Written Answers Nos. 382-400
382. Deputy Willie O'Dea asked the Minister for Health his views on the constant overcrowding in University Hospital Limerick; the actions he has taken to address the matter; and if he will make a statement on the matter. [17694/19]
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 one of the 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, the HSE sought to maximise the use of existing resources across hospital groups and CHO's and to target additional investment at both hospital and community services and supports. This includes additional home support packages and transitional care beds to support people to leave the hospital and return home.
The range and prioritisation of measures was a matter for UHL and CHO Mid-West. Key measures included:
- extended opening hours in the AMAU;
- opening of a surgical short stay unit;
- additional access to diagnostics.
The NTPF have established a fund of €1m that will support the HSE Winter plans with a focus on increasing access to diagnostics in both private facilities and in-house. 6,050 vouchers had been issued to Emergency Departments for diagnostics as of 31 March 2019, including 1,050 vouchers issued to UHL.
It is widely agreed that a key part of the solution for Limerick is additional beds. Over the past 18 months, an additional 25 beds have opened in Limerick, including 8 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.
In addition, the National Development Plan includes a 96-bed replacement ward block in Limerick and capital funding was provided in 2018 to progress the design phase of this project.
I have asked the HSE to respond to you directly on the actions that are being taken to maximise the use of existing resources in UL Hospital Group and CHO 3 and to reduce overcrowding.
383. Deputy Willie O'Dea asked the Minister for Health if he has discussed the constant overcrowding in University Hospital Limerick with the HSE recently; the actions being taken in this regard; and if he will make a statement on the matter. [17695/19]
View answerI am in regular contact and have regularly scheduled meetings with the HSE on all matters related to Emergency Departments, including University Hospital Limerick. I discussed UHL specifically with the HSE at a very recent meeting.
The 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 one of the 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, the HSE sought to maximise the use of existing resources across hospital groups and CHO's and to target additional investment at both hospital and community services and supports. This includes additional home support packages and transitional care beds to support people to leave the hospital and return home.
The range and prioritisation of measures was a matter for UHL and CHO Mid-West. Key measures included:
- extended opening hours in the AMAU;
- opening of a surgical short stay unit;
- additional access to diagnostics.
The NTPF have established a fund of €1m that will support the HSE Winter plans with a focus on increasing access to diagnostics in both private facilities and in-house. 6,050 vouchers had been issued to Emergency Departments for diagnostics as of 31 March 2019, including 1,050 vouchers issued to UHL.
It is widely agreed that a key part of the solution for Limerick is additional beds. Over the past 18 months, an additional 25 beds have opened in Limerick, including 8 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.
In addition, the National Development Plan includes a 96-bed replacement ward block in Limerick and capital funding was provided in 2018 to progress the design phase of this project.
I have asked the HSE to respond to you directly on the actions that are being taken to maximise the use of existing resources in UL Hospital Group and CHO 3 and to reduce overcrowding.
384. Deputy Noel Grealish asked the Minister for Health the progress of the expert group which was established to consider alternative mechanisms to the court process for resolving clinical negligence claims; the status of the publication of the final report; and if he will make a statement on the matter. [17698/19]
View answerGovernment agreed in June this year to the establishment of an Expert Group to review the law of torts and the current systems for the management of clinical negligence claims. They agreed that High Court Justice Charles Meenan would chair the Group which would advise on whether there are alternative mechanisms to the current court process for resolving clinical negligence and personal injury claims.
Judge Meenan's Expert Group will especially examine the system from the perspective of the person who has made the claim to explore if there is a better way to deal effectively yet more sensitively with certain cases. In this process the Group will also look at the impact of tort legislation on the overall patient safety culture and open disclosure.
Judge Meenan submitted an Interim Report to the Minister for Health and the Minister for Justice and Equality on the 9 January 2019 and it is now available on my Department's website. The Expert Group's Final Report is expected in June 2019.
385. Deputy Eamon Scanlon asked the Minister for Health the number of paediatric physiotherapists working in County Sligo. [17699/19]
View answerI have asked the HSE to respond directly to the Deputy on this matter.
386. Deputy Jonathan O'Brien asked the Minister for Health the legislation that will be utilised or invoked in order to make additional appointments and increase the number of members on the board of the National Paediatric Hospital Development Board in view of the fact that under SI No. 246 of 2007, the board’s membership is prescribed as 13 and there is no provision within the statutory instrument for exceeding the membership of 13 through further appointments. [17700/19]
View answerThe process for appointing the Chairperson and members to the Board of the National Paediatric Hospital Development Board is set out in the National Paediatric Hospital Development Board (Establishment) Order 2007. In order to better reflect the competency requirements for the Board for the next phase of the project, the Establishment Order was amended by the Children’s Health Act 2018 in December to provide that the Board shall consist of a Chairperson and ordinary members who are persons who have experience and expertise in relation to matters connected to the functions of the Board.
In May 2018, the Chairperson of the Board advised my Department of the importance of maintaining continuity on the Board at the critical phase of the project and indicated that Board members were willing to be reappointed, and following the appointment process then in existence, I issued letters of reappointment to the outgoing Chairperson and outgoing members of the Board. However, the appointment letters made clear to all parties that their term of office would be until such time as new appointments were made in line with the new legislative provision.
The Children’s Health Act 2018 includes a provision which, on commencement by means of a Ministerial Order, provides that the Board in existence at the time of commencement will cease to be in office, thereby enabling new appointments to be made to the Board. There is currently one vacancy on the Board.
387. Deputy Pearse Doherty asked the Minister for Health the service schedule for a respite care facility (details supplied) in County Donegal; the days of the week and number of hours per day respite care will be provided at the unit; and if he will make a statement on the matter. [17702/19]
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.
388. Deputy Fiona O'Loughlin asked the Minister for Health the services available to persons who have been adversely affected by the use of defective synthetic vaginal mesh implants; and if he will make a statement on the matter. [17704/19]
View answer389. Deputy Fiona O'Loughlin asked the Minister for Health when the implementation plan for the recommendations set out in the report of the chief medical officer in regard to the use of vaginal mesh will be published; and the steps he is taking to ensure no further delay in the establishment of mechanisms for women who have suffered complications from mesh accessing aftercare [17705/19]
View answerI propose to take Questions Nos. 388 and 389 together.
As Minister for Health, I requested Dr Tony Holohan, Chief Medical Officer (CMO) to draft a report on the use of Uro-Gynaecological Mesh in the surgical treatment of stress urinary incontinence (SUI) and pelvic organ prolapse (POP) in women. The report covers the clinical and technical issues involved in ensuring both:
1. the safe and effective provision of mesh procedures in urogynaecology and
2. an appropriate response to women who suffer complications as a result of undergoing such procedures.
This report has been completed and was published on the Department of Health website on 21 November 2018. Preparation of the report 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 was informed by review of international reports and safety reviews of mesh surgery which have been published in recent years.
The report was informed by the personal experiences and concerns of women who have suffered complications following mesh surgery, including through written representations to me and my Department, those concerns raised in Parliamentary Questions on this subject, and the issues raised by the Mesh Survivors Ireland group at its meeting with me on 14 June 2018. I acknowledge the bravery, commitment and dignity shown by the women I met and by those women who have written to me concerning this issue, in sharing what were often harrowing, deeply personal experiences.
The priority issues relating to patient care which were raised by women suffering complications and by others on their behalf are addressed in the report recommendations and are being addressed by the HSE.
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, were not 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, a number of women whose procedures were postponed wrote to me and my Department expressing concern at the impact that this is having on them personally as they await treatment for the distressing symptoms of SUI, reflecting another important group of women affected directly by this issue.
The CMO’s Report identifies that for many women, surgical procedures using synthetic mesh devices have provided a more effective and less invasive form of treatment than traditional SUI and POP procedures. However, mesh devices are associated with significant and severe complications in a minority of women. These are of concern given the difficulties of mesh implant removal.
The Report makes 19 recommendations including:
- the development of patient information and informed consent materials;
- surgical professional training and multidisciplinary expertise in units carrying out mesh procedures;
- the development of clinical guidance;
- the development of information systems to monitor the ongoing use of mesh devices;
- ensuring the reporting of mesh related complications; and
- ensuring timely, appropriate and accessible care pathways for the management of women with complications.
In advance of the report’s completion, the HSE was requested in May 2018 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. The HSE was also asked by the Chief Medical Officer on 24 July to pause all mesh procedures where clinically safe to do so, until a number of key recommendations are implemented.
A Synthetic Mesh Devices Advisory Group has been convened by the HSE, to advise on and progress all of the recommendations. The Group 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 action all of the recommendations above. The HSE has advised that it is unable to facilitate membership on the Advisory Group to every patient or patient group who has a mesh experience. The NWIHP has sought to have a range of mesh experiences from the patient’s perspective represented by a patient advocate on the Group – including patients who have had mesh with post-operative problems, patients who have had successful mesh surgery and patients who are on the waiting list for a mesh procedure. The HSE advises that women who wish to submit views or submissions to the overall work of the Group should contact the National Women & Infants Health Programme at smi.nwihp@hse.ie.
I am informed that an ongoing work programme for the development of appropriate patient information resources and consent materials, and the clarification and development of treatment pathways and appropriate referral services for women suffering from mesh-related complications 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.
The HSE has advised that many women have already engaged with this pathway system and have attended centres for second opinion and follow up appointments. The HSE has published a dedicated webpage about vaginal mesh implants, including contact information for women suffering complications, which I hope is a useful resource. This can be found on the HSE website.
The Secretary General of my Department wrote to the HSE on November 27 2018 to request that it prepare a detailed Implementation Plan for the complete set of recommendations set out in the CMO’s Report, to be approved by the Leadership Team in the HSE and published on the HSE website within three months of receipt of the report, or sooner if completed. It was also requested that a copy of the Implementation Plan, together with an interim report on the implementation of those recommendations on which work has already commenced, should be submitted to the Department at the time of publication of the Implementation Plan.
I am informed that the HSE has advised that the final version of the Implementation Plan will be published on its website and submitted to my Department in coming weeks.
At my recent meeting with the Mesh Survivors Ireland Group on 7 March 2019 I agreed to continue engagement with them on a pathway forward, to ensure that the ongoing clinical management of this patient group is in line with international best practice and emerging evidence.
390. Deputy Fiona O'Loughlin asked the Minister for Health the waiting time for an assessment of a child with special needs, for example, speech and language, occupational therapy and so on in counties Kildare and Laois. [17707/19]
View answer391. Deputy Fiona O'Loughlin asked the Minister for Health the number of occupational therapists employed in the south Kildare disability network team, DNT; if additional personnel will be employed; and if he will make a statement on the matter. [17708/19]
View answerI propose to take Questions Nos. 390 and 391 together.
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.
392. Deputy Fiona O'Loughlin asked the Minister for Health the amount of funding allocated to County Kildare for respite for children who require same; and if he will make a statement on the matter. [17710/19]
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.
393. Deputy Fiona O'Loughlin asked the Minister for Health if his attention has been drawn to the practice that general practitioners are seeking further payments on top of medical cards from nursing homes; and if he will make a statement on the matter. [17712/19]
View answerUnder the terms of the current GMS contract, GPs are required to provide eligible patients with ''all proper and necessary treatment of a kind usually undertaken by a general practitioner and not requiring special skill or experience of a degree or kind which general practitioners cannot reasonably be expected to possess." There is no provision under the GMS GP contract for persons who hold a medical card or GP visit card to be charged for medical services provided under the contract.
GPs contracted by the HSE under the GMS scheme are obliged to provide services to their medical card and GP visit card patients, including those resident in nursing homes. GPs are remunerated for these services primarily on a capitation basis, with a range of additional support payments and fees for specific items of service. An annual capitation payment of €434.15 is payable in respect of each GMS patient over 70 years of age residing in a private nursing home approved by the HSE for periods in excess of 5 weeks. Along with most other capitation rates the nursing home rate will increase by approximately 48% over the next 4 years, under the recent agreement with the IMO on the reform and modernisation of the GMS contract
However,if a nursing home requires GPs to provide services to the home above and beyond what is covered by the GMS contract, this would be a matter of private contract between the Nursing Home and the GPs concerned.
If a nursing home feels that a GP is not providing the required care to a GMS patient as provided for in the GMS contract, they should contact their local HSE Primary Care Unit who will look into the matter.
394. Deputy Mary Butler asked the Minister for Health the services available to patients when a new respite centre (details supplied) is completed; the services that will be provided; if these services include day respite, after school and overnight respite for students; if there will be weekend respite care provided; if transport options will be made available for those availing of the services; the expected official opening date of the facility; and if he will make a statement on the matter. [17713/19]
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.
395. Deputy Peadar Tóibín asked the Minister for Health the number of home help hours allocated under the home care package in each of the years 2016 to 2018 and to date in 2019, in each county in tabular form; and if he will make a statement on the matter. [17720/19]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
397. Deputy Maurice Quinlivan asked the Minister for Health the length of time a person (details supplied) will have to wait for a CT urogram scan at University Hospital Limerick; and if he will make a statement on the matter. [17725/19]
View answerUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
The National Waiting List Management Policy, a standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, since January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
398. Deputy Niamh Smyth asked the Minister for Health if an appointment with a child development team will be secured in the case of a person (details supplied); and if he will make a statement on the matter. [17727/19]
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.
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.
399. Deputy Michael McGrath asked the Minister for Health further to Parliamentary Question No. 662 of 15 January 2019, if his attention has been drawn to the fact that the counselling service previously available under the youth health service is not currently available; the reason this is the case in view of the assurance given that services would not be impacted by the reorganisation; and if he will make a statement on the matter. [17729/19]
View answerAs the issue raised refers to service matters, it has been referred again to the Health Service Executive for their direct reply to the Deputy.
400. Deputy Clare Daly asked the Minister for Health the reason the house of a person in a nursing home under the fair deal scheme cannot be sold while the person is alive in the context of assisting families whose children may want to buy out, for example, grandparents’ homes, generating new mortgages, stamp duties and giving the HSE revenue earlier than it would otherwise receive; and if he will make a statement on the matter. [17730/19]
View answerThe 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.
Participants in the Scheme contribute up to 80% of their assessable income, such as their pension and a maximum of 7.5% per annum of the value of assets held, such as their principal private residence or cash assets. The first €36,000 of an individual’s assets is not counted at all in the financial assessment. The capital value of an individual’s principal private residence is only included in the financial assessment for the first three years of their time in care. This is known as the three year cap.
The Scheme has no restrictions in place in relation to the sale of a home. However, if a participant in the Scheme were to sell an asset, such as a home, after their first financial assessment the proceeds of the sale would therefore become a cash asset. The three-year cap will then no longer apply and the participant must pay a contribution of 7.5% based on this cash asset.
A participant in the scheme can request a financial review if 12 months have passed since their initial review. However, the HSE may review a financial assessment at any stage.
