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Tuesday, 23 Oct 2018

Written Answers Nos. 1-100

National Maternity Hospital

Questions (76)

Louise O'Reilly

Question:

76. Deputy Louise O'Reilly asked the Minister for Health the status of the commitment given by Dáil Éireann to ensure the national maternity hospital remains within public ownership and has legally guaranteed independence from all non-medical influence; and if he will make a statement on the matter. [43443/18]

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Written answers

Following extensive mediation discussions, agreement was reached between the St Vincent’s Healthcare Group and the National Maternity Hospital (NMH) on the relocation of the NMH to the Elm Park campus. The terms of this agreement provides for the establishment of a new company which will have clinical and operational, as well as financial and budgetary independence in the provision of maternity, gynaecology and neonatal services. It is vitally important that the legal and governance arrangements associated with this project are robust. Considerable work has been undertaken to develop a legal framework to protect the State's significant investment in the new hospital and ensure the hospital building remains in State ownership; it is hoped to conclude this work shortly. This legal framework will underpin the operational and clinical independence of the new hospital, ensuring care in the new maternity hospital will be delivered without religious, ethnic or other distinction and any medical procedure which is in accordance with the laws of the land will be carried out there. Once finalised, proposals will be subject to consideration with the parties concerned. I can assure the Deputy that I remain committed to the development of the new maternity hospital on the St Vincent's campus. This is a vital project for women and babies in Ireland, representing the flagship project of the National Maternity Strategy and the largest single investment ever made in maternity services in Ireland. The model of stand-alone maternity hospitals is not the norm internationally. Government policy is therefore to co-locate all remaining maternity hospitals with adult acute services in order to provide optimal clinical outcomes. In that context, it is proposed to relocate not only the NMH, but also University Maternity Hospital Limerick to University Hospital Limerick, Dooradoyle, the Rotunda Hospital to the Connolly Hospital campus in Blanchardstown and the Coombe Women & Infants University Hospital, to St James's Hospital. More broadly, the Deputy will be aware that the Government has established an independent review group to examine the role of voluntary organisations in the operation of health and personal social services in Ireland. The terms of reference provide for:

- An examination of current arrangements across the health and social care sector;

- Consideration of issues currently arising, and those likely to arise in the future;

- Recommendations on how the relationship between the State and voluntary organisations should evolve in the future.

Community Care

Questions (77)

Louise O'Reilly

Question:

77. Deputy Louise O'Reilly asked the Minister for Health if he will discuss the HSE CHO networks and operating model proposal; and if he will make a statement on the matter. [43444/18]

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Written answers

The expansion of community-based care is at the heart of the Sláintecare vision. A key building block in this vision will be the 96 community healthcare networks and 433 Primary Care Teams that are already working across the country and delivering a wide range of health services to people in their local communities.

In recent years, the HSE has made concerted efforts to move many social care services, including mental health and disability services, into the community. Much progress has been made in developing services that are more integrated, less centralised and more focused on the patient. I do however believe we can be more ambitious in terms of developing primary and community-based care. The Sláintecare Implementation Strategy sets out a number of strategic actions and concrete sub-actions that I intend to progress over the coming months and years to bring care closer to home for the benefit of the patient.

The HSE has been working to progress and deepen the implementation of multidisciplinary team working. To this end nine learning sites (one per CHO) are being put in place. The experience gained through these learning sites will inform future decision making and proposals in relation to the best way forward.

I am aware that concerns were expressed by nurse representatives in relation to the potential effect of multidisciplinary working arrangements on existing reporting structures. In light of this, and in order to facilitate progress with the learning sites, it has been agreed that, for the present, reporting relationships for nursing staff will remain unchanged within the new structures.

I recognise that today many professionals working in front line services already work collaboratively. It is important that this collaborative working arrangement continues and indeed develops regardless of reporting structure.

Medicinal Products Reimbursement

Questions (78)

John Brassil

Question:

78. Deputy John Brassil asked the Minister for Health if Respreeza will continue to be provided to patients with Alpha-1 antitrypsin deficiency; and if he will make a statement on the matter. [43564/18]

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Written answers

The HSE assessed the application for the pricing and reimbursement of Respreeza and in August 2017, the manufacturer, CSL Behring, was notified that the HSE did not recommend reimbursement.

A number of patients were on an access scheme for this product, operated by the manufacturer, for the treatment of Alpha-1 Antitrypsin Deficiency. That scheme was being run independently by the manufacturer without reference to the HSE.

The company notified the HSE that it had decided to terminate the access scheme from 30 September 2017. Following interventions by the HSE, the company modified its decision and agreed to continue to supply the medication free of charge for the patients on the access scheme. Due to the critical and exceptional circumstances, the HSE agreed to fund the provision of the necessary nursing service to ensure that patients could continue to receive the medicine

The HSE is continuing to liaise with the treating Consultant and the company and has drafted the terms of an agreement for the long term care of the 19 alpha one clinical trial patients. This proposal is being reviewed by CSL Behring and it is hoped that a final agreement can be reached shortly.

In so far as the provision of Respreeza to other patients is concerned, it is open to the company to submit a new reimbursement application which will be assessed by the HSE in line with the Health (Pricing and Supply of Medical Goods) Act 2013. As the Deputy will appreciate, the Minister for Health has no statutory role in such matters.

Services for People with Disabilities

Questions (79)

Seán Haughey

Question:

79. Deputy Seán Haughey asked the Minister for Health the waiting time for intake assessment for the early intervention team for children in north County Dublin. [43615/18]

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Written answers

As Deputies will be aware, there is a high demand for Early Intervention Services and unfortunately, waiting times for children to access these services have reached excessive levels in many parts of the country.

I understand that the current longest waiting time for children to access services from the Early Intervention Team in North County Dublin is 32 months.

I recognise that services for school-aged children with disabilities and early intervention services are paramount and need to be improved and organised more effectively and this process is well under way nationwide. A major reconfiguration of therapy resources for children with disabilities into multi-disciplinary geographically based teams, is underway as part of the HSE's National Programme on Progressing Disability Services for Children and Young People.

HSE Disability Services in Dublin North City and County are working proactively with the HSE's National Disability Office to address waiting times. However, there are a number of factors driving the demand for services, including an increase in the population of children overall and an increase in the number of children presenting with complex needs.

Addressing and improving services for children and adults with a disability remains a priority of the Government and for the Health Service Executive. I am pleased to inform the House that Dublin North City and County Disability Service has recently received approval of an increased allocation of resources which will provide five posts across a number of disciplines including: Psychology, Occupational Therapy, Speech and Language Therapy, Physiotherapy and Social Work.

The HSE has commenced the recruitment process for these posts which will assist in the reduction of waiting times for early intervention services across the area.

In addition, as part of the Government’s commitment to children with disabilities, funding for an additional 100 therapy posts was secured as part of Budget 2019. This investment will have a significant positive impact on waiting times for assessment and therapy service delivery over the course of the next year.

National Dementia Strategy

Questions (80)

Danny Healy-Rae

Question:

80. Deputy Danny Healy-Rae asked the Minister for Health if further investment will be made available to provide funding for community supports for persons with dementia to ensure they can remain active in their communities and continue to live in their own homes; and if he will make a statement on the matter. [43279/18]

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Written answers

The National Dementia Strategy was launched in December 2014 to meet the challenges faced by people living with dementia in Ireland and to provide services to meet growing demand in future years. The Strategy contains 35 priority and additional actions and its implementation is being led by the National Dementia Office in the HSE. The office has made substantial progress towards developing evidence-based care pathways for people with dementia and progress to date, as well as future plans, is recorded in the mid-term review of the Strategy's implementation, which was published in May this year. The Strategy emphasises the need for a "whole community response" to dementia, as the majority of people with dementia live in their own communities and wish to avail of services in their local area.

To support future development of services and supports for people with dementia, the National Dementia Office and the Alzheimer Society of Ireland undertook a joint project in 2016 and 2017 to map dementia-specific community-based services across the country. Information from the project is included in an on-line service finder on the Understand Together website so people can find out what services are available in each county.

It is acknowledged that there are gaps in access to services and a large variance in what services are provided across the country. The National Dementia Office has met with senior HSE officials in each Community Healthcare Organisation region to highlight gaps in each area and to develop local action plans to improve service provision.

The National Dementia Strategy calls for the HSE to consider the provision of dementia advisers, based on the experience of demonstrator sites. An evaluation of the Dementia Adviser Service was published on 26 September. It recommends the continuation and expansion of the service to ensure equity of access countrywide.

In addition to these community supports, in 2014 the HSE introduced Dementia-Specific Intensive Homecare Packages to test the feasibility of providing a high level of support to people with dementia with complex needs to facilitate them to remain living at home. These were initially co-funded by the HSE and the Atlantic Philanthropies and now fully funded by the HSE, which has committed to continue to provide approximately 120 packages at any one time. In addition to the IHCPs, people with dementia are also able to avail of standard home care services on the basis of need and within the resources available.

The Department of Health has secured €6.26 million from the Dormant Accounts Fund for numerous projects to improve care and supports for people with dementia. Projects receiving funding include the delivery of post-diagnostic supports; a dementia diagnostic service for people with intellectual disability; a national network of memory technology resource rooms; the development of a national dementia registry; the national rollout of a dementia training programme for HSE homecare staff; the development of dementia resource centres; funding for a dementia community activation coordinator; and community support projects for people with dementia.

In July and September, I met with the Alzheimer Society of Ireland to discuss dementia issues. I have also met Senator Colette Kelleher, a former CEO and advocate of the ASI, to specifically discuss the needs of people with dementia. I am very aware of the need to address issues surrounding dementia, and am committed to maintaining the constructive relationships the Department has with advocacy groups as we continue to work towards the greater provision of services and care to people with dementia, their carers and families in the HSE's National Service Plan for 2019.

In terms of plans to expand support levels for people with dementia, the quantum of services to be provided by the HSE will be considered as part of the HSE's 2019 National Service Planning.

Hospital Waiting Lists Action Plans

Questions (81)

Jack Chambers

Question:

81. Deputy Jack Chambers asked the Minister for Health the action he will take to address the long outpatient waiting times in the children’s hospital group in which 10,329 persons are waiting more than 18 months for an appointment. [43584/18]

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Written answers

In Budget 2019 the Government has prioritised improving access and reducing waiting times for patients, with funding to the National Treatment Purchase fund (NTPF) increasing from €55 million in 2018 to €75 million in 2019, of which, €6 million will be committed to outpatient activity. In addition, specific investments to improve paediatric services have been made including the establishment of the Outpatient and Urgent Care Centre at Connolly Hospital in 2019 and the development of sustainable and safe paediatric orthopaedic service, including scoliosis, for children and young people

To date in 2018, the NTPF has approved almost 12,700 additional first-time outpatient appointments and this is projected to increase to 40,000 appointments next year. I recently met with the CEO’s of all hospital groups to discuss improving access for patients and requested that they work with the NTPF and HSE in 2019 develop innovative proposals to address the number of long waiters on outpatient lists in 2019.

This year, the NTPF has approved 504 Outpatient appointments for Temple Street as part of an initiative to support implementation of an extended working day in the hospital. The NTPF is also due to meet with the Children’s Hospital Group (CHG) this month to review proposals for additional insourcing and outsourcing initiatives in cardiology, ENT, and other specialties.

In addition, the CHG advises that it has implemented a number of new and innovative initiatives to improve access to outpatient appointments for patients across a range of specialties including cardiology, dermatology, and orthopaedics. This includes:

- additional clinics in ENT and dermatology;

- the appointment of additional staff in general paediatrics, ophthalmology and orthopaedics; and

- the use of virtual assessment clinics for rheumatology.

The Outpatient and Urgent Care Centre at Connolly Hospital in 2019 the will result in 6,350 outpatient appointments being issued for the new facility next year, with projected full year outpatient attendance of 15,240 in subsequent years.

The additional €9 million provided to the Children’s Hospital Group (CHG) in 2018, to support the development and implementation of a sustainable and safe paediatric orthopaedic service for children and young people, has also led to the improvement in waiting times for outpatient appointments for children.

Hospital Beds Data

Questions (82)

Eugene Murphy

Question:

82. Deputy Eugene Murphy asked the Minister for Health the status of the proposed 50-bed unit at Portiuncula Hospital; and if he will make a statement on the matter. [43604/18]

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Written answers

It is proposed to provide a 50 bed ward block to replace existing ward accommodation at Portiuncula University Hospital, Ballinasloe. Funding has already been made available to bring the project to the design and planning stage. The ward block has now received planning permission.

Following publication of the Budget and estimates last week, the HSE is preparing a Capital Plan for 2019, having regard to the level of commitments and the costs to completion already in place. On completion of the Capital Plan, it will be submitted to my Department for consideration. It requires my approval together with the consent of the Minister for Public Expenditure and Reform.

The HSE is concentrating on applying the funding available for infrastructure development in the most effective way possible to meet current and future needs.

HSE Staff Recruitment

Questions (83)

Margaret Murphy O'Mahony

Question:

83. Deputy Margaret Murphy O'Mahony asked the Minister for Health the timeframe for recruiting the additional therapists announced in budget 2019. [43560/18]

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Written answers

Deputies will be aware that funding was recently announced in Budget 2019 for an additional 100 therapy posts for Assessment of Need and therapeutic interventions for children. This will enable the HSE to reduce the waiting list for Assessment of Need under the Disability Act and to drive implementation of the Progressing Disability Services for Children and Young People Programme through new staff appointments to reconfigured multi-disciplinary, geographic-based teams.

The HSE is now in the process of developing its National Service Plan in accordance with the relevant legislative provisions and funding allocation. As planning for service provision for 2019 is currently underway it is not possible to provide detailed information on how the allocated funding will be spent in 2019. Decisions have yet to be made with regard to the types of therapy posts that will be created, the areas to which they will be allocated, and the time-frame for the recruitment of the additional posts.

However, as soon as these decisions are finalised, the HSE and agencies funded through Section 38 and Section 39 of the Health Act will make every effort to recruit these clinicians as quickly as possible, within the budget allocation provided. The additional funding for 100 therapy posts for children’s disability services will have a significant positive impact on waiting times for assessment and services over the course of the next year.

Hospital Staff Recruitment

Questions (84)

Mick Wallace

Question:

84. Deputy Mick Wallace asked the Minister for Health the status of progress to recruit additional staff to expand the existing cath lab activity at University Hospital Waterford; and if he will make a statement on the matter. [43545/18]

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Written answers

As the Deputy is aware, Dr Herity concluded that the needs of the effective catchment population of University Hospital Waterford could be accommodated from a single cath lab and recommended that the operating hours of the existing cath lab should be extended to provide 12 sessions of 4 hours each per week. Approval and funding has been provided for the additional staff required to facilitate this service expansion. Pending the completion of the recruitment process, a mobile cath lab has been in place since October 2017 which has improved access and reduced waiting times for patients. The recruitment of the additional staff, which is being progressed by local management and the HSE’s National Recruitment Service, is now at an advanced stage.

Emergency Departments Waiting Times

Questions (85)

Jim O'Callaghan

Question:

85. Deputy Jim O'Callaghan asked the Minister for Health the reason 738 persons over 75 years of age had to wait more than 24 hours in the emergency department in St. Vincent's Hospital during January to August 2018. [43593/18]

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Written answers

I wish to acknowledge the distress overcrowded Emergency Departments (EDs) cause to patients, their families and frontline staff working in very challenging working conditions in hospitals throughout the country.

Reflecting the demographic pressures associated with the growth in our aging population, this year has been characterised by high demand for unscheduled care, particularly among the over-75 age group. Patients in this age group are the highest users of most health and social care services, have more complex needs and longer stays in our Acute Hospitals.

I recognise that hospitals are increasingly operating at or above capacity, with year-round demand pressures that are further challenged over the winter months. However, the National Service Plan 2018 includes an expected activity target that 100% of patients aged 75 and over are discharged or admitted within 24 hours of registration. Therefore, any breach of this target in respect of patients in this age cohort is unacceptable.

Ireland East Hospital Group, which includes St Vincent's Hospital, advise that the hospital did not meet the target because of an increased demand and activity for unscheduled care this year. Between January and August 2018, the total attendances in St Vincent's Hospital ED increased by 7.4%, while admissions rose by 13%, as compared with the same period in 2017. For those over 75, attendances increased by 10.8% and admissions by 18.6% to the end of August 2018.

As Minister for Health, I am committed to maintaining the focus on addressing overcrowding in our hospital emergency departments. My Department is working closely with the HSE to ensure that local and regional winter plans at hospital group and community health care organisation level are consolidated and supported through policies and plans at national level to ensure the most effective response to the winter challenges to unscheduled care provision.

In addition, as part of Budget 2019, €10m in funding has been allocated in 2018, to enable hospitals to de-escalate before the end of the year, with a focus on supporting patients in the over 75 age group.

Services for People with Disabilities

Questions (86)

Declan Breathnach

Question:

86. Deputy Declan Breathnach asked the Minister for Health the measures that will be put in place to boost respite facilities for persons with disabilities and their families in County Louth. [43607/18]

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Written 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.

The Programme for Partnership Government states that the Government wishes to provide more accessible respite care to facilitate full support for people with a disability.

The current adult respite provision in County Louth is - 3 beds in Moorehall Lodge, Ardee; 3 beds in Sruthan House. Since April 2018 service users also have access to 3 additional beds in Bower House in North Co Dublin.

Respite services in Co. Louth will be further enhanced by year end with the following planned developments - 4 additional beds in Moorehall and 4 additional beds to be provided by Praxis.

In addition children’s respite services currently provided by Rehab Care at the Maria Goretti Foundation, Lordship, Co. Louth provides one respite bed since August 2018 with a further additional bed coming on stream in early 2019.

Additional day and residential are to be provided by Positive Futures.

This level of service will continue throughout 2019.

Health Services Reform

Questions (87)

Bernard Durkan

Question:

87. Deputy Bernard J. Durkan asked the Minister for Health if in the context of reorganisation of the health services, consideration will be given to the establishment of regional bodies consisting of public representatives, the professional stakeholders and patient representatives with a view to restoring a demographic structure nationally at which the specific issues relative to these particular regions can be discussed in detail, senior representatives of which might then be considered for a national body accountable to him; and if he will make a statement on the matter. [43484/18]

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Written answers

In August, I published the Sláintecare Implementation Strategy which provides the framework within which a system-wide reform programme will be advanced. The Strategy contains specific commitments in relation to improving governance and accountability across the health service.

One of the key actions outlined in the Strategy is to establish an independent Board for the HSE and to reconfigure the HSE to improve accountability and support integrated care. Legislation to establish a Board for the HSE is currently before the Oireachtas. I intend to establish the Board once the legislation has been passed. I have already announced Mr Ciarán Devane as Chair designate of the Board.

More broadly, the task of identifying the optimal set of health structures including national and regional bodies, and the most appropriate governance, accountability and performance framework for the future health system will be an important stream of work under the Sláintecare programme of reforms. As set out in the Implementation Strategy, I am committed to the development of a new system of health structures comprising a leaner national centre with responsibility for national planning, strategy and standard setting, complemented by regional integrated care organisations with responsibility for the planning and delivery of services at a regional level.

As a first step, my Department has undertaken a public consultation regarding the geographical alignment of Hospital Groups and Community Healthcare Organisations. The submissions to the consultation are currently being analysed by my Department and I hope to publish the report of the analysis shortly. This work will inform the development of detailed proposals in this area, including the role and function of regional bodies.

Health Reports

Questions (88)

Joan Collins

Question:

88. Deputy Joan Collins asked the Minister for Health if €3 billion will be provided for the Sláintecare implementation fund beginning with a €600 million commitment; and if he will make a statement on the matter. [31055/18]

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Written answers

A key recommendation in the Sláintecare Report is to 'Implement transitional and legacy funding arrangements to a total of €3 billion over six years, to boost reinvestment into one-off system changing measures, training capacity and capital expenditure'. The report proposed that this funding be used to provide ehealth infrastructure, develop primary care infrastructure including primary care centres and community diagnostics, expand training places, provide for system change and to renovate and increase hospital capacity.

The report suggested that €500 million per annum for the next 6 years will be required for this.

The National Development Plan (NDP), published earlier this year as part of Project Ireland 2040 provides €10.9 billion to invest in infrastructure, equipment and additional service capacity for the public health sector over the next 10 years. This represents an increase of 165% in capital funding over the previous decade. This capital provision will address all of the capital components of the proposals in the Sláintecare Report, albeit, over a ten year period as opposed to six years as recommended in the report.

The funding provided for in the NDP will deliver:

- 2,600 additional acute hospital beds, including elective-only hospitals in Cork, Dublin and Galway;

- 4,500 additional long and short-term community beds;

- A modern ehealth and ICT infrastructure;

- Additional Primary Care facilities with greater access to diagnostics; and

- Additional facilities for mental health services and for people with disabilities

The NDP provides for an unprecedented capital investment in the health service and represents one of the largest building programmes in its history. This won't be delivered overnight. It is essential that new capacity and facilities are properly planned and designed. This process will be undertaken under the auspices of the Sláintecare Programme Office in line with the specific actions outlined in the Sláintecare Implementation Strategy.

In addition to this I am delighted that I have secured over €200m in budget 2019 which will directly support a range of additional services including initiatives proposed in the Sláintecare Report and committed to in the Sláintecare Implementation Strategy including:

- Ringfenced funding for the Sláintecare Programme Office;

- €20m for the establishment of a new ring-fenced Sláintecare Integration Fund to drive improvements in the way we deliver care across the system;

- Funding for a new GP contract which is critical to the Sláintecare vision of delivering more care in the community;

- Expansion of free GP care, by increasing the weekly income threshold for GP Visit card by €25 which could benefit up to 100,000 people. This supports the Sláintecare recommendation to move towards universal GP care over 5 years;

- Additional funding for 100 new therapy posts to address assessment of need waiting lists for children with disabilities and funding to ensure that the needs of all those leaving school in 2019 will be addressed;

- €55m in new development funding aimed at further enhancing community mental health teams for adults and children;

- Reducing user charges and out of pocket payments by further reductions in prescription charges - 50 cent reduction in prescription charges from €2.00 to €1.50 for all medical card holders over the age of 70. This is in line with a Sláintecare recommendation to reduce prescription charges;

- A €10 reduction in the monthly Drugs Payment Scheme threshold from €134 to €124 which is also in line with a key Sláintecare recommendation;

- Increased investment of €20m in the National Treatment Purchase Fund. €75m will be available to the NDPF IN 2019 which will be used to treat 70,000 patients on waiting lists in 2019; and

- Additional funding for care redesign and the National Children's Hospital.

Funding has also been provided to expand existing health services, in line with Sláintecare recommendations and full details of this will be contained in the National Service Plan to be published in December.

Hospitals Funding

Questions (89)

Eugene Murphy

Question:

89. Deputy Eugene Murphy asked the Minister for Health if the necessary funding will be allocated to upgrade the central sterile services department facilities at Roscommon University Hospital in order to meet the required HIQA decontamination standards and to allow for the expansion of surgical services at the hospital; and if he will make a statement on the matter. [43277/18]

View answer

Written answers

An upgraded Central Sterile Services Department at Roscommon University Hospital has been included in the National Development Plan (NDP), announced earlier this year.

The HSE has advised that HSE Estates and the Saolta University Health Care Group have agreed on a proposal and the project brief will be submitted shortly for review by the HSE's National Capital and Property Steering Group in line with HSE protocols for capital developments.

A project brief has been prepared and will be progressed to design stage in 2019 and construction timelines will be determined.

Hospital Staff Recruitment

Questions (90)

Peadar Tóibín

Question:

90. Deputy Peadar Tóibín asked the Minister for Health when all necessary consultant and staff posts will be filled in Our Lady's Hospital, Navan. [43504/18]

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Written answers

Our Lady’s Hospital Navan (OLHN) is part of the Ireland East Hospital Group. Every hospital in that Group, large and small, including OLHN, has a vital role to play within the Group. In 2013 OLHN was included in the list of designated Model 2 Hospital under the Smaller Hospitals Framework which set out the role of smaller hospitals in managing routine, urgent or planned care locally while more complex care is managed in the larger hospitals.

I understand from the HSE, recruitment at Our Lady’s Hospital Navan is an ongoing process to fill vacant posts. The hospital strives to ensure the timely filling of all staff grades. While awaiting the permanent filling of vacant posts every effort is made to have the role filled by agency or temporary staff.

Currently, the Hospital Group is engaged in a programme of re-design work to further integrate and enhance the role of OLHN within the Ireland East Hospital Group and to ensure that it will provide more services safely and appropriately.

The future staff requirements for OLHN will be considered in the context of the evolving role for the hospital and the need to further develop particular services there in the context of overall service reorganisation in the Ireland East Hospital Group. Such service include extended day surgery, selected acute medicine, local injuries, a large range of diagnostic services, specialist rehabilitation medicine and palliative care.

The Hospital Group is continuing to engage closely with all interested parties to ensure that the needs of patients, staff, the local and wider community are addressed.

Psychological Services

Questions (91)

Mick Wallace

Question:

91. Deputy Mick Wallace asked the Minister for Health his plans to expand counselling in primary care service to children and adolescents under 18 years of age; and if he will make a statement on the matter. [43544/18]

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Written answers

Psychology services in primary care settings can play a key role in promoting good mental health and offer the opportunity to provide early and cost-effective interventions for children and adolescents.

In order to improve access to psychology services in primary care settings, additional funding of €5 million has been made available for the recruitment of 22 staff grade psychologists and 114 assistant psychologists. The vast majority of these posts have been filled and, already, a reduction can be seen in the numbers waiting to access these services.

As well as additional investment, the HSE is also examining the scope for improved ways of working through a Service Improvement Initiative for Counselling in Primary Care. These new ways of working include:

- standardised psychology protocols;

- a single point of contact for all non-crisis and non-complex emotional and behavioural referrals; and

- assistance for service users in stepping ‘up to’ and ‘down from’ more specialist health services.

Other options to improve access times for children and adolescents are also being pursued, including a computerised cognitive behavioural therapy programme. This programme utilises new technologies, delivering supports through weekly sessions based around a computer, with a healthcare professional as support.

Hospital Waiting Lists Action Plans

Questions (92)

Aindrias Moynihan

Question:

92. Deputy Aindrias Moynihan asked the Minister for Health his plans to reduce waiting lists for gynaecological procedures at Cork University Maternity Hospital; and if he will make a statement on the matter. [43542/18]

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Written answers

Reducing waiting time for patients for hospital operations and procedures is a key priority for the Government. This year has seen ongoing improvements with the number of patients waiting for inpatient and daycase procedures (IPDC), now at 72,700 from the peak of 86,100 in July 2017. This represents a 16% reduction in the overall number of patients waiting for an inpatient or day case procedure.

In Budget 2019 the Government has further increased investment in this area, with funding to the NTPF to increase from €55m in 2018 to €75m in 2019.

My Department is working closely with the National Treatment Purchase Fund and the HSE to finalise the 2019 Waiting List Initiatives before the end of this year. This approach is to ensure a seamless continuation of the considerable progress made this year into next year.

The HSE has advised that there are currently 3,379 patients on the Outpatient waiting list and 442 on the inpatient waiting list.

In early 2018 CUMH committed again to reduce the Gynaecology Inpatient/Daycase waiting lists and with the support of the South/South West HG and the NTPF rented theatre space in the Mater Private Hospital Cork. From April to October this year CUMH held 8 full day theatre sessions to operate on the long waiters treating 56 patients and a further full day planned for December (8 patients).

Initiatives to address the Gynaecology Outpatient waiting list have included the commencement of additional Gynaecology OP Clinics out of hours (368+ extra patients seen so far) at CUMG which has resulted in almost 370 additional patients been seen. In addition, CUMH started 6 new weekly Registrar clinics on Monday 30th July. In September, a new Friday OPD commenced which is seeing 25/30 new patients (long waiters). Later this year CUMH will also be commencing a new weekly Outreach Clinic in Mallow Primary Health in conjunction with the GPs.

Mental Health Services Provision

Questions (93)

Fiona O'Loughlin

Question:

93. Deputy Fiona O'Loughlin asked the Minister for Health the status of plans to build a standalone mental health facility in Naas; and if he will make a statement on the matter. [43599/18]

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Written answers

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Hospital Facilities

Questions (94)

Charlie McConalogue

Question:

94. Deputy Charlie McConalogue asked the Minister for Health when the short stay ward will open in Letterkenny University Hospital; the preparations the HSE has underway to ensure it is opened promptly; and if he will make a statement on the matter. [43298/18]

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Written 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.

General Practitioner Services

Questions (95)

Peadar Tóibín

Question:

95. Deputy Peadar Tóibín asked the Minister for Health the steps he will take to repair the general practitioner system nationally. [43505/18]

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Written answers

General Practitioners play an important role in the primary care system. The number of GPs on the specialist register continues to increase – up from 2,270 in 2010 to 3,669 as at July 2018. The number of GPs holding GMS contracts has also risen from 2,098 in 2008 to 2,507 as at 1 September 2018.

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.

GP training places have been increased from 120 in 2009 to 193 places filled in 2018, an increase of around 60% over a nine year period. 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 for GPs 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.

Officials from my Department and the HSE recently re-engaged with the Irish Medical Organisation to set out the State's position in relation to reform of the GMS contract. Agreement on the delivery of service improvements and contractual reform has the potential to facilitate a substantial increase in the resourcing of general practice on a multiannual basis.

Emergency Departments Waiting Times

Questions (96)

James Lawless

Question:

96. Deputy James Lawless asked the Minister for Health the reason for the significant increase in overcrowding in Naas hospital emergency department over the past two years. [43596/18]

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Written answers

I fully acknowledge the distress overcrowded Emergency Departments cause to patients, their families and frontline staff working in very challenging working conditions in hospitals throughout the country. I recognise that hospitals are increasingly operating at or above capacity, with year-round demand pressures that are further challenged over the winter months.

As Minister for Health, I am committed to maintaining the focus on addressing overcrowding in our hospital emergency departments. My Department is working closely with the HSE to ensure that local and regional winter plans at hospital group and community health care organisation level are consolidated and supported through policies and plans at national level to ensure the most effective response to the winter challenges to unscheduled care provision.

I have asked the HSE to respond directly to the specific query raised by the Deputy in relation to Naas Hospital.

Hospital Waiting Lists Action Plans

Questions (97)

Barry Cowen

Question:

97. Deputy Barry Cowen asked the Minister for Health the action he will take to address the long outpatient waiting times in the Midland Regional Hospital, Tullamore in which 3,691 persons are waiting more than 18 months for an appointment. [43567/18]

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Written answers

In Budget 2019 the Government has prioritised improving access and reducing waiting times for patients, with funding to the National Treatment Purchase fund (NTPF) increasing from €55 million in 2018 to €75 million in 2019, of which, €6 million will be committed to outpatient activity.

To date in 2018, the NTPF has approved almost 12,700 additional first-time outpatient appointments and this is projected to increase to 40,000 appointments next year. I recently met with the CEO’s of all hospital groups to discuss improving access for patients and requested that they work with the NTPF and HSE in 2019 develop innovative proposals to address the number of long waiters on outpatient lists in 2019.

Outpatient waiting list figures for the end of September for Midlands Regional Hospital Tullamore show that there were more than 14,282 patients waiting for a first outpatient appointment, of which 74% are waiting less than 18 months.

More broadly, Dublin Midlands Hospital Group is working to introduce complete 'episode of care' clinics, as well as evaluating options for outsourcing appropriate specialties to reduce outpatient waiting lists.

In addition, the Central Waiting List Validation function, which was established in the NTPF last month, will deliver a standardised approach to validation across all hospitals in line with best patient-centred practices. This new function will have many benefits including the identification of patients on waiting lists who are ready and available to proceed with hospital care, the reduction in the Did Not Attend rate (DNA), and an improvement in information for managing waiting lists. The NTPF estimates that 30,000 patients who no longer require treatment will come off the outpatient waiting list in 2019 as a result of this activity.

Drug Treatment Programmes

Questions (98)

Ruth Coppinger

Question:

98. Deputy Ruth Coppinger asked the Minister for Health if there has been an assessment of the loss of drug treatment, counselling and other services in the Blanchardstown community since the closure of an organisation (details supplied); and if he will make a statement on the matter. [38840/18]

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Written answers

As this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.

Hospital Waiting Lists Action Plans

Questions (99)

Bernard Durkan

Question:

99. Deputy Bernard J. Durkan asked the Minister for Health the extent to which waiting lists for various procedures are likely to be improved in the course of 2019 having regard to the demographics and the improvements made or to be made in terms of improving staffing levels and facilities and the maximisation of the utilisation of theatre facilities; and if he will make a statement on the matter. [43485/18]

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Written answers

Reducing waiting time for patients for hospital operations and procedures is a key priority for the Government. This year has seen ongoing improvements with the number of patients waiting for inpatient and daycase procedures (IPDC), now at 72,700 from the peak of 86,100 in July 2017. This represents a 16% reduction in the overall number of patients waiting for an inpatient or day case procedure.

In Budget 2019 the Government has further increased investment in this area, with funding to the NTPF to increase from €55m in 2018 to €75m in 2019. In 2019, the NTPF plans to deliver 25,000 Inpatient Day Case treatments, building on the 20,000 procedures delivered in 2018. In addition, 5,000 Gastro Intestinal Scopes will be carried out, bringing to 9,000 the additional scope activity provided by the NTPF since the start of 2018. Furthermore, 40,000 Outpatient appointments will be arranged as part of 2019 activity. It is expected that a further 34,000 patients who no longer need treatment will be removed from the waiting lists by the NTPF Central Validation Unit.

As a result, the NTPF projects by year end to reduce the overall number of patients on the IPDC waiting list from just over 86,000 in July 2017, to 70,000 at the end of 2018 and to under 59,000 by the end of 2019.

My Department is working closely with the NTPF and the HSE to finalise the 2019 Waiting List Initiatives before the end of this year. This will include the continuing engagement of the NTPF with the HSE and public hospitals, inviting proposals for waiting list initiatives either through the private sector or through public sector insourcing. The NTPF will provide funding to the solutions proposed if appropriate.

More broadly, the recent Budget provided an increase of €1.05 billion in Health funding. This brings the health budget for 2019 to €17 billion. This is the highest level of Health investment in the history of the State. This will allow the health service to meet additional demands caused by the demographic pressure of a growing and ageing population. The additional funding provided as part of Budget 2019 will directly support a range of additional services including initiatives proposed in the Sláintecare Report and committed to in the Sláintecare Implementation Strategy. Sláintecare will focus on meeting the demand for health care that our population currently has, and which will continue to grow in future years.

The Health Service Executive is currently in the process of finalising its National Service Plan for 2019, in consultation with officials from my Department. This will inform the activity to be provided by the HSE next year as well as informing the number of new staffing positions that will need to be created in 2019.

Health Services Provision

Questions (100)

Seán Barrett

Question:

100. Deputy Seán Barrett asked the Minister for Health if there has been progress in respect of services for venesection patients with haemochromatosis; if the issue of the €80 fee that these persons must pay when they have to attend outpatient departments is being considered in the context of the overall general practitioner contract review process (details supplied); and if he will make a statement on the matter. [43276/18]

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Written answers

The issue of the provision of therapeutic phlebotomy services for hereditary haemochromatosis patients, including the issue of charges, is currently under consideration by my Department and the HSE. It is agreed that such services should be provided at the lowest level of complexity that is clinically and operationally feasible. In time it is envisaged that the majority of this work will be done in a primary care setting.

Also, my Department and the HSE recently re-engaged with the Irish Medical Organisation to set out the State's position in relation to reform of the GMS contract. The provision of therapeutic venesection services for medical and GP visit card holders is being considered as part of the consultations.

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