transport Grant, which was payable once in any three-year period, was €5,020. Following closure of the scheme in February 2013, no further Motorised Transport Grants have been payable.
It is important to note that the Disabled Drivers and Disabled Passengers scheme operated by the Revenue Commissioners, remains in place. This scheme provides VRT and VAT relief, an exemption from road tax and a fuel grant to drivers and passengers with a disability, who qualify under the relevant criteria set out in governing regulations made by the Minister for Finance. Specifically adapted vehicles driven by persons with a disability are also exempt from payment of tolls on national roads and toll bridges. Transport Infrastructure Ireland has responsibility for this particular scheme.
There are improvements in access to a range of transport support schemes available to persons with disabilities in the State and on-going work is being carried out by Government Departments, agencies and transport providers to further improve access to public transport services. Under the National Disability Inclusion Strategy, the Department of Transport, Tourism and Sport has responsibility for the continued development of accessibility and availability of public transport for people with a disability.
Health Services Expenditure
Questions (441)
Bernard Durkan
Question:441. Deputy Bernard J. Durkan asked the Minister for Health the full extent of the health expenditure overrun in 2018 and in each of the previous years back to when annual overruns became a feature of costs in the health services including the operation of the health boards; if a particular feature has emerged which might point to the most common cause of overruns; if it is applicable to specific sectors or disciplines; if specific action has been taken at year end with a view to arresting the trend; and if he will make a statement on the matter. [43663/18]
View answerWritten answers
A number of areas within the HSE are contributing to the overspend in 2018:
1. A private patient income shortfall, arising from the campaign by the PHI to dissuade their policyholders from using their insurance when admitted through an ED
2. Non- achievement of the tranche 3 of the VIP programme
3. Higher level of State Claims Agency payouts than budgeted for
4. PCRS driven by costs and demand for drugs (especially Hi Tech and LTI)
5. Higher level of spend on national reform projects
6 Higher level of spend on service areas (Acute and Social Care)
7. Other smaller items, such as overseas treatment, winter response
The overspend in the service areas is driven by a number of factors, including non-achievement of VIP tranche 2, higher levels and higher complexity of demand, costs associated with meeting national standards, emergency placement over level funded.
Over the last 5 years, the Health sector received the following supplementary estimates:
- 2017 - €195m
- 2016 - €600m (not an official supplementary, included in 2016 Health allocation, approved by the Oireachtas)
- 2015 - €665m
- 2014 - €680m
- 2013 - €219m
There are a number of key drivers that contribute to the increases in expenditure in recent years in the health service. These are;
- Aging demographics: The population in Ireland over 65 years per the CSO census data has increased 54% since 1996. Both the numbers and the age profile within the over 65yrs are contributing factors. The number of the population aged 85 and over has increased 95% from 1996 to 2016 or over 32k (Source: CSO census).
- Increase in co-morbidities: Due to the continuous improvements in health delivery more people are living longer with more illnesses, but they require increased ongoing support from the health system e.g. diabetes, dementia
- Regulation: There are almost 1100 designated centres in disability services that require to be registered under the National standards for residential and respite for adults and children with a disability. There are 25 designated centres remaining to be registered by HIQA. A significant element of the overrun has arisen following HIQA inspections of a designated centre and the recommendations for improvements required to be implemented prior to achieving registration.
- Emergency Residential Places: The Community Healthcare Organisations prioritized 790 individuals in 2017 who require an immediate service response in terms of new residential placements to be provided to meet identified waiting list. An analysis of the waiting lists highlighted the Death or Incapacity of the main carer which accounts for 29.5% of total cases. Such immediate priorities frequently lead to a bed-blocking situation in local respite services, which has the knock-on implication of reducing dramatically the overall quantum of respite available to non-residential service users within the CHO area. Almost two-thirds of required residential placements (65.5%) are for individuals who require supports to be delivered at high support staffing levels and frequently at 1:1 or above. The majority of new placements are commissioned from private providers as there is minimal capacity available in the public system.
- State Claims Agency: An actuarial assessment for potential claims under the Clinical Indemnity Scheme is prepared annually by the State Claims Agency and a determination is taken with regard to the level of funding that will be required by year end. As the year end position is an estimate it can come in under or over budget. In the last few years it has come in over budget, this is typically due to settlement of cases prior to the courts closing at year end. The increasing cost of settlements is determined by the court system and not within the remit of the health system.
- Drugs: The main drivers behind this is the expenditure on new High Tech drugs, in areas such as cystic fibrosis, rheumatology, and cancer drugs, increased spend on drugs on the Long Term Illness scheme e.g. diabetes, cystic fibrosis, epilepsy and General Medical Services Drugs & Pharmacy costs.
Pensions: Health is one of the few public services which has its pension costs reflected in its Vote; changes to pension rates, and the fact that pensioners are living longer has resulted in a significant increase in the share of the health vote which is attributable to pensions.
- Pay : The growth in both staff numbers, pay rate premia and underlying pay costs linked to Workplace Relations Commission agreements.
It is important to note that growth in health expenditure is a feature of all health systems and is not unique to Ireland.
Medicinal Products Supply
Questions (442)
Niamh Smyth
Question:442. Deputy Niamh Smyth asked the Minister for Health if a required medical product will be supplied to a person (details supplied); and if he will make a statement on the matter. [43664/18]
View answerWritten answers
Medicines play a vital role in improving the health of Irish patients. Securing access to existing and new and innovative medicines is a key health service objective. However, the challenge is to do this in a safe and sustainable manner. Treatment must be appropriate and proportionate and clinical decision-making, such as prescribing, should be based on both patient needs and sound medical evidence.
Lidocaine 5% medicated plasters are licensed for localised relief of post-shingles pain in adults. This is the patch's only licensed use in Ireland. It has been reimbursed in the community drugs schemes since 2010.
Clinical concern arose when, from 2012 on, usage increased significantly, to the point where more plasters were being used in Ireland than in the entire UK National Health Service. In such situations, it is important and appropriate for clinicians to review usage and, in 2016, the HSE Medicines Management Programme (MMP) reviewed the use of the plasters. The review estimated that only 5-10% of prescribing was for the licensed indication.
From September 2017, following the clinical review, the HSE introduced a new reimbursement approval system for the patches, to support appropriate use and patient care. Under these arrangements, the patient's GP or consultant applies to the MMP for reimbursement approval on behalf of the patient. If an application is refused, the clinician may submit an appeal, making a clear clinical case for the patient, to the MMP. Information for patients and practitioners is on the HSE MMP website at: hse.ie/yourmedicines.
The decision to introduce a new reimbursement approval process is a matter for the HSE. However, I fully support the objectives of the HSE Medicines Management Programme.
Hospital Beds Data
Questions (443)
Pearse Doherty
Question:443. Deputy Pearse Doherty asked the Minister for Health when the short stay ward in Letterkenny University Hospital will be open; the number of beds which will be opened in 2018; the plans in budget 2019 that included this opening; the number of beds that will be opened in 2019 and 2020; if they will be open on a permanent basis; and if he will make a statement on the matter. [43668/18]
View answerWritten answers
Arising from the recommendations in the Health Service Capacity Review, my Department engaged with the HSE this year to identify the location and mix of beds across the hospital system which could be frontloaded to address pressures being experienced in our hospital Emergency Departments.
This process culminated in the development by the HSE of a Capacity Plan, which identified over 600 acute beds and 290 residential care beds, to be phased in between 2018 and 2020, including a 20-bed short stay ward in Letterkenny University Hospital.
As a first step towards the implementation of the Capacity Plan, €10 million in funding is being made available in 2019 to prepare the ground for opening additional acute beds for winter 2019/2020. My Department is currently engaging with the HSE to finalise the details of this investment.
Ambulance Service
Questions (444)
Brendan Griffin
Question:444. Deputy Brendan Griffin asked the Minister for Health his views on a matter (details supplied); and if he will make a statement on the matter. [43681/18]
View answerWritten answers
As this is a service issue, I have asked the HSE to reply to you directly.
Hospital Waiting Lists
Questions (445)
Kevin O'Keeffe
Question:445. Deputy Kevin O'Keeffe asked the Minister for Health if a person (details supplied) will be called for a surgery. [43683/18]
View answerWritten answers
Under the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The National Waiting List Management Policy, a standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, since January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
Hospital Waiting Lists Data
Questions (446)
Patrick O'Donovan
Question:446. Deputy Patrick O'Donovan asked the Minister for Health if he will address a matter (details supplied) regarding scoliosis surgery; and if he will make a statement on the matter. [43686/18]
View answerWritten answers
The long-term strategy to develop sustainable scoliosis services from 2018 has been prioritised by the Department and the HSE. The Children's Hospital Group, with the additional €9 million provided to the HSE in 2018, has continued to progress the move toward the implementation of a long-term sustainable and safe paediatric orthopaedic service, including scoliosis services for children and young people.
Figures for the end of September for the full scoliosis waiting list breakdown, for both spinal fusion and spinal other, are provided for the Deputy below. In terms of capacity, Children's Hospital Group (CHG) aims to deliver 446 procedures this year, compared to 371 in 2017, and 224 in 2016. This represents an increase in activity of 99.5% since 2016.
End September
|
Spinal Fusion |
OLCHC |
Temple Street |
Cappagh |
Totals |
|
Active |
51 |
6 |
2 |
59 |
|
Planned |
2 |
0 |
0 |
2 |
|
TCI |
1 |
1 |
9 |
11 |
|
Suspended |
15 |
9 |
2 |
26 |
|
Total |
69 |
16 |
13 |
98 |
|
Spinal Other |
OLCHC |
Temple Street |
Cappagh |
|
|
Active |
27 |
2 |
0 |
29 |
|
Planned |
11 |
18 |
0 |
29 |
|
TCI |
4 |
6 |
0 |
10 |
|
Suspended |
9 |
2 |
0 |
11 |
|
Total |
51 |
28 |
0 |
79 |
|
Fusion & Other |
120 |
44 |
13 |
177 |
Question No. 447 answered with Question No. 408.
Hospital Waiting Lists
Questions (448, 450, 451, 453)
Patrick O'Donovan
Question:448. Deputy Patrick O'Donovan asked the Minister for Health if he will address a matter (details supplied) regarding a medical procedure; and if he will make a statement on the matter. [43689/18]
View answerPatrick O'Donovan
Question:450. Deputy Patrick O'Donovan asked the Minister for Health if he will address a matter (details supplied) regarding waiting lists; and if he will make a statement on the matter. [43695/18]
View answerPatrick O'Donovan
Question:451. Deputy Patrick O'Donovan asked the Minister for Health if he will address a matter (details supplied) regarding waiting lists; and if he will make a statement on the matter. [43702/18]
View answerPatrick O'Donovan
Question:453. Deputy Patrick O'Donovan asked the Minister for Health the number of persons aged 16 to 21 years of age waiting for spinal surgery in the Mater Hospital; the wait times experienced by these children and young adults; and if he will make a statement on the matter. [43705/18]
View answerWritten answers
I propose to take Questions Nos. 448, 450, 451 and 453 together.
The long-term strategy to develop sustainable scoliosis services from 2018 has been prioritised by the Department and the HSE. The Children's Hospital Group, with the additional €9 million provided to the HSE in 2018, has continued to progress the move toward the implementation of a long-term sustainable and safe paediatric orthopaedic service, including scoliosis services for children and young people.
In terms of capacity, Children's Hospital Group (CHG) aims to deliver 446 procedures this year, compared to 371 in 2017, and 224 in 2016. This represents an increase in activity of 99.5% since 2016.
In terms of the operational issues raised by the Deputy, including wait times for first spinal assessments; waiting times for growth rod insertion; MRI wait times at OLCHC and TSCUH; and the number of those between the ages of 16-21 at MMUH, I have asked the HSE to prepare a direct response.
Treatment Abroad Scheme
Questions (449)
Patrick O'Donovan
Question:449. Deputy Patrick O'Donovan asked the Minister for Health if he will address a matter (details supplied) regarding scoliosis surgeries; and if he will make a statement on the matter. [43691/18]
View answerWritten answers
Last year, the HSE published the Scoliosis Waiting List Update and Service Development Plan, which addressed treatment for children requiring corrective surgery for scoliosis. The approach set out in the Plan included insourcing of surgical procedures in the Children's Hospital Group (CHG), and the broader public hospital sector, as well as outsourcing initiatives, including private providers nationally and abroad.
In 2017, as part of the outsourcing initiative, families were offered the opportunity to have their child's surgery abroad. CHG advise that in total as part of this initiative 28 patients have had their treatment abroad and that arrangements have been agreed with services in the UK to undertake follow up reviews to ensure those children who received outsourced surgery in the UK receive appropriate follow up care as per the agreed protocol. This will include face to face outpatient clinics in Our Lady's Children's Hospital Crumlin, in addition to phone call and Skype follow up, if needed. These reviews are scheduled according to the patient's clinical care plan.
This year a small number of families were offered the opportunity to have their child's surgery abroad but did not avail of the offer as they did not want to travel abroad. One child did have surgery abroad in 2018; this was a procedure that was due to have taken place in 2017, but which was deferred until 2018.
The CHG advise that the €9 m investment in paediatric orthopaedics this year, which includes scoliosis services, has already improved access for surgery and outpatient review. By September 2018 there had been a reduction of 26% in the waiting times experienced to access surgery since the start of the year. This year the CHG aims to deliver 446 procedures, compared to 371 in 2017, and 224 in 2016.
Questions Nos. 450 and 451 answered with Question No. 448.