Written Answers Nos. 189-213
189. Deputy Michael Harty asked the Minister for Health his plans to appoint an independent expert to examine claims contained in new documentation given to him regarding missing blood samples that were taken for an investigation (details supplied); if the independent expert will also advise if a public inquiry is warranted; and if he will make a statement on the matter. [49617/18]
View answerCorrespondence received from the Deputy on this matter is being examined by my Department and a response will issue once this is completed.
190. Deputy Mattie McGrath asked the Minister for Health the areas that will be addressed under the general scheme and heads of the human tissue Bill; and if he will make a statement on the matter. [49645/18]
View answerThe General Scheme of the Human Tissue (Transplantation, Post-Mortem, Anatomical Examination, and Public Display) Bill will include provisions on:
- Organ donation and transplantation;
- Post-mortem practices;
- Anatomical examination (including medical education and training); and
- Public display of bodies after death.
191. Deputy Seán Haughey asked the Minister for Health the status of an application by a person (details supplied) in respect of the early intervention team; and if he will make a statement on the matter. [49646/18]
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.
192. Deputy Clare Daly asked the Minister for Health further to Parliamentary Question No. 108 of 10 October 2018, when a substantive response from the HSE is likely to issue. [49651/18]
View answerAs this is a service matter I have asked the HSE to respond directly to the Deputy on this matter.
193. Deputy Stephen S. Donnelly asked the Minister for Health when a detailed action plan to implement Sláintecare will be published. [49668/18]
View answerThe detailed 2019 Action Plan to implement Sláintecare is currently in the process of being compiled. It is linked with service plan discussions with the HSE. The action plan will be submitted, before year end, to the High Level Delivery board comprised of the Secretaries General of the Departments of Health, Taoiseach and Public Expenditure and Reform, the CEO of the HSE and the Sláintecare Executive Director. Following its consideration of the Action Plan, the Board will submit the plan to me and I expect to publish it shortly thereafter.
194. Deputy Pearse Doherty asked the Minister for Health the number of children awaiting an initial assessment as part of CAMHS for 3, 6, 9, 12, 15 and more than 15 months, respectively by CHO area, in tabular form; and if he will make a statement on the matter. [49671/18]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
195. Deputy Bernard J. Durkan asked the Minister for Health when a homecare package will be provided in the case of a person (details supplied); and if he will make a statement on the matter. [49677/18]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
196. Deputy Stephen S. Donnelly asked the Minister for Health when the multi-annual unscheduled care plan will be published. [49678/18]
View answerIn line with the Sláintecare implementation strategy, the HSE is developing a three year unscheduled care plan, the first element of which will be the implementation of measures at acute hospital and community level to achieve an initial increase in capacity.
In this context, €10 million in funding is being made available in 2019 to increase acute bed capacity in line with the recommendations of the Health Service Capacity Review. My Department is currently in discussion with the HSE, in the context of the National Service Plan 2019, to identify the sites for investment and the associated number of beds, as part of an agreed capacity programme for 2019.
The selection and opening of beds on specific sites in 2019 and future years will be considered as part of the annual estimates and service planning process, and subject to financial, operation, human resource and policy considerations and priorities.
197. Deputy Stephen S. Donnelly asked the Minister for Health if he will report on the determination and progress of priority objectives for general practitioner contractual reform. [49679/18]
View answerThe Department and HSE recommenced engagement with the Irish Medical Organisation (IMO) in early October on a package of measures comprising service improvements and contractual modernisation and reform.
The goal is to develop a contractual framework that has a population health focus, providing in particular for health promotion, disease prevention and for the structured care of chronic conditions. This will enable general practitioners to better meet the needs of patients and will also promote general practice as a viable and rewarding career for both existing doctors and future medical graduates.
Agreement on the delivery of these service improvements and contractual reforms has the potential to facilitate a substantial increase in the resourcing of general practice on a multiannual basis.
In line with the long established approach to such processes, and by agreement of the parties concerned, I am not in a position to give further details at this stage.
198. Deputy Stephen S. Donnelly asked the Minister for Health if he will report on the implementation of a patient safety, complaints and advocacy policy. [49680/18]
View answerThe Department of Health has been engaged in the development of policy in relation to the areas of Patient Safety, Complaints and Advocacy for considerable period of time. Notably, in December 2015, the Government approved the establishment of a new Patient Safety Office to bring forward legislation and provide the policy lead for patient safety.
Patient Safety Complaints and Advocacy Policy
In approving the Memorandum to Government on Patient Safety, the Government also directed the National Patient Safety Office in the Department of Health to undertake:
- A review, in association with the Health Service Executive, the Office of the Ombudsman and the Department of Public Expenditure and Reform, of S.I. No. 652/2006 Health Act (Complaints Regulations 2006 with a view to enhancement of the statutory provisions for management of complaints within the health services;
- Establishment of a patient advocacy service.
Public Consultation for the Patient Safety Complaints and Advocacy Policy took place between June and November of 2017 and a report of its findings was published in July 2018.
Following on from that work, a tender was recently commissioned seeking bids for the establishment of a new Patient Safety Advocacy Service, with the successful tenderer expected to be announced before the end of this year.
Work has also been undertaken to develop a competency framework, and a training programme, that will be available to the advocates that will be employed by the new service. This will be available in early 2019, and will ensure that competent and trained advocates are provided to work in the service.
The Patient Safety Advocacy Service will provide free and independent advocacy for anyone wishing to make a formal complaint about the care or treatment they received in the health service and for anyone who has been involved in a patient safety incident. The service will initially be provided for in the public acute hospital sector and will then extend to the community.
Simultaneously, my Department is continuing to review Statutory Instrument No. 652/2006 - Health Act 2004 (Complaints) Regulations 2006 with a view to enhancement of the statutory provisions for management of complaints within the health services and to consider the inclusion of clinical judgment in healthcare complaints. This review process will also encompass inputs from the Health Service Executive, the Office of the Ombudsman and the Department of Public Expenditure and Reform. It is expected that this process will be finalised in 2019.
Patient Safety Legislation Programme
My Department is committed to driving openness and transparency to ensure patient safety. I believe that all staff must be open and honest with patients. Patient safety is fundamental to the delivery of quality healthcare and to public confidence in the health system and open disclosure is an integral element of patient safety incident management and learning.
In line with international best practice, my Department has been driving a progressive legislative framework to build an open and just culture for patient safety which balances the need for an open and honest reporting culture that facilitates a learning environment, and quality healthcare with accountability for both individuals and organisations. Disclosure and reporting are opportunities to learn, to improve, to address errors that have happened and to apply the lessons to make the service safer for the next patient and the patient after that.
Civil Liability (Amendment) Act 2017
Part 4 of the Civil Liability (Amendment) Act 2017 provides the process and procedures for open disclosure. The Act of 2017 covers the open disclosure of all patient safety incidents, unintended and unanticipated, including near misses. It provides provisions to create a safe space for staff to be open and transparent with patients in order that they would be given as much information as possible, as early as possible, including an apology where appropriate. The Commencement of Part 4 of the Act and the Civil Liability (Open Disclosure) (Prescribed Statements) Regulations 2018, came into effect on 23rd September 2018.
During the Report Stage debate of these provisions, I also committed to examining how legislation could be expedited to provide for mandatory open disclosure to patients of serious incidents.
Patient Safety Bill
The general scheme for the Patient Safety Bill provides the legislative framework for a number of important patient safety issues, including: mandatory open disclosure of serious patient safety incidents and the notification of same, clinical audit guidance against explicit clinical standards on a national basis and the extension of the Health Information Quality Authority remit to private hospitals.
The General Scheme of the Patient Safety Bill is intended to provide clarity and assurance regarding the requirement for open disclosure to patients and or their family with regard to serious patient safety incidents, the management of the incident itself and the need to ensure the dissemination of any learning from the review of the incident across the whole health system. This is further facilitated by the requirement for mandatory external reporting of those same incidents by health service providers to the appropriate regulatory authority and the State Claims Agency. The general scheme of the Patient Safety Bill underwent pre-legislative scrutiny at the Oireachtas Joint Committee on Health on the 26 September 2018 and is currently being drafted by the Office of the Parliamentary Council.
Patient Safety Licensing Bill
In addition to the legislation described above, my Department is also progressing a Patient Safety Licensing Bill. This will for the first time introduce a requirement to hold a licence in order to operate a hospital and will apply to both the public and the private sector. It will also be a requirement to hold a licence in order to carry out certain high-risk activities outside of a hospital setting, which will be designated by the Minister for Health. HIQA will be the licensing authority.
Once enacted, those entities in possession of a licence will have to operate in accordance with Ministerial regulations, so that there will be assurance that appropriate standards of clinical governance are being adhered to. This will also include a requirement to engage in open disclosure, as required.
Establishment of a Surveillance System
Research of patient safety frameworks in place internationally has been undertaken and the outputs of this are being evaluated for their applicability or relevancy to the Irish healthcare context. This research will inform the scoping work for the development of a national patient safety surveillance system. This patient safety surveillance system will build upon work already undertaken through the National Healthcare Quality Reporting System, the National Patient Experience Survey, Maternity Patient Safety Statements and Hospital Patient Safety Indicator Reports.
Clinical Effectiveness measures
The National Clinical Effectiveness Committee, the NCEC, also continues to lead an ambitious work programme. This year saw the publication of National Clinical Guidelines for the Management of Type 1 Diabetes and the early warning system for the Emergency Department that focuses on clinical deterioration of patients. There are now eighteen NCEC National Clinical Guidelines in the suite providing evidence-based guidance to clinical staff across the health service. In addition, the NCEC has published 2 guidance documents and tool-kits; one on public involvement in clinical effectiveness and another on implementation of clinical guidelines. Aligning levers of policy and implementation help create a more integrated and evidence based approach to patient safety.
199. Deputy Stephen S. Donnelly asked the Minister for Health when the Sláintecare executives task force will be appointed; and if he will make a statement on the matter. [49681/18]
View answerThe Sláintecare Programme Office is currently in the process of compiling a detailed action plan for 2019. As part of this process the lead executives with responsibility for each action will be identified. Following on from this the Executives Task Force will be established and will be chaired by the Executive Director of the Sláintecare Programme Office.
The role of the Executives Task Force will be to ensure a coordinated, integrated and effective approach to implementation of the reform programme.
200. Deputy Stephen S. Donnelly asked the Minister for Health if he will report on the expansion of activity based funding for inpatient and day cases to other acute hospitals during 2018. [49682/18]
View answer201. Deputy Stephen S. Donnelly asked the Minister for Health if he will report on the examination of the use of activity based funding for outpatient services. [49683/18]
View answerI propose to take Questions Nos. 200 and 201 together.
An Irish Outpatient classification system (IOCS) has been created based on the Australian Tier 2 Non-admitted and Sub-acute care classification. A pilot project collecting Outpatient data at the patient level has commenced in 10 hospitals. This is the first time that Outpatient data is being collected at individual patient level. The purpose of the pilot project is to determine if the Outpatient data currently in the system is robust enough to implement Activity Based Funding (ABF). This pilot is ongoing. However, the introduction of a new Patient Administration System ( IPIM’s) in a number of hospitals has impacted on the pilot by causing amendments to the mapping of clinics to the classification system.
Currently 39 of 48 public acute hospitals are using ABF for Inpatient and daycase activity. These 39 hospitals account for in excess of 91% of national activity. Feasibility studies will be carried out to determine which, if any, of the remaining hospitals are suitable for inclusion in the ABF model with two more expected to be brought into the model next year. It should be noted that not all acute hospitals may be suitable for ABF and it is the norm in other jurisdictions for smaller hospitals to continue to be funded by way of block grants.
202. Deputy Stephen S. Donnelly asked the Minister for Health if a governance review of the drugs approval and procurement process has taken place; and the status of same. [49684/18]
View answerMy Department is currently preparing a mini-tender to appoint an external firm to undertake a review of the HSE governance of the drugs assessment process. This will be undertaken by the Department in conjunction with the Office of Government Procurement.
The successful tenderer will complete a review of the governance arrangements and resources in place in the HSE to support decision-making on reimbursement applications from drug companies. In particular, the review will examine governance arrangements (including the systems, structures) and the resources (e.g. the National Centre for Pharmacoeconomics), which support the decision-making process for the consideration of an application.
203. Deputy Róisín Shortall asked the Minister for Health the number of children on waiting lists for preliminary team assessments by CHO area, age category and time waiting. [49685/18]
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.
I understand that the Deputy's question relates to waiting lists for Assessment of Need. As this is a service matter, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
204. Deputy Róisín Shortall asked the Minister for Health the number of preliminary team assessments carried out by LHO area in each of the past five years; and the proportion of those that have been provided with additional services based on the results of the assessments. [49686/18]
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.
I understand that the Deputy's question relates to Assessments of Need carried out by CHO area. As this is a service matter, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
205. Deputy Willie O'Dea asked the Minister for Health when a clinical specialised MS nurse will be provided at University Hospital Limerick (details supplied); and if he will make a statement on the matter. [49691/18]
View answerAs this is a service issue, I have asked the HSE to reply to you directly.
206. Deputy Bernard J. Durkan asked the Minister for Health the details of living expenses which are taken into account for persons that are applying for the fair deal; and if he will make a statement on the matter. [49697/18]
View answerThe Nursing Homes Support Scheme (NHSS) is a system of financial support for those in need of long-term nursing home care. Participants contribute to the cost of their care according to their income and assets while the State pays the balance of the cost. The Scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings.
Participants in the Scheme contribute up to 80% of their assessable income and a maximum of 7.5% per annum of the value of assets held. In the case of a couple, the applicant’s means are assessed as 50% of the couple’s combined income and assets. The first €36,000 of an individual’s assets, or €72,000 in the case of a couple, is not counted at all in the financial assessment. The capital value of an individual’s principal private residence is only included in the financial assessment for the first three years of their time in care. This is known as the three year cap.
Under the primary legislation an NHSS applicant may apply for certain items of expenditure to be taken into account and netted off against their means prior to the calculation of their contribution. These items are referred to as allowable deductions. An applicant can apply for the following to be deducted:
- Health Expenses such a doctors' fees, pharmacy costs and prescription charges;
- Interest on loans related to the applicant’s principal residence;
- Certain rent payments on the principal residence of the applicant;
- Property Tax and levies required by law to be paid;
- Maintenance payments as part of a separation agreement; and
- Child care costs.
207. Deputy Mick Wallace asked the Minister for Health if he is considering reforms to the fair deal scheme which would ring fence the funds raised by the sale of homes after paying contributions to the scheme after a certain period of years and which would help older persons that sell their homes to avoid handing over the entire sum of the proceeds of the sale of their home to cover their nursing home costs. [49702/18]
View answerMy officials are engaging with their counterparts in the Department of Housing, Planning and Local Government (DHPLG) and are currently examining the issue of vacant homes that arise when an individual enters long term care under the NHSS.
I am not in a position, however, to provide detail on these as discussions are ongoing and any potential proposals have not been finalised.
208. Deputy Michael Healy-Rae asked the Minister for Health the status of a hospital appointment for a person (details supplied); and if he will make a statement on the matter. [49722/18]
View answerUnder 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.
209. Deputy Louise O'Reilly asked the Minister for Health the number of vacant posts in whole-time equivalent terms in CAMHS for each CHO in tabular form. [49727/18]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
210. Deputy Louise O'Reilly asked the Minister for Health the staffing levels for CAMHS teams by CHO; and the way in which this compares with the necessary full complement of staff as outlined by A Vision for Change. [49728/18]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
211. Deputy Louise O'Reilly asked the Minister for Health the number on waiting lists for CAMHS by county; the number waiting zero to three, three to six, six to nine, nine to 12, 12 to 18 and more than 18 months, respectively in tabular form; and if he will make a statement on the matter. [49729/18]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
212. Deputy Louise O'Reilly asked the Minister for Health the number on waiting lists for CAMHS monthly in 2016, 2017 and to date in 2018, by county in tabular form. [49730/18]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
213. Deputy Noel Rock asked the Minister for Health if patients are being mandatorily screened for sepsis in hospitals; if not, his plans to implement mandatory screenings in the near future; and if he will make a statement on the matter. [49731/18]
View answerAs this is a service matter, the question has been referred to the Health Service Executive for attention and direct reply to the Deputy.
