Written Answers Nos. 52-77
52. Deputy Clare Daly asked the Minister for Health the status of the geographical accessibility of termination of pregnancy services; the locations in which ultrasound scanning is provided; if hospitals are operating catchment areas for the provision of termination of pregnancy services; and if he will make a statement on the matter. [11792/19]
View answerTwo hundred and ninety-four (294) GPs have signed the contract to provide a termination of pregnancy service and more GPs are signing up as the service evolves. The HSE is satisfied that there is a good geographic spread of GPs taking part, enough to meet the needs of people who may need to access the service. In consultation with GPs, a decision was made to make participating GP details available by calling the ‘My Options’ helpline, rather than publishing a list of GPs. Due to GP availability and capacity to take additional patients, not all 294 GPs are on the ‘My Options’ list at any one time.
All maternity hospitals are providing some level of termination of pregnancy services, with 10 hospitals providing terminations in early pregnancy (up to 12 weeks), as follows:
Ireland East Hospital Group
1. National Maternity Hospital - Holles Street
2. Midland Regional Hospital Mullingar
RCSI Hospital Group
3. Rotunda Hospital
4. Our Lady of Lourdes Hospital Drogheda
Dublin Midlands Hospital Group
5. Coombe Women and Infants University Hospital
Saolta Hospital Group
6. University Hospital Galway
7. Mayo University Hospital
University of Limerick Hospitals
8. University Maternity Hospital Limerick
South/South West Hospital Group
9. Cork University Maternity Hospital
10. University Hospital Waterford
The matter of catchment area is no longer an issue for the Rotunda or the Coombe. The catchment area issue for the National Maternity Hospital is to be addressed by the Group CEO of Ireland East Hospital Group.
A private provider is currently providing ultrasound scans, for termination of pregnancy, in Letterkenny, Cork and Dublin. Outside of these locations, ultrasound scans are being provided by the local maternity hospital.
There is regular ongoing engagement between the Department of Health and the HSE to facilitate the smooth-running of the termination of pregnancy service and to resolve any issues that may arise.
53. Deputy Niamh Smyth asked the Minister for Health his plans to address the ongoing respite crisis being experienced by dozens of families in counties Cavan and Monaghan (details supplied); and if he will make a statement on the matter. [12395/19]
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.
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.
54. Deputy Louise O'Reilly asked the Minister for Health the number of consultant doctor vacancies in hospitals nationally by hospital and speciality; and if he will make a statement on the matter. [12173/19]
View answerI have asked the HSE to respond directly to the Deputy on this matter.
55. Deputy Billy Kelleher asked the Minister for Health the timeframe for the construction of a new hospital in County Cork; if a site has been selected; the stage the process is at; and if he will make a statement on the matter. [12211/19]
View answerProject Ireland 2040 and the National Development Plan are the long term plans which will provide the capital funding to develop dedicated ambulatory elective-only hospital facilities.
We must ensure that we carefully plan the use of this capital funding so as to meet the populations health needs and achieve value for money.
New dedicated ambulatory elective-only hospital facilities will be delivered in Dublin, Cork and Galway. These facilities will provide high volume, low complexity procedures on a day and outpatient basis, together with a range of ambulatory diagnostic services. The aim is to both increase capacity in the hospital system and provide a better separation of scheduled and unscheduled care, in line with the recommendations of the Health Service Capacity Review and the Sláintecare Report. They will provide increased, protected capacity for elective treatment and free up capacity in major acute hospitals to address higher complexity and emergency care. These new standalone ambulatory, elective-only hospital and diagnostic facilities will be developed in line with hospital groups' strategic plans.
Developing criteria and selection/approval processes for the new ambulatory elective-only hospital facilities is a 2019 priority in the Slaintecare implementation plan.
56. Deputy Eamon Ryan asked the Minister for Health the professional fees agreed in the 2014 contract for the national children’s hospital; and the estimated cost of the provision of the services in the present economic circumstances. [10619/19]
View answerAs this is an operational matter, I have referred your question to the National Paediatric Hospital Development Board for direct reply.
57. Deputy Catherine Connolly asked the Minister for Health further to Parliamentary Question No. 730 of 17 April 2018, the status of the interstate property transfer relating to the provision of a healthcare centre on Inisbofin, County Galway; and if he will make a statement on the matter. [12075/19]
View answerAs the Health Service Executive is responsible for the delivery of healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to a replacement primary care centre on Inishbofin, County Galway.
58. Deputy Eamon Scanlon asked the Minister for Health if the provision of home care packages in CHO1 will be increased; and if he will make a statement on the matter. [12334/19]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
59. Deputy Richard Boyd Barrett asked the Minister for Health if he will report on his implementation of the recommendations of the Joint Committee on the Future of Mental Health Care, in particular the commitment to invest in talk therapies as an alternative to relying on psychiatric medication; and if he will make a statement on the matter. [12388/19]
View answerWhen the Joint Oireachtas Committee on the Future of Mental Health Care was convened, as part of its Terms of Reference it recognised that the Department of Health was simultaneously conducting a refresh of the national mental health policy, ‘A Vision for Change’. A major review was undertaken to include recent policy recommendations and all submissions to the Joint Oireachtas Committee were coded with relevant actions embedded in the Vision for Change refresh.
It is anticipated that the final report of the Vision for Change refresh will be completed in the coming weeks. The refresh has looked at a comprehensive range of interventions, including increased access to counsellors and psychologists providing a range of talking therapies - appropriate to the majority of mental health presentations encountered in primary care, and will make recommendations in these areas.
The Government currently invests in the provision of Talk therapies, and there are a range of services already available.
The HSE National Counselling Service within GP practices and primary care teams offers access to time-limited counselling to adults presenting in primary care with non-complex psychological needs.
The Counselling in Primary Care (CIPC) service offers counselling sessions for medical card holders, who are 18 years of age or over, and who need help with mild to moderate psychological issues that can be appropriately dealt with by time-limited counselling in a primary care setting.
Funding has also been provided for Psychologist and Assistant Psychologist posts in primary care to deliver rapid access low intensity psychological interventions for those under 18 years of age.
The HSE is implementing two tele-counselling pilot projects. These are being provided to service users that have been identified by GPs as potentially benefitting from counselling for mild to moderate mental health difficulties. These service users are being offered the opportunity to avail of free online counselling at a location of their choice.
The HSE is also undertaking two tele-psychiatry pilots to address CAMHS waiting lists and provide remote consultations on the national adolescent addiction and substance abuse service.
In tandem with this I am aware that HSE Mental Health has engaged with a leading international provider of instant text messaging support services with a view to establishing such a service in Ireland. HSE is working closely with partner NGOs to act as a host/incubator organisations for the service, which will initially be rolled out on a pilot basis.
In addition, there is a number of Voluntary and Community Sector organisations that provide a range of talking therapies and related supports, through a service level agreement with the HSE, to individuals experiencing mild to moderate mental health problems. These can be broadly targeted or relevant to particular constituencies of need and age ranges. These supports are an important component of psychological and social recovery services available at local level.
60. Deputy Stephen Donnelly asked the Minister for Health his plans to address the new entrant pay disparity for consultant doctors; the status of the new contracts for hospital consultants; the number of meetings he has had on these topics with consultant representative groups (details supplied) in the past 12 months; and if he will make a statement on the matter. [12198/19]
View answerThe difference in pay between established consultants and new entrants, those who joined the public health service from 1 October 2012, has been highlighted by the consultants’ representative bodies in the past 12 months. In the last year, I met with the IMO, at its AGM last year, when I addressed the issue of new entrant pay. I also met with representatives of the IHCA last week, when the issue was discussed. I have also met members of the representative bodies at various engagements at which the issue was raised. The matter has also been highlighted in meetings involving Department officials in the past year.
The Public Sector Pay Commission, in its Report published on 4 September 2018, identified difficulties in attracting consultant applications for advertised posts and acknowledged that the pay rates for new entrants had been highlighted as a factor in this.
Given its analysis, the Pay Commission proposed that the Parties to the Public Service Stability Agreement jointly consider what further measures could be taken, over time, to address the pay differential between pre-existing consultants and new entrant consultants. The Department of Public Expenditure and Reform and the Department of Health have noted the Commission's views and consideration will need to be given to potential solutions which are in line with public sector pay policy and available budgets. However, it is recognised that this will be a significant challenge given the amounts involved.
With regard to the new contracts for hospital consultants, no engagement has taken place with the representative bodies to-date. The contract currently available to new entrants is the 'common' 2008 Consultant Contract.
61. Deputy Eamon Scanlon asked the Minister for Health the status of the provision of a diabetic unit in Sligo University Hospital; and if he will make a statement on the matter. [12207/19]
View answerAs the Health Service Executive is responsible for the delivery of healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.
62. Deputy Barry Cowen asked the Minister for Health when his Department will base health expenditure on multi-year budgeting supported by a five-year health service plan; and if he will make a statement on the matter. [12209/19]
View answerThe Programme for Partnership Government set out the Government's intention to work with the Oireachtas to sustain appropriate annual increases in the Health Budget. Expenditure is to be based on multi-year budgeting supported by a five year Health Service Plan based on realistic and verifiable projections.
Slaintecare supports this and proposes to establish an interdepartmental working group to review multi-annual budgeting in 2019.
63. Deputy Tony McLoughlin asked the Minister for Health the status of the proposed capital developments at Sligo University Hospital, St. Patrick’s Hospital, Carrick-on-Shannon, County Leitrim, and the North West Hospice, County Sligo; and if he will make a statement on the matter. [11983/19]
View answerAs the Health Service Executive is responsible for the delivery of healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.
64. Deputy Eamon Ryan asked the Minister for Health the steps he is taking to facilitate access to non-medication treatments needed to stem the rise of anti-depressant prescriptions. [12412/19]
View answerMental Health is a complex matter requiring a broad range of treatments depending on individual patient need. In many cases, medication plays an important part in helping the patient to deal with mental health issues. At the same time, it is necessary to ensure that alternatives, such as talk therapies, are available where needed.
The HSE provides a comprehensive range of community-based mental health services. It is committed to the provision of a person-centred approach to the care for each patient. It provides evidence-based psychological interventions that are delivered through Primary Care and where necessary through specialist mental health services. The recruitment of 20 Psychologists and 114 Assistant Psychologists to Primary Care services last year is expected to alleviate capacity issues within mental health specialist services.
Interventions are tailored to each patient’s individual needs and can include a broad range of interventions that may include psychopharmacological treatments and various forms of psychotherapy including those which have their roots in cognitive behavioural therapies, systemic therapies and psychodynamic therapies.
The Department of Health is working with the HSE to explore the increased use of digital technologies and early intervention services are being introduced. These include tele-psych facilities, which will provide increased talk therapies to patients within the primary care setting and directly to their digital device as is proven to be the preference of many teens and adolescents.
In recognition of the importance of mental health, the Government increased the mental health allocation for 2019 to nearly €1 billion. 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. €3 million of the new development funding is being used to develop resilience and early intervention programmes. The HSE will work with sports, community and voluntary groups to ensure that services are delivered at community level, where required.
In addition, the HSE Medicines Management Programme has Prescribing Tips and Tools information cards for a number of anti-depressants and are available on their website for all prescribers to access.
In conclusion, I am satisfied that the HSE is exploring different types of treatments while employing the most appropriate for each individual patient.
65. Deputy Catherine Connolly asked the Minister for Health further to Parliamentary Question No. 111 of 5 February 2019, the status of the report setting out the preferred option for development; and if he will make a statement on the matter. [12079/19]
View answerIn relation to the particular query raised, as this is a service matter, I have asked the HSE to reply to the Deputy directly.
66. Deputy Gino Kenny asked the Minister for Health if his attention has been drawn to, and his plans to address, the contradiction in granting licences for the prescription of THC products for children with intractable epilepsy but they are then omitted from the cannabis access programme; the steps he will take to include children with intractable epilepsy, with the recommendation of their consultant, in the cannabis access programme; and if he will make a statement on the matter. [12398/19]
View answerAs the Deputy has been made aware on numerous occasions, there are two separate pathways for accessing cannabis for medical use. Each pathway serves a different purpose and therefore the Deputy's assertion that a contradiction exists is misinterpreted.
For the purposes of clarity the two different access pathways are:
1. Via Ministerial licence:
Under the Misuse of Drugs legislation the Minister for Health may grant a licence to an Irish registered medical practitioner for access to cannabis for a named patient, where the course of cannabis treatment has been endorsed by a consultant who is responsible for the management of the patient and who is prepared to monitor the effects of treatment over time.
Whilst the legal basis for the granting of licenses exists under the Misuse of Drugs Regulations, the decision to prescribe such treatment for an individual patient is a clinical matter and as such will be a decision for the prescribing clinician, in consultation with their patient.
2. Medical Cannabis Access Programme (currently under development)
The Medical Cannabis Access Programme, once operational, will be based on the recommendations of the HPRA's report “Cannabis for Medical Use-A Scientific Review”, and on the ‘Clinical Guidance on Cannabis for Medical Use’ which has been drawn up by an expert group of doctors, pharmacists, patient representatives and scientific experts, to support the Medical Cannabis Access Programme. These guidelines are available on the Department’s website. The guidelines contain detailed information on the use of medical cannabis, including the clinical indications for which cannabis may be prescribed under the access programme. The contents of these guidelines are based on expert clinical advice. It would be wholly inappropriate for a Minister for Health to seek to alter these expert guidelines in any way against the advice of the clinical experts that produced them.
It is intended that the Ministerial licence application scheme will continue to operate in parallel with the Cannabis for Medical Use Access Programme, after the programme becomes operational, for exceptional cases only where there is an unmet clinical need.
67. Deputy Thomas P. Broughan asked the Minister for Health the level of unfilled hospital consultant posts in the health service; the steps he is taking through pay restoration or otherwise to urgently remedy the situation; and if he will make a statement on the matter. [11799/19]
View answerI have asked the HSE to respond directly to the Deputy in relation to the details sought on unfilled posts.
The Government is committed to increasing the consultant workforce to support service delivery and to move to a consultant delivered service. While the Pay Commission noted that the incremental measures being introduced for new entrants would not be sufficient to bridge the gap between the pay of existing and new entrant consultants, new entrant consultants will benefit from these measures.
The HSE is also committed to supporting consultant recruitment and retention, pursuing a number of initiatives including improvements to the recruitment process, offering contracts to the Hospital Group rather than individual sites and focusing on family friendly arrangements.
At the end of December 2018 there were 3,096 whole time equivalent consultants working in the public health services, the highest number in the history of the State. Notwithstanding recruitment and retention challenges, the number of consultants has increased by 125 in the 12 months to end December 2018 and by 540 in the past five years. There are approximately 450 consultant posts which are not filled on a permanent basis at present. Most of these posts are filled by locums or temporary staff to support the delivery of essential services.
68. Deputy Fiona O'Loughlin asked the Minister for Health the timeline for the refurbishment of the HSE property in Drogheda Street, Monasterevin, County Kildare. [12321/19]
View answerAs the Health Service Executive is responsible for the delivery of healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.
70. Deputy Bríd Smith asked the Minister for Health his plans for rolling out a new HPV based CervicalCheck programme. [12411/19]
View answerI have asked the HSE to introduce HPV testing as the primary screening method for the prevention of cervical cancer as soon as possible. Funding to implement the switch to HPV screening, and extend HPV vaccination to boys, has been allocated in Budget 2019.
The decision to switch to primary HPV screening follows on from a Health Technology Assessment carried out by HIQA. This found that it would be beneficial, both clinically and from a cost effectiveness perspective, to make this transition.
The HPV test is a more accurate testing mechanism than liquid-based cytology, which is the current testing mechanism. Its use will result in fewer false negative results, though it is very important to be clear that false negatives will always be inherent in screening. Where a positive result for HPV is found, cytology is then undertaken as a second test.
The introduction of primary HPV screening is in line with developments in cervical screening internationally. Ireland will be among the first countries in the world to make this transition. The HSE has been engaging with other countries who have already made the switch – the Netherlands, and Australia - or who are preparing to do so, to identify learnings for the project, and has been progressing work across a range of workstreams including procurement, ICT and colposcopy services. Pre-tender market engagement has been completed and a Prior Information Notice was published on 20 February.
71. Deputy Niall Collins asked the Minister for Health the target date for beds at the 60-bed modular unit at University Hospital Limerick to be opened; the projected expenditure for these beds; if this figure has increased or decreased; and if he will make a statement on the matter. [12231/19]
View answerThe Emergency Department in University Hospital Limerick is one of the busiest in the country, with the number of patients attending growing year on year.
Limerick was identified as a one of 9 sites requiring additional investment, focus and support as part of this year’s Winter Plan. The problem of overcrowding in hospitals requires a full system, patient focused response. Recognising this, in the Winter Plan investment is targeted at both hospital and community services and supports. This includes additional home support packages and transitional care beds to support people to leave hospital and return home.
It is widely agreed that a key part of the solution for Limerick is additional beds.
Over the past 18 months, an additional 23 beds have opened in Limerick, including 5 as part of this year’s Winter Plan.
A Capital Allocation of €2 million has been granted in recent weeks and the HSE advise that this will facilitate the completion of enabling works for the 60 bed modular ward in 2019.
72. Deputy Mick Wallace asked the Minister for Health his plans to address waiting times for access to counselling in primary care services. [12393/19]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
73. Deputy Mattie McGrath asked the Minister for Health the steps he has taken to address the concerns raised in the recent report of the Mental Health Commission about St. Luke's psychiatric facility in County Kilkenny; and if he will make a statement on the matter. [11800/19]
View answerThe Mental Health Commission is an independent body that was set up in 2002. Its functions are set out in the Mental Health Act 2001. These include the promotion, encouragement and fostering of high standards and good practices in the delivery of mental health services and the protection of the interests of patients who are involuntarily admitted.
On 21 December 2018, the Mental Health Commission issued a summons against the HSE as registered proprietor of the Department of Psychiatry, St. Luke’s Hospital (Kilkenny). On 25 February, Kilkenny District Court found against the HSE on a number of charges relating to breaches of the 2001 Mental Health Act. St Luke’s Hospital pleaded guilty to four charges including poor maintenance of seclusion facilities and failure to comply with the rules governing signing of the seclusion register by a consultant psychiatrist responsible as required by the law.
Developing Mental Health services remains a priority for Government. The recent Budget provided an additional €55 million to progress new developments in mental health which brings overall HSE mental health funding to nearly €1 billion in 2019.
The HSE has guaranteed that actions will be taken to address these failings. These include the prioritisation of the Department of Psychiatry facility in Kilkenny for upgrading works in excess of €1 million to bring the unit up to standard. This investment will address deficiencies identified during inspection processes and will include a comprehensive decorative maintenance programme across the facility, to ensure full compliance with MHC set regulations in respect of privacy and premises.
In addition, a Household Supervisor and additional household personnel will be appointed to address the cleaning deficits, while training programme for staff on rules governing the use of seclusion will be commenced.
The Department of Health, along with the Mental Health Commission, will continue to monitor efforts by the HSE to improve standards and conditions for all patients in line with rules and regulations as directed by the Mental Health Act 2001.
74. Deputy Joan Collins asked the Minister for Health the number of children in the Dublin 8 and 10 areas diagnosed with a need for an ASD unit placement for primary schools through the assessment of needs diagnoses. [11954/19]
View answerPart 2 of the Disability Act (2005) establishes a system for the assessment of the health needs of children and young people born on or after 1st June 2002 who are suspected of having a disability. Although the Act refers to education needs, it is clarified that this relates to adults only. An Assessment of Need for a child provides a determination as to whether or not they have a disability. Where the child is deemed to have a disability their Assessment of Need report will include:
1. A statement of the nature and extent of the disability
2. A statement of the health needs occasioned by the disability
3. A statement of the services required to meet these needs and the period of time for the provision of those services
4. A statement of the period in which a review of the assessment should be carried out.
The report does not always include a diagnosis. During 2018 4,237 Assessment of Need reports were completed nationally. 27% of these indicated that the child/young person presented with an Autism Spectrum Disorder (ASD). Assessments of Need are not required to identify the education needs of children and as such the HSE does not collect this data. It should also be noted that not all children with an ASD diagnosis will require placement in an ASD class.
Access to special educational placements such as ASD classes is via the National Council for Special Education. Your query regarding the numbers of applications for placement in primary level ASD classes should be directed to the NCSE or Department of Education & Skills.
75. Deputy Richard Boyd Barrett asked the Minister for Health his plans to deal with the dramatic increase in the prescription of psychiatric medication over the period from 2012 to 2017; and if he will make a statement on the matter. [12387/19]
View answerMental Health is a complex matter requiring a broad range of treatments depending on individual patient need. In many cases, medication plays an important part in helping the patient to deal with mental health issues. At the same time, it is necessary to ensure that alternatives, such as talk therapies, are available where needed.
The HSE provides a comprehensive range of community-based mental health services. It is committed to the provision of a person-centred approach to the care for each patient. It provides evidence-based psychological interventions that are delivered through Primary Care and where necessary through specialist mental health services. The recruitment of 20 Psychologists and 114 Assistant Psychologists to Primary Care services last year is expected to alleviate capacity issues within mental health specialist services.
Interventions are tailored to each patient’s individual needs and can include a broad range of interventions that may include psychopharmacological treatments and various forms of psychotherapy including those which have their roots in cognitive behavioural therapies, systemic therapies and psychodynamic therapies.
The Department of Health is working with the HSE to explore the increased use of digital technologies and early intervention services are being introduced. These include tele-psych facilities, which will provide increased talk therapies to patients within the primary care setting and directly to their digital device as is proven to be the preference of many teens and adolescents.
In recognition of the importance of mental health, the Government increased the mental health allocation for 2019 to nearly €1 billion. 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. €3 million of the new development funding is being used to develop resilience and early intervention programmes. The HSE will work with sports, community and voluntary groups to ensure that services are delivered at community level, where required.
In addition, the HSE Medicines Management Programme has Prescribing Tips and Tools information cards for a number of anti-depressants and are available on their website for all prescribers to access.
In conclusion, I am satisfied that the HSE is exploring different types of treatments while employing the most appropriate for each individual patient.
76. Deputy Martin Heydon asked the Minister for Health the status of developments in the provision of mental health services in County Kildare; and if he will make a statement on the matter. [12391/19]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
77. Deputy Alan Kelly asked the Minister for Health if the targets under the 1994 dental health action plan that children are entitled to three routine screenings in first or second class, third or fourth class and in sixth class, including orthodontic screening, are being achieved across each HSE region; the percentage figures achieved for same across all regions in each of the years 2015 to 2018; and if he will make a statement on the matter. [11796/19]
View answerAs this is a service matter it has been referred to the HSE for reply to the Deputy.
