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Tuesday, 18 Dec 2018

Written Answers Nos. 435-453

Psychological Services Waiting Lists

Questions (435)

John Brady

Question:

435. Deputy John Brady asked the Minister for Health the position of a person (details supplied) on the waiting list to see a psychiatrist at Enniscorthy child and adolescent mental health service, CAMHS; the length of time the person has been on the waiting list; and if he will make a statement on the matter. [53248/18]

View answer

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.

Medical Aids and Appliances Provision

Questions (436)

Jan O'Sullivan

Question:

436. Deputy Jan O'Sullivan asked the Minister for Health if the use of transvaginal mesh will not be sanctioned for use again unless there has been a detailed scientific examination of its use that would justify such a decision; if survivors who have ongoing health issues as a result of its use can receive the treatment they require; and if he will make a statement on the matter. [53250/18]

View answer

Written answers

In late 2017, concerns were brought to my attention about the frequency and severity of complications associated with the use of mesh devices in the surgical treatment of Stress Urinary Incontinence (SUI) and Pelvic Organ Prolapse (POP) in women in Ireland; the regulation and audit of their use; the extent of use of these devices in Ireland and the availability of services for women affected by mesh-associated complications, including through the tabling of several Parliamentary Questions.

In responding to these questions and in recognition of the complexity of the matters arising, I requested the Chief Medical Officer (CMO) to prepare a report for me on the clinical and technical issues involved in ensuring both:

a) the safe and effective provision of mesh procedures in urogynaecology and

b) an appropriate response to women who suffer complications as a result of undergoing such procedures.

The Report, entitled The Use of Uro-gynaecological Mesh in Surgical Procedures, has now been presented to me and was published on the 21st November 2018 on the Department of Health website.

The report provides a brief background description of mesh implant devices, including the complications associated with their use; and summarises international best practice in the use of mesh procedures in the clinical management of SUI and POP. A range of recommendations for action by the HSE in collaboration with other stakeholders is identified, to provide assurance that the use of mesh implants and the care of women requiring aftercare in Irish hospitals is in line with emerging evidence and best practice internationally, based on expert advice received and review of international experience.

Methodology

Preparation of the report has involved consultation and engagement with national and international bodies, including the Health Products Regulatory Agency (HPRA); the relevant professional training bodies, the Institute of Obstetricians and Gynaecology (IOG) and the Royal College of Surgeons in Ireland (RCSI); the Continence Foundation of Ireland (CFI) and the Health Service Executive (HSE), as well as colleagues in other jurisdictions. The report has been informed by review of international reports and safety reviews of mesh surgery which have been published in recent years. The report has also been informed by the personal experiences of women who have suffered complications following mesh surgery.

I wish to acknowledge the bravery, commitment and dignity shown, by the women that met with me and by those women who have written to me concerning this issue, in sharing what were harrowing, deeply personal experiences.

It is important to note that the views of the many women who have undergone mesh procedures and have had satisfactory outcomes, with minor or no complications, have not been formally sought and so are not reflected in this report. Also, following the implementation of a pause in mesh procedures by the HSE in July 2018, as described in Section 2, a number of women whose procedures were postponed made representations to the Department expressing concern at the impact that this has on them personally as they await treatment for the distressing symptoms of SUI, reflecting another important group of women affected directly by this issue.

Report Findings

The report makes a number of overall findings, in addition findings are presented which relate to informed consent, aftercare of women with complications, clinical and professional issues and information issues. The findings are:

Overall Findings

- Mesh implant devices are certified as compliant with relevant European Union (EU) legislation and no market action against mesh devices for the treatment of SUI or POP has been taken by any of the European device regulatory competent authorities.

- There is an extensive evidence base supporting (i) the use of the mid-urethral sling (MUS) devices in the treatment of SUI and (ii) the use of abdominally placed mesh in the management of POP. A significant majority of patients benefit greatly from these procedures, with reduced long-term complications and improved functional outcomes compared to non-mesh procedures.

- Mesh procedures should be performed by trained personnel, in patients who are appropriately selected and counselled and when appropriate multidisciplinary expertise and clinical governance mechanisms are in place.

- Transvaginal placement of mesh for the treatment of POP is no longer regarded as appropriate first line treatment. Its use is restricted by clinical guidance in some jurisdictions. Regulatory restrictions on its use are in place in Australia and New Zealand.

- Mesh devices are associated with significant and severe complications in a minority of women, which are of concern given the difficulties of mesh implant removal.

- Many other health systems, including the United Kingdom (UK), Australia and the Netherlands have implemented specific measures in recent years to ensure appropriate use of mesh procedures in the treatment of SUI and POP and to ensure appropriate aftercare for women suffering mesh complications.

Informed Consent

- As would be usual with many surgical conditions, standardised information resources were not available at national level to ensure that all patients receive consistent information about the benefits and risks of mesh devices, to advise of other treatment options and to support informed consent processes.

- Many women reported that they were not informed of other treatment options; they had not been informed that their surgeries involved the use of mesh; they were not informed of mesh complications; and they were not made aware of the difficulties associated with mesh removal or with the treatment of long-term mesh complications.

Aftercare of Women with Complications

- Structured treatment or referral pathways were not evidently in place for the minority of women requiring specialist, multidisciplinary care for serious complications following mesh surgery.

- Some women reported considerable difficulty in accessing timely, compassionate and appropriate specialist aftercare for complications.

- Some women reported that individual clinicians responded to their personal concerns in an inappropriate manner which greatly added to their distress. Women also reported feeling that they were not believed, or that their clinicians minimised or did not understand the severity of their complications.

Clinical and Professional Issues

- Governance mechanisms are not in place at national level to provide assurance that mesh surgeries are carried out in accordance with agreed international best practice and clinical guidance.

- There is no mandated professional clinical guidance at national level to guide the use of mesh implants in the management of SUI or POP or to guide the management of women with complications.

- Communication mechanisms currently in place at national level between the HPRA, healthcare providers and professional bodies do not provide assurance that the findings and recommendations of safety reviews such as those circulated by the HPRA in recent years regarding mesh implants are systematically analysed and acted upon where appropriate.

Information

- There are significant gaps in knowledge about current practice in Ireland regarding the use of urogynaecological mesh implants.

- Routinely collected clinical information at national level does not provide the capacity for monitoring or audit of mesh surgeries for the treatment of SUI and POP.

- Based on international experience, there is under-reporting of adverse events relating to mesh surgeries by clinicians to both the HPRA and to the National Incident Management System (NIMS) operated by the State Claims Agency (SCA).

Recommendations

Nineteen recommendations in total are identified throughout the report in response to the findings above:

- Patient Information and Consent – 2 recommendations

- Aftercare for Women Suffering Complications – 5 recommendations

- Clinical and Professional Recommendations – 8 recommendations

- Information Recommendations – 5 recommendations

These include recommendations about the development of patient information and informed consent materials to ensure appropriate patient selection and counselling, ensuring clinical and professional standards of practice are met by ensuring that all surgeons have undergone appropriate surgical professional training and ensuring that appropriate multidisciplinary expertise is available in units carrying out mesh procedures, the development of clinical guidance for the management of SUI and POP, the development of information resources to monitor the ongoing use of mesh devices and to permit long-term research and audit of practice, ensuring the reporting of mesh related complications, and ensuring timely, appropriate and accessible care pathways for the management of women with complications.

Full implementation of the report’s recommendations will provide significant assurance that all patients presenting for treatment for SUI and POP and all women who develop mesh-related complications receive high quality, patient centred care in accordance with accepted evidence and supported by robust clinical governance mechanisms.

Actions to date

A number of important interim system actions to address the safety and effectiveness of mesh implant use have been progressed in advance of completion of the report.

1. Pause on all uro-gynaecological mesh procedures

On July 24th, 2018, the HSE was requested by the CMO to pause all uro-gynaecological mesh procedures, in cases where it is clinically appropriate and safe to do so, pending confirmation by the HSE of the implementation of recommendations relating to (i) professional training requirements, (ii) patient information and consent and (iii) the development and maintenance of a national data set for all mesh procedures carried out in HSE funded hospitals. The request to institute a pause in vaginal mesh procedures was considered proportionate and necessary to address public and patient concern about the ongoing safety of mesh devices as comprehensively as possible.

2. Development of patient information and consent materials

Prior to this request, in May 2018, the HSE had been requested to begin work immediately on the development of national standardised patient information and informed consent materials and the clarification and development of treatment pathways and appropriate referral services for women suffering serious complications.

3. Learning Notice on mesh devices

A Learning Notice concerning mesh devices in uro-gynaecological procedures was circulated by the National Women and Infants’ Health Programme (NWIHP) on 26th June 2018 to all maternity hospitals and acute hospitals with gynaecological services to highlight the importance of appropriate patient selection, adequate information and consent and also to inform the service providers that a Response Group has been convened to propose remedies for and address the provision of aftercare for complications. This learning notice has been posted on the NWIHP website.

https://www.hse.ie/eng/about/who/acute-hospitals-division/woman-infants/quality-and-safety/learning-notice-0518-transvaginal-mesh.pdf

4. Synthetic Mesh Devices Group

A Synthetic Mesh Devices Advisory Group has been convened by the NWIHP which includes three patient representatives, as well as representatives of the HPRA, the IOG, the RCSI, the CFI and all Hospital Groups, to advise on and progress all the interim recommendations as advised to the HSE in May 2018 and in July 2018. To ensure that the spectrum of views of women affected by mesh safety concerns is represented, the three patient representatives include Ms Melanie Power, representative of Mesh Survivors Ireland; as well as a woman who has had a successful outcome of mesh surgery for the treatment of SUI and a woman who is on the waiting list for surgery (currently paused).

I am informed that a work programme for the development of appropriate patient information resources and consent materials, the clarification and development of treatment pathways and appropriate referral services for women suffering from mesh-related complications including access to specialist diagnostic facilities such as translabial scanning is being progressed through this Group. The work being progressed by the HSE will include identifying the appropriate specialist clinical expertise and facilities required at hospital group level and nationally to provide comprehensive aftercare services. Pending the completion of this, the HSE will also examine the need to look at sourcing services from abroad to address any immediate shortfalls identified, either through utilisation of the treatment abroad scheme or by commissioning services from abroad.

Next Steps

As requested by the CMO in July 2018, the pause in the use of mesh procedures for the management of SUI and POP in HSE-funded hospitals is ongoing, in cases where it is clinically appropriate and safe to do so, pending confirmation by the HSE of the implementation of recommendations.

The Department of Health has written to the HSE to request that it prepare a detailed Implementation Plan for the complete set of recommendations set out in the CMO’s Report, working in conjunction with other stakeholders.

As promised at my meeting with Mesh Survivors Ireland on June 14th 2018, I provided the group with a copy of the CMO’s Report on the date of publication and a date will be arranged for a further meeting with the group in the near future.

Vaccination Programme

Questions (437)

Niamh Smyth

Question:

437. Deputy Niamh Smyth asked the Minister for Health if a person and 400-plus girls here suffering adverse health effects from Gardasil relating to a treatment clinic (details supplied) will receive compensation in relation to same; and if he will make a statement on the matter. [53251/18]

View answer

Written answers

The Health Service Executive is committed to providing accurate information for parents about diseases, the vaccines to prevent them and potential side effects to allow them to choose whether or not to give consent to vaccination.

The HSE's National Immunisation Office has developed a comprehensive range of materials for parents, schools and medical practitioners as part of the immunisation programme. All the information provided to parents about vaccination takes into account the available licensed documentation for each vaccine, the Summary of Product Characteristics (SPC) and Patient Information Leaflet (PIL).

The Patient Information Leaflet provides information on the vaccine, its uses and on any precautions that require advice from a healthcare professional before it is administered. Therefore, like other countries providing school immunisation programmes, the Patient Information Leaflet is replaced by an information leaflet which provides the same information on the potential side effects of the vaccine in a manner that ensures that it is easily understood.

The information is presented in clear and simple language which has been approved by the National Adult Literacy Agency, ensuring that it can be understood by all adults. The Health Information and Quality Authority guide ‘Communicating in plain English’ (2015), developed in partnership with NALA, states that “one in six people find reading and understanding everyday texts difficult: for example, reading a health leaflet, bus timetable or medicine instructions”.

Prior to all school immunisations, parents receive an information pack in a sealed package with an information leaflet, consent form and cover letter. The information packs for all immunisations are standardised nationally. The information booklets include information on all the known potential side effects that can occur after each vaccination (as is the case with the HPV vaccine, Gardasil). Parents are also given contact details for their local immunisation office and advised to speak to a member of the school immunisation team if they have any further questions.

It is not the case that parents are being denied the information on the Patient Information Leaflet. In fact, the HSE parent information leaflet refers parents to the HPV website (hpv.ie) where links to additional information including the licensing documentation, the Summary of Products Characteristics and the Patient Information Leaflet for each vaccine can be found. The HPV website has been endorsed by the World Health Organisation.

The Health Products Regulatory Authority (HPRA) is responsible for monitoring the safety and quality of all medicines including vaccines that are licensed in Ireland. The HPRA operates a national adverse reaction reporting system, which members of the public and healthcare professionals are encouraged to submit any suspected adverse reactions to. All Reports received by the HPRA are routinely transmitted to the European Medicines Agency's adverse reaction database for inclusion in global signal detection and monitoring activities.

The HPRA and the European Medicines Agency (EMA) continually monitor adverse events relating to vaccination. Gardasil is one of the most closely studied and monitored medicinal products. The vast majority of reports received by the HPRA have been consistent with the expected pattern of short term adverse side effects for the vaccine, as described in the product information. The most frequently reported side effects are local redness and/or swelling at the point of injection and fever. Fainting has occurred after vaccination with Gardasil, especially in adolescents. Mild and temporary reactions to any kind of vaccination are not unusual.

It is important to reiterate that all medicines, including vaccines are subject to on-going review and evaluation of all available data from a range of sources, including systematic scientific literature review, to consider any impact that their data may have on the overall assessment of the benefits and risks of a medicinal product. Taking into account the totality of the available information, the benefits of the HPV vaccines continue to outweigh their risks. The safety of these vaccines continues to be monitored at EU level through the EMA and its expert committees, which includes representatives from member state competent authorities such as the HPRA.

I would also like to reassure any persons who are suffering ill health that they are eligible to seek medical attention, and to access appropriate health and social care services, irrespective of the cause of their symptoms. As there is no scientific evidence that the vaccine causes long term illnesses, the HPV vaccine cannot be held responsible for these illnesses.

I would urge any parent who has doubts or questions about vaccination to engage with their family doctor, or alternatively to visit the HPV website: hpv.ie.

Respite Care Services Provision

Questions (438)

Niamh Smyth

Question:

438. Deputy Niamh Smyth asked the Minister for Health if a matter (details supplied) regarding respite facilities in County Cavan will be addressed; and if he will make a statement on the matter. [53252/18]

View answer

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.

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.

Nursing Homes Support Scheme Review

Questions (439)

Bobby Aylward

Question:

439. Deputy Bobby Aylward asked the Minister for Health the status of the review of the system for setting prices under the nursing home support scheme; if he is satisfied that the process has been conducted in an efficient manner; and if he will make a statement on the matter. [53254/18]

View answer

Written answers

The Nursing Homes Support Scheme (NHSS), commonly referred to as Fair Deal, is a system of financial support for people who require long-term residential care. Participants contribute to the cost of their care according to their means 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.

The Report of the NHSS Review published in 2015 identified a number of issues for more detailed consideration, including a review of the pricing mechanism used by the NTPF, with a view to:

- Ensuring value for money and economy, with the lowest possible administrative costs for clients and the State and administrative burden for providers;

- Increasing the transparency of the pricing mechanism so that existing and potential investors can make as informed decisions as possible; and

- Ensuring that there is adequate residential capacity for those residents with more complex needs.

A Steering Group was established to oversee and manage the pricing review. The Steering Group is chaired by the NTPF and includes representatives from the Department of Health and the Department of Public Expenditure and Reform (DPER). As part of its work on the review the NTPF sought various inputs including external expertise and stakeholder engagement to inform the review. These inputs are being considered in detail.

The last meeting of the Steering Group was held on the 24th of October 2018 where the range of inputs were further shared and discussed. The NTPF are now close to completing the report and aim to have an updated and close to final draft with the Steering Group before year end. The Steering Group will meet to discuss the draft and next steps early in the new year with a view to completing the review in early course.

The report of the review will then be submitted to the Department.

Services for People with Disabilities

Questions (440)

Seán Fleming

Question:

440. Deputy Sean Fleming asked the Minister for Health if service providers will meet with a family to discuss the long-term needs of a person (details supplied); and if he will make a statement on the matter. [53283/18]

View answer

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.

As the Deputy's question relates to an individual case, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.

Dental Services

Questions (441, 445)

Seán Fleming

Question:

441. Deputy Sean Fleming asked the Minister for Health the position regarding the development of a new oral health policy; when it is expected to be completed and published; and if he will make a statement on the matter. [53284/18]

View answer

Seán Fleming

Question:

445. Deputy Sean Fleming asked the Minister for Health the person or body that has commissioned the new oral health policy; if it will be provided; if the work is being carried out by an independent organisation (details supplied); and if he will make a statement on the matter. [53310/18]

View answer

Written answers

I propose to take Questions Nos. 441 and 445 together.

The new National Oral Health Policy is being developed by my Department. The Policy is evidence-informed and aligns with relevant national and international policies and approaches.

The work has drawn on a wide range of inputs including deliberations of oral healthcare professionals through a series of working groups, detailed research and service user surveys which were commissioned to inform the work, consultation with a range of dental and oral health organisations and engagement on specific topics with dental practitioners. The resources of the Dental Health Foundation were utilised to assist with certain elements of policy development.

The aim of the policy is to develop a model of care that will enable preventative approaches to be prioritised, improve access, and support interventions appropriate to current and future oral health needs. It is currently being finalised and I expect it will be published early in 2019.

Health Services Provision

Questions (442)

Seán Fleming

Question:

442. Deputy Sean Fleming asked the Minister for Health the position regarding a redevelopment project (details supplied); and if he will make a statement on the matter. [53285/18]

View answer

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 Procedures

Questions (443)

John McGuinness

Question:

443. Deputy John McGuinness asked the Minister for Health if intensity-modulated radiation treatment as recommended by a consultant will be arranged and expedited in the case of a person (details supplied). [53299/18]

View answer

Written 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.

HIQA Investigations

Questions (444)

Seán Fleming

Question:

444. Deputy Sean Fleming asked the Minister for Health if HIQA has been given authority to carry out inspections as a result of complaints from a person. [53305/18]

View answer

Written answers

The Health Information and Quality Authority (HIQA) is an independent authority established to drive high-quality and safe care for people using our health and social care services in Ireland. HIQA’s role is to develop standards, inspect and review health and social care services and support informed decisions on how services are delivered. HIQA's role includes monitoring the safety and quality of health services and investigating as necessary serious concerns about the health and welfare of people who use these services.

HIQA does not investigate individual complaints, however the Department understands from HIQA that concerns it receives are used to inform its inspection and monitoring processes, informing the risk profile for the service and where appropriate are passed on to the relevant bodies.

Under the Health Act 2007, HIQA is responsible for developing standards for the quality and safety of healthcare services and for monitoring compliance with those standards. Under the Act, HIQA also has responsibility to investigate the safety, quality and standards of healthcare services if it believes that there is a serious risk to the health and welfare of patients.

Persons who have an individual complaint about a service can do this by contacting the person in charge of delivering the service or a complaints officer within the service.

Detailed information on how to make a complaint or give feedback about health and social care services in Ireland can be found at www.healthcomplaints.ie. This service has been developed for people who use health and social care services in Ireland, as well as for their families, care-givers and advocates. The HSE has an established mechanism to enable the making of a complaint through the Your Service, Your Say process. In addition, the Ombudsman also has a role in the investigation of individual complaints, as do professional regulatory bodies such as the Medical Council and the Nursing and Midwifery Board of Ireland. The appropriate pathway for making a complaint is dependent on the particular issue of concern.

Question No. 445 answered with Question No. 441.

Departmental Funding

Questions (446)

Seán Fleming

Question:

446. Deputy Sean Fleming asked the Minister for Health the funding available from his Department and the Health Service Executive, HSE, to an organisation (details supplied); and if he will make a statement on the matter. [53311/18]

View answer

Written answers

The Dental Health Foundation has received funding of almost €215,000 from the Department of Health this year for the provision of secretariat services to the Irish Expert Body on Fluorides and Health including staffing and office costs.

The Dental Health Foundation's Financial Statement for 2017 is published on its website and indicates that it received funding of over €308,000 from the HSE in 2017.

Services for People with Disabilities

Questions (447)

Richard Boyd Barrett

Question:

447. Deputy Richard Boyd Barrett asked the Minister for Health if a service (details supplied) will remain available in view of a recent review of same; if, after the recent review of the service, the five-days-a-week 9 a.m. to 5 p.m. drop-in service that has been available to service users in CHO 6 for the past ten years will remain available; and if he will make a statement on the matter. [53318/18]

View answer

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.

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.

Services for People with Disabilities

Questions (448)

Richard Boyd Barrett

Question:

448. Deputy Richard Boyd Barrett asked the Minister for Health if his Department was involved in the plans for a new centre (details supplied) in Dublin 24; if the business plan was reviewed; if funding was contributed; and if he will make a statement on the matter. [53319/18]

View answer

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.

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.

Home Care Packages Provision

Questions (449)

John Curran

Question:

449. Deputy John Curran asked the Minister for Health the progress made to date regarding the development of a new statutory home care scheme; and if he will make a statement on the matter. [53346/18]

View answer

Written answers

The Department of Health is currently developing policy proposals for the future financing and regulation of home-support services. The recently published Sláintecare Implementation Strategy commits to the introduction of the new statutory scheme in 2021.

The new scheme will introduce clear rules in relation to the services for which individuals are eligible and in relation to service-allocation. The system of regulation for home-support will help to ensure that the public can be confident that the services provided are of a high standard. The new scheme will be designed to support family/unpaid carers and will be integrated with other health and social care services, such as long-term residential care (including the Nursing Homes Support Scheme), primary and community care, and hospital services.

As an initial step in the development of the new scheme, the Department of Health commissioned the Health Research Board to undertake a review of the home-care systems in place in four European countries. The review, which was published last April, will help to ensure that Ireland’s new home-care scheme and system of regulation is informed by international experience. In addition a public consultation on the financing and regulation of home-care was undertaken last year. A report on the findings of the consultation was published on 26th June and will inform the development of the new scheme.

The Department is also progressing various work-streams in order to deliver on the goal of implementing the statutory scheme. On-going work includes research to inform the conceptualisation of the overarching aim, objectives, actions and outcomes of the statutory scheme and the compilation of the data required for a review of the management, operation and funding of existing services. Further consultation will take place as the new scheme is developed.

The development of a statutory scheme and system of regulation for adult home-support services is a complex undertaking. While to date important steps have been taken towards the development of the new scheme, a significant amount of additional work remains to be carried out before final decisions are taken on the form that it will take. This is required if the reforms are to be successful, affordable and sustainable. While the new home-support scheme is under development, the Department of Health and Health Service Executive (HSE) are continuing efforts to incrementally improve the existing home-support services.

Hospital Waiting Lists Action Plans

Questions (450)

John Curran

Question:

450. Deputy John Curran asked the Minister for Health the new initiatives and proposals taken to reduce the number of children waiting over a year for an outpatient appointment; and if he will make a statement on the matter. [53347/18]

View answer

Written answers

Improving access to hospital treatment is a key priority for government.

Budget 2019 announced that the Government had further increased investment in tackling waiting lists, with funding to the National Treatment Purchase fund (NTPF) increasing from €55 million in 2018 to €75 million in 2019. My Department is working closely with the NTPF and the HSE to finalise a Scheduled Care Access Plan for inpatients/day case and outpatients for 2019.

I recently met with the CEOs of all hospital groups and requested that they develop innovative proposals to address their 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 Outpatient proposals covering the specialities of Cardiology, Ophthalmology, and Dental Surgery.

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 and ophthalmology, and the use of virtual assessment clinics for rheumatology.

In addition, the establishment of the Outpatient and Urgent Care Centre at Connolly Hospital in 2019 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.

There are currently 45,346 patients on the CHG Outpatient waiting list (see table attached). Of these, 51% (23,273) are waiting 9 months or less and 61% (27,551) are waiting 12 months or less.

CHG - Outpatient

Row Labels

Values

 0-3Months

 3-6Months

 6-9Months

 9-12Months

12-15Months

15-18Months

18-21Months

21-24Months

24-36Months

36-48Months

48+Months

Grand Total

Children's Hospital Group

 2018-11-29

10919

6886

5468

4278

3715

3061

2792

2097

5138

949

43

45346

 2017-11-30

10811

6920

5460

4111

3671

3110

2516

1909

3012

111

3

41634

 Yr Var

108

-34

8

167

44

-49

276

188

2126

838

40

3712

Drug and Alcohol Task Forces

Questions (451)

Jack Chambers

Question:

451. Deputy Jack Chambers asked the Minister for Health if funding will be restored for drugs services in the local drugs and alcohol task force areas that have had a 30% reduction over the past ten years in view of calls by community groups and agencies in Ballymun and the recent rise in anti-social behaviour and crime linked to crack cocaine in the area. [53357/18]

View answer

Written answers

The HSE's allocation to Task Forces in 2018 is in the region of €22.6 million, this includes one off funding of €0.25 million. In addition, Task Forces are being consulted by the HSE on the provision of €0.71 million in one off funding for priority projects and services in CHO areas in 2018.

In 2018 over €5.25 million was allocated to Drug and Alcohol Task Forces by the Department of Health under the 'Drugs Initiative'. It is expected a similar amount will be allocated in 2019.

Drug and Alcohol Task Forces will be notified of their 2019 funding allocations as soon as the HSE National Service Plan for 2019 has been approved by the Minister for Health.

Implementing the health-led national drugs strategy continues to be a Government priority. The HSE national service plan for 2019 prioritises funding for integrated treatment services for co-occurring mental health and substance abuse concerns, improved healthcare services for people who are homeless and have addiction needs and greater access to services for those affected by drug and alcohol addiction in hospitals and communities.

Services for People with Disabilities

Questions (452)

Seán Haughey

Question:

452. 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. [53360/18]

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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.

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.

Assisted Decision Making

Questions (453)

Caoimhghín Ó Caoláin

Question:

453. Deputy Caoimhghín Ó Caoláin asked the Minister for Health his plans to commence Part 8 of the Assisted Decision-Making (Capacity) Act 2015 in full and at the earliest practicable date; the timeframe for its commencement; and if he will make a statement on the matter. [53365/18]

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Written answers

Part 8 of the Assisted Decision-Making (Capacity) Act 2015 provides a legislative framework for advance healthcare directives (AHDs). An AHD is a statement made by a person with capacity setting out his or her will and preferences regarding treatment decisions that may arise in the future when he or she no longer has capacity.

Section 91 of the Act relates to the development of a code of practice to accompany the AHD provisions. On 17 October 2016 I established a multidisciplinary working group to prepare a detailed series of recommendations for the Director of the Decision Support Service, in relation to the code of practice under section 91(2) of the Act. This process is ongoing and in anticipation of its completion I commenced the remainder of section 91 on 17 December 2018 [S.I. No. 527 of 2018], which will enable the Director of the Decision Support Service to progress the preparation of the code of practice on the AHD provisions, based on the working group’s recommendations, and in accordance with the specific process outlined in the Act.

Once completed the final code of practice can be published by the Director with my consent.

The development of the code of practice to accompany the AHD provisions is a key piece of work in facilitating the subsequent commencement of Part 8 in its entirety.

It is not possible at this time to give a definitive timeline for the commencement of Part 8. However, given the clear interconnections between Part 8 and the provisions within the rest of the Act, officials in my Department will continue to engage closely with the Department of Justice and Equality and the Director of the Decision Support Service to ensure that an expedient, coherent and coordinated approach is taken to the commencement of the provisions within the Act, including those in Part 8.

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