Questions Nos. 1 to 8, inclusive, answered orally.

HSE Agency Staff

Questions (9)

Jonathan O'Brien

Question:

9. Deputy Jonathan O'Brien asked the Minister for Health the progress made on reducing the use of agency staff in the public sector under the terms of the Public Service Stability Agreement 2018 to 2020. [5957/19]

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Written answers (Question to Health)

The Public Service Stability Agreement 2018 to 2020 provides that management will engage with the Parties with a view to minimising the use of agency as far as possible and practicable over the lifetime of the Agreement.

The level of spending on agency staff in the health sector is under constant review.  Agency staff are utilised by the sector where there is a difficulty in recruiting and employing hospital staff and where there is a short-term critical service need. Agency staff are also used for flexibility to allow for variations in activity and to meet patient demand.

The level of health sector agency expenditure is influenced by a range of factors including increasing demand for services; ongoing challenges in recruiting and retaining clinical staff; and the need to comply with the European Working Time Directive.

However, despite these issues it is clear that in certain services, the level of reliance on agency staffing is high, or has increased.  As a result, the HSE has assured the Minister for Health that the reduction and minimisation of agency costs remains an area of focus.

Generally, progress achieved by the HSE in agency expenditure reduction last year was disappointing.  However, in the Acute Hospitals Division, agency spending reduced from over €202m in 2017 to under €200m in 2018. Within the Medical/Dental staff category, there was a reduction of over 10% between 2017 and 2018 representing an average monthly saving of over €1m.  

The HSE National Service Plan 2019 provides for a number of initiatives to address the overall financial challenges being faced by the HSE this year.  A target to reduce agency/overtime spend by €17.5m has been identified and this has been subject to ongoing engagement with HSE service areas as part of operational planning for 2019. The HSE have advised that this process is nearing completion.

Hospital Services

Questions (10, 69)

Brian Stanley

Question:

10. Deputy Brian Stanley asked the Minister for Health if a facilitator has been appointed to conduct a consultation process on the future of services at the Midlands Regional Hospital, Portlaoise. [11938/19]

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Brian Stanley

Question:

69. Deputy Brian Stanley asked the Minister for Health the status of plans for the provision of emergency department services at the Midlands Regional Hospital, Portlaoise; and if such plans are dependent on the outcome of a consultation process on the future of services. [11939/19]

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Written answers (Question to Health)

I propose to take Questions Nos. 10 and 69 together.

I am committed to securing and further developing the role of the Midland Regional Hospital Portlaoise as a constituent hospital within the Dublin Midlands Hospital Group. Since 2014, the focus has been on supporting the hospital to develop and enhance management capability, implementing changes required to address clinical service deficiencies, and incorporating the hospital into the governance structures within the Dublin Midlands Hospital Group.

Significant work has been undertaken to strengthen and stabilise current arrangements for services at the hospital to ensure that services that are not sustainable are discontinued and those that are, are safety assured and adequately resourced. Funding has increased by 42% relative to the 2012 budget and staffing levels have risen by 31% from the 2014 base.  Governance and management arrangements in Portlaoise Hospital have been strengthened, additional clinical staff have been appointed and staff training, hospital culture and communications have improved.

As I have outlined previously, no decision has been made yet on the draft Action Plan for Portlaoise Hospital. I am committed to ensuring that local clinicians and the community will be consulted with before a decision is made. I have decided that a comprehensive consultation exercise should be undertaken by the HSE, with an external facilitator, with the key stakeholder groups involved in the Portlaoise Hospital.  The consultation will involve key stakeholders and local community representatives and provide an opportunity to listen to and address the issues and concerns the stakeholders have highlighted.  The consultation will also provide an opportunity to set out clearly the immediate priorities for service development and improvement in the hospital.

The appointment of an external facilitator for the consultation process is being finalised. The outcome of the consultation process will be a submission from the Department of Health, setting out the key findings from the consultation process and recommended response to inform me in making a final decision on the draft Action Plan. 

Hospital Facilities

Question No. 12 answered orally.

Questions (11)

Catherine Connolly

Question:

11. Deputy Catherine Connolly asked the Minister for Health the date on which contracts were first exchanged relating to the provision of modular theatres at Merlin Park Hospital, Galway; if the contracts have been signed; the reason for the delay; the number of persons awaiting surgery due to the closure of the theatres; and if he will make a statement on the matter. [12076/19]

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Written answers (Question to Health)

As the Deputy is aware, as a result of the infrastructural issues affecting the roof of the building that housed the two orthopaedic theatres on the Merlin Park University Hospital site, remedial work was carried out in March 2018 to facilitate the reopening of one of the elective orthopaedic theatres.

Following the recommissioning of the theatre procedures started again and in the twelve months to September 2018 there were 2,337 operations for orthopaedics at Merlin Park.  

Saolta University Health Care Group is working towards restoring the full elective orthopaedic service.  A tender process to provide two modular theatres for orthopaedics was undertaken and a successful vendor was selected. The preferred supplier is responsible for the fabrication, installation and fit out of the modular theatres.

I have been advised by the HSE that the first draft of contracts was issued by the HSE in May 2018. There has been active engagement with both legal teams and discussions are continuing.  A planning application was submitted in December 2018. Galway City Council has sought additional information which the HSE is now responding to.

The Government has further increased investment in tackling waiting lists, with funding to the NTPF increasing from €55 million in 2018 to €75 million this year.

The joint Department of Health/HSE/NTPF Scheduled Care Access Plan 2019 was published on Monday. The plan sets out measures to improve care for patients waiting for scheduled care in 2019 by reducing wait times for inpatient/day case treatment and outpatient appointments.  The Plan will, again this year, place a strong focus on high volume procedures, including orthopaedics. When combined with HSE activity it is projected that the NTPF will be in a position to offer treatment to all clinically suitable patients waiting more than 6 months for hip or knee replacement.

The NTPF will deliver additional activity in the health service by working with hospital groups and individual hospitals as well as private health providers to maximise the number of patients treated in both a public and private capacity. I would strongly encourage all hospitals, including Galway University Hospital, to collaborate with the NTPF to identify waiting list initiatives.

Subject to a successful determination of the planning application and successful discussions on the contract with the preferred bidder, the provision of the two modular orthopaedic theatres at Merlin Park University Hospital will proceed.

Question No. 12 answered orally.

Mental Health Policy

Question No. 14 answered orally.

Questions (13)

Pat Buckley

Question:

13. Deputy Pat Buckley asked the Minister for Health his plans to support the establishment of an Oireachtas mental health committee to oversee the implementation of the previous committee's report and scrutinise upcoming mental health legislation in particular; and if he will make a statement on the matter. [12390/19]

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Written answers (Question to Health)

In July 2017, the Joint Committee on the Future of Mental Health Care was established with the aim of achieving cross-party agreement on the implementation of a single, long-term vision for mental health care and the direction of mental health policy in Ireland.

The main aim of the Joint Committee was to examine current delivery of mental health services with a focus on funding, recruitment challenges and increased access to services. The Joint Committee produced two interim reports dated December 2017 and April 2018 and a final report was launched in October 2018.

As part of its Terms of Reference, the Committee recognised that the Department of Health was simultaneously conducting a review of the national mental health policy, ‘A Vision for Change’.

Upon completion of its final report, the work of the Oireachtas Committee came to an end. In this report, the Committee requested that it be established on a permanent footing. The Committee’s Terms of Reference, however, stated that “the Joint Committee shall make its final report to both Houses of the Oireachtas by 31 October 2018, and shall thereupon stand dissolved”. Consequently, there are no plans to establish the Committee on a permanent basis at present.

One of the main objectives of the Committee was to ‘assist with the completion of the implementation of ‘A Vision for Change’ in order to provide a more integrated mental health service of the highest quality’. As a result, the Committee’s work is firmly affiliated with the Vision for Change refresh policy which is now nearing completion.

It is anticipated that the final report of the Vision for Change refresh will be completed in the coming weeks. This report will be informed by the work of the Joint Oireachtas Committee. For example, the key concerns presented to the Committee by various stakeholders during the Committee’s consultation process will be taken on board.

In line with the recommendations of the Committee, the refreshed Vision for Change will support better access, personalised choice and greater service user involvement. It will be implemented by the Department of Health and the HSE. Similarly to other health areas, those charged with its implementation will be fully accountable to the Oireachtas Committee on Health and to the Dáil itself.       

In relation to the review of the Mental Health Act 2001, it is intended to finalise the draft heads of the bill in the coming weeks.  This initial draft will then be passed on to the Mental Health Commission for its views.  In line with normal procedures, the proposed legislation will be scrutinized by both Houses of the Oireachtas.

Question No. 14 answered orally.

Health Strategies

Question No. 16 answered orally.

Questions (15)

James Browne

Question:

15. Deputy James Browne asked the Minister for Health when the Sláintecare action plan will be published; if it will contain detailed costings; and if he will make a statement on the matter. [12200/19]

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Written answers (Question to Health)

In September 2018, the Sláintecare Programme Implementation Office commenced refining the three-year Implementation Strategy into a single-year Action Plan for 2019. This process has involved reviewing the 106 sub-actions of the Sláintecare Implementation Strategy - which was published in August 2018 - and identifying where further actions were required. A readiness assessment of all the sub-actions was then initiated, which examined the degree to which there were plans and assigned responsibilities, behind the subactions, both new and existing. Finally, the Programme Implementation Office looked at how best to structure teams for successful and effective delivery. A Citizen Care Masterplan Framework for the implementation of the Sláintecare actions was developed in order to establish a programmatic approach to delivery.

At the end of December 2018, the Action Plan for 2019 was presented to me and I can confirm that, following its presentation to the Sláintecare Implementation Advisory Council at the end of February, it will be published today (13 March 2019).

It is a detailed and comprehensive plan for 2019 which firmly establishes a programmatic approach to the delivery of the Sláintecare Strategy. It is a fundamental milestone in the delivery of the Sláintecare vision for reformed health and social care services in Ireland. 

The 2019 funding for the deliverables in the Action Plan have been provided in the relevant spending lines as part of the Estimates process for 2019.

The Sláintecare Programme Implementation Office is committed to transparency at all stages of the implementation of Sláintecare. The Programme Office will publish rolling plans annually and progress reports will be published on a biannual basis.

Question No. 16 answered orally.

Mental Health Services Provision

Question No. 18 answered orally.

Questions (17)

Gino Kenny

Question:

17. Deputy Gino Kenny asked the Minister for Health if his attention has been drawn to the fact that adult community mental health services in Clondalkin may be lost as a result of a lack of suitable premises; if his attention has been further drawn to the fact that organisations such as a task force (details supplied) are extremely concerned about the impact this will have on service users who benefit from having access to local services; if his attention has been further drawn to the fact that Clondalkin has one of the highest levels of referrals for mental health services in the country and the detrimental impact the loss of local mental health services will have on the community; the measures he will take to urge the HSE to ensure that services are kept in the locality; and if he will make a statement on the matter. [12399/19]

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Written answers (Question to Health)

Mental Health is, and will continue to be, a priority for the Government.

This is illustrated in the recent budget, which saw the mental health allocation increase to nearly €1 billion. This is a clear indication of the importance placed on the mental health of the nation by the Government. The overall HSE Mental Health Budget has been increased by €276 million, or 39%, since 2012.

Budget 2019 allocated an additional €55 million to progress new developments in mental health this year. These developments include the development of a number of clinical programmes on such areas as early intervention psychosis, ADHD in adults and Eating Disorders. In addition, mental health services' capacity will be augmented by an increase in Primary Care counselling.

The Clondalkin Mental Health Team provides specialist mental health services to people living in the Clondalkin area. Currently the team consists of 22.1 WTEs (whole time equivalent staff), serving a population of 60,256 from two locations.

The Mental Health Service based in Clondalkin Village is temporarily relocating due to a number of health and safety issues. Services delivered at the Rowlagh Health Centre are unaffected by these issues.

I am informed that in the interests of both clients and staff, the HSE plans to deliver Community Mental Health services for Clondalkin in the proposed new Clondalkin Primary Care centre on Boot Road.

In the interim, alternative options are being pursued including a plan to temporarily relocate community mental health services to an existing HSE facility on the Belgard Road.

The Deputy might note that it is the intention of the HSE to continue to work with all stakeholders, including the Drugs and Alcohol Task Force, as plans develop.

Question No. 18 answered orally.

Voluntary Sector Funding

Questions (19)

Margaret Murphy O'Mahony

Question:

19. Deputy Margaret Murphy O'Mahony asked the Minister for Health the status of plans to reduce HSE funding to community voluntary organisations by €4 million in 2019; and if he will make a statement on the matter. [12406/19]

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Written answers (Question to Health)

Major increases in public funding for our health services in recent years has brought the Governments annual investment to a level that compares favourably with spending in other countries.  

In the last five years funding for community delivered services has increased by 27% to €5,876m, this increase in funding has facilitated key service developments.  However, it is important that when assessing the scope to develop services that the additional opportunities available through the improved management of existing resources, to benefit the greatest possible number of service users, receives ongoing attention by organisations in receipt of health service funding.

The HSE, in the 2019 National Service Plan, adopted a range of actions and initiatives to address the need to improve the scope of the delivery of services within existing resources.  These initiatives include engaging with community voluntary organisations with a view to identifying opportunities to achieve greater value across the totality of resources provided to such voluntary organisations without impacting on the quality and level of services currently provided.

The National Service Plan requires the HSE to protect and promote the health and well-being of the population, having regard to the resources available to it, and making the most efficient and effective use of those resources. Implementation of the Service Plan is ongoing and my Department understands that the position of the HSE is that protection of front line service delivery is its priority.

Hospital Waiting Lists Action Plans

Questions (20)

Frank O'Rourke

Question:

20. Deputy Frank O'Rourke asked the Minister for Health the measures he plans to take to reduce the waiting times for cataract surgery (details supplied); and if he will make a statement on the matter. [12099/19]

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Written answers (Question to Health)

I am conscious that waiting times are often unacceptably long and of the burden that this places on patients and their families. In this regard I am committed to improving waiting times for hospital appointments and procedures.

Cataract surgery is one of the most common surgical procedures carried out in the Ophthalmology specialty. Last year, under the Inpatient/Day Case Action Plan for 2018, I sought real progress to not only drive down waiting lists for high volume procedures, but also to treat patients with life-limiting conditions such as cataracts.

Waiting List figures published by the National Treatment Purchase Fund for the end of February show the total number of patients waiting for a cataract procedure fell from 10,024 in July 2017 to under 6,300, a reduction of almost 38%.

The numbers waiting more than 3 months almost halved in the same period, down from 8,000 to just under 4,000, while those waiting more than 9 months fell from 4,371 to 536, a reduction of 88%.

Last year also saw the establishment of a dedicated Cataract Centre at Nenagh Hospital. This is a stand-alone high-volume consultant-led cataract theatre facility which, at full capacity, will provide a 5-day service and is expected to deliver approximately 2,000 cataract procedures in 2019.

Budget 2019 announced that the Government had further increased investment in tackling waiting lists, with funding to the NTPF increasing from €55 million in 2018 to €75 million in 2019.

Yesterday, I published the joint Department of Health/HSE/NTPF Scheduled Care Access Plan 2019, which sets out measures to improve care for patients waiting for scheduled care in 2019 by reducing waiting times for inpatient, day case and outpatient appointments. The plan places a strong focus on ten high volume procedures, including cataracts. When combined with HSE activity it is projected that the NTPF will be in a position to offer treatment to all clinically suitable patients waiting more than 6 months for one of these procedures.

Healthcare Infrastructure Provision

Questions (21)

Seán Fleming

Question:

21. Deputy Sean Fleming asked the Minister for Health when work will commence on the redevelopment of Mountmellick community hospital; and if he will make a statement on the matter. [12224/19]

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Written answers (Question to Health)

The five-year capital investment programme for community nursing units announced in 2016 provides the framework to allow for an enhanced programme to replace, upgrade and refurbish care facilities, as appropriate, at 90 locations. Significant work was undertaken to determine the optimum scheduling of projects within the phased provision of funding to achieve compliance and registration with the Health information and Quality Authority.

The Health Service Executive is responsible for the delivery of health and personal social services, including healthcare infrastructure projects, and has advised that Design Stage 1 is nearing completion in respect of the development of Mountmellick Community Nursing Unit. The HSE is currently aiming to commence works for Phase 1 development of Mountmellick Community Nursing Unit in early 2020 for completion by the end of 2021.

Health Services Funding

Questions (22)

Michael Moynihan

Question:

22. Deputy Michael Moynihan asked the Minister for Health if he is satisfied that section 39 services are in receipt of adequate funding to provide necessary services; and if he will make a statement on the matter. [12229/19]

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Written answers (Question to Health)

The Health Service Executive’s 2019 National Service Plan is based on an increased budget of over €848 million over the revised allocation for last year and brings their total budget for the 2019 financial year to over €16 billion.

This is the largest ever financial allocation provided to our health services and will enable the continued improvement of services for our patients and for the Irish public who want to see continued investment in public services.

In the last five years funding for community delivered services has increased by 27% to €5,876m, this increase in funding has facilitated key service developments including an annual allocation in excess of €3.3 billion to voluntary service providers.

Within this funding envelope the Health Service Executive, as required under its National Service Plan, and through its service level agreements will ensure that the health and well-being of population in receipt of services through the voluntary sector will be protected and promoted, having regard to the resources available.

The Report of the Independent Review Group highlighted the need for both the statutory and the voluntary sectors and recognised that they depend upon and benefit from each other.

The voluntary sector will continue to play an integral role in the delivery of health and social care services and I intend to establish a new dialogue process to provide a forum for engaging with the voluntary sector, in particular on proposed Sláintecare reforms and other policy initiatives.

It is important, however, that when assessing the scope to develop services that the additional opportunities available through the improved management of existing resources, to benefit the greatest possible number of service users, receives ongoing attention by organisations in receipt of health service funding. This is a key objective of the National Service Plan which is ongoing.

Primary Care Centres Provision

Questions (23)

Pat Casey

Question:

23. Deputy Pat Casey asked the Minister for Health when primary care centres will open in Baltinglass, Rathdrum and Arklow, County Wicklow; and if he will make a statement on the matter. [12227/19]

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Written answers (Question to Health)

I am pleased to be able to inform the Deputy that the development of the  primary care centres in Arklow, Baltinglass and Rathdrum is being progressed.   

Construction has commenced on the Baltinglass site, with the opening of the centre scheduled for 2020.  Construction of Rathdrum Primary Care Centre is planned to commence shortly and is also expected to become operational  in 2020.  The proposed Primary Care Centre in Arklow has received planning permission and initial design is commencing, although it is not possible at this stage to provide an estimated operational date. 

The investment in these three centres  is representative of this Government's support for the development of the primary care sector.  There are now 127 primary care centres in operation across the country, 18 of which became operational  in 2018.  A further 11 centres are expected to open in 2019. 

These modern, well-equipped and accessible premises are key to the development of primary care services in line with the vision of Sláintecare to deliver care in the local community at the lowest level of complexity. 

National Children's Hospital Status

Questions (24)

Bernard Durkan

Question:

24. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he remains satisfied that the new children’s hospital project can proceed as planned without restrictions to the scale and content of the proposed facilities in line with what was originally anticipated; and if he will make a statement on the matter. [12339/19]

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Written answers (Question to Health)

As I advised Government in December 2018, the overall cost to complete the new children’s hospital project is €1,433m – €450m more than advised to Government in April 2017.  The Revised Estimates adopted by Government for 2019 provide for the costs arising this year in respect of this priority project. The costs in future years will inform future capital expenditure plans. As the Deputy will be aware, in light of the concerns over the major and sudden cost escalation associated with the finalisation of the Guaranteed Maximum Price, Government also approved the commissioning of an independent review of the escalation in cost at the same time.

The review is examining the contributory factors and associated responsibilities so that any potential weaknesses are identified and comprehensively and speedily resolved in the interests of the successful completion of the project and the effective management of public funds.

While it is not my intention to compromise in any way on the scale and content of this  project the terms of reference also require the review to develop recommendations if possible, which may identify any areas of potential cost savings or reductions, which are consistent with the applicable contractual undertakings and the completion of the project to deliver on the vision to improve services for the children and young people of Ireland.  

This independent review is underway, and PwC have recently advised that the report is now expected to be completed by early April.  

Generic Drugs Substitution

Questions (25)

John Brassil

Question:

25. Deputy John Brassil asked the Minister for Health when the biosimilars policy will be published; and if he will make a statement on the matter. [12202/19]

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Written answers (Question to Health)

My Department and the HSE are engaging in a number of initiatives which will endeavour to lead to better access to medicines for patients, value for the taxpayer and the cost- effective provision of medicines in Ireland. 

A public consultation on a National Biosimilar Medicines Policy was undertaken by my Department in 2017.  The responses to that consultation and other possible policy levers are being considered by my Department with a view to developing a National Biosimilar Medicines Policy statement which will be published later this year.

At an operational level, the HSE's Acute Hospitals Drugs Management Programme has a biosimilar strategy in place since 2017 which is making considerable progress using a collaborative approach with hospital pharmacists and clinical teams to bring about changes in prescribing practice. In that respect, hospitals are working towards a targeted minimum prescribing rate for biosimilars of 50%.

The HSE is also working on identifying barriers to the prescribing of biosimilars with a specific focus on education and support.  It is seeking to increase understanding of biosimilars through targeted presentations to clinicians and hospitals. 

The culmination of these initiatives is a greater uptake in the usage of biosimilars and this is evident by hospital dispensing data.  For example, the prescribing rate for the biosimilar drug Infliximab has increased from 5% in 2017 to 40% in 2018.

My Department proposes to build on these positive developments and to bring forward a policy statement that would support and complement the many initiatives which are already underway.