Written Answers Nos. 141-151
141. Deputy Fiona O'Loughlin asked the Minister for Health the action being taken to reduce the long waiting times for a first assessment for occupational therapy in County Kildare and west County Wicklow; and if he will make a statement on the matter. [20914/19]
View answerAs this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply.
142. Deputy Mick Wallace asked the Minister for Health the reason no public benchmarking analysis was completed prior to the issuing of a tender in respect of the national children's hospital; and if he will make a statement on the matter. [18045/19]
View answerThe National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for planning, designing, building and equipping the new children's hospital. I have referred your question to the NPHDB for direct reply.
143. Deputy Mick Wallace asked the Minister for Health his views on the fact that the public spending code guidelines may have been ignored with regard to the construction of the national children's hospital; if he is satisfied that, in terms of the hospital, the public spending code guidelines on money being spent as efficiently as possible and waste being avoided have been followed; and if he will make a statement on the matter. [18044/19]
View answerAn independent review into the cost escalation associated with the new children’s hospital construction project was commissioned to understand the reasons for the cost escalation. PwC conducted this review.
The review Report, "New Children's Hospital Independent Review of escalation in costs", was published on 9 April 2019. The Report found that the Definitive Business Case which was completed by the National Paediatric Hospital Development Board did not adhere to the requirements defined in the Public Spending Code. The Report did not find that the guidelines were ignored but instead identified specific issues including the Business Case treatment of tendered costs, residual risk relating to quantities and optimism bias.
The PwC Report breaks down the cost escalation as between underestimation (by far the largest contributory factor), execution issues including delays in concluding the GMP process, consequential costs (e.g. VAT) and uncontrollable costs.
The Report also recommends more generally that the rules governing public sector spending on major capital projects should be strengthened. The Minister for Public Expenditure and Reform has already advised the Oireachtas of the work underway in his Department to revise the Public Spending Code. Finalisation of this Code will be informed by the PwC Report including the incorporation of further guidance as to how costs should be estimated, risk assessed and quantified and account taken of potential optimism bias.
The Minister for Public Expenditure and Reform and I are to revert to Government with a plan for implementing the PwC recommendations, and I expect that we will do so shortly. When the implementation plan is approved by Government, it will be published.
144. Deputy Richard Boyd Barrett asked the Minister for Health his plans for implementing the outstanding recommendations from the Citizens' Assembly. [14251/19]
View answerThe Citizens’ Assembly met in June and July 2017 to consider the topic of “How We Best Respond to the Challenges and Opportunities of an Ageing Population.” The Report including the results of votes cast by the Assembly made 21 recommendations.
In response to the challenges of how we as a country respond to the Challenges and Opportunities of an Ageing Population the Department of Health are currently focusing on a number of different areas of work relating to this issue.
The National Positive Ageing Strategy (NPAS), published on 24 April 2013, provides a framework for cooperation to address age-related policy and service delivery across Government and society in the years ahead. The Strategy is intended to promote older people’s health and well being so that older people can continue to contribute to social, economic, cultural and family life in their own communities for as long as possible, thereby representing a vision for an age-friendly society. The Strategy highlights that ageing is not just a health issue, but rather requires a whole of Government approach to address a range of social, economic and environmental factors that affect the health and wellbeing of our ageing citizens.
The inaugural Positive Ageing stakeholder forum took place in 2017. Stakeholders were asked to identify key priorities to propose to Government to consider for its focus in the coming year. Through this forum, clear channels of communication between the stakeholder representative group and relevant Government Departments to discuss these priorities have been facilitated by the Department of Health. The second annual stakeholder forum took place in the Department of Health in October 2018. Again, stakeholder identified clear priorities and collaborative work in this area is ongoing.
As part of the NPAS implementation process, a Healthy and Positive Ageing Initiative (HaPAI) was established in collaboration with the HSE’s Health and Wellbeing Programme and the Atlantic Philanthropies. HaPAI provides an ongoing system for measuring and reporting on positive ageing and implement the research objectives of the National Positive Ageing Strategy (NPAS). It was jointly funded by the Department of Health, the HSE’s Health and Wellbeing Programme, and the Atlantic Philanthropies.
The initiative aims to monitor changes in older people’s health and wellbeing linked to the goals and objectives of the NPAS. This is done primarily through the development of national positive ageing indicators which will be published at suitable intervals. The indicators report will allow all Departments to identify areas of improvement in relation to older persons' health and well-being, as well as areas requiring improvement and potential for evidence-based policy intervention.
Home support is an important part of the supports for enabling older people to remain in their own homes and communities for as long as possible and for facilitating their discharge from acute hospitals. Improving access to home support is a priority for Government. Over the past four years the Government has overseen a considerable increase of nearly €140 million in the budget which has grown from €306 million in 2015 to almost €446 million this year. This year the HSE intend to provide over 18 million home support hours to be delivered this year to over 53,000 people.
The Department of Health is also currently engaged in the development of a new statutory scheme and system of regulation for home-support services. In preparation for the development of the statutory scheme, the Department commissioned the Health Research Board to carry out a review of the home-care systems in four European countries. In addition, the Department conducted a public consultation on home-care services, on which a report was published in 2018. These reports are available on the Department’s website and will help to ensure that the new scheme is informed both by international experience and by the views of stakeholders, including service-users.
Work is on-going to determine the optimal approach to the development of the statutory scheme within the broader context of the Sláintecare reforms. The Department’s Sláintecare Implementation Strategy commits to the introduction of the statutory scheme in 2021. In 2019 work will focus on the design of the scheme, the options for regulation and a review of existing services. Further consultation will also be undertaken in 2019 (with key stakeholders and service-users) and will continue throughout the process of developing the new scheme.
The development of a new statutory scheme and system of regulation for home-support services is a complex process. Accordingly, it will be early 2020 before it is possible to set out in principle the parameters of the scheme and to seek Government approval to proceed to draft the heads of a bill.
The Assisted Decision-Making (Capacity) Act 2015 is the policy responsibility of the Department of Justice & Equality. The 2015 Act provides for the establishment of the Decision Support Service within the Mental Health Commission to support decision-making by and for adults with capacity difficulties and to regulate individuals who are providing support to people with capacity difficulties. A Steering Group chaired by the Department of Justice and Equality meets monthly to progress the establishment of the DSS. The Decision Support Service is working towards being operational and ready for the commencement of the main provisions of the Act in 2020.
The Department of Health has policy responsibility for Part 8 of the 2015 Act, which 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 the Minister for Health established a multidisciplinary working group to prepare a detailed series of recommendations for the Director of the Decision Support Service (DSS), in relation to the code of practice under section 91(2) of the Act. In anticipation of the completion of that process, the Minister for Health commenced the remainder of section 91 in December 2018 [S.I. No. 527 of 2018]. This will enable the Director of the DSS 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. The multidisciplinary working group submitted its recommendations on the code of practice to the Director of the DSS on in December 2018.
Once completed the final code of practice can be published by the Director with the Minister's 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.
Elder abuse (in a health sector context) is among the topics which will be covered in a new national policy on adult safeguarding in the health sector, currently being developed by the Department of Health following a Government decision in December 2017. It is intended that the policy will apply across the full spectrum of the Irish health and social care sector i.e. all public, voluntary and private health and social care services. A draft policy (which the Department aims to finalise around the end of 2019) will be the subject of a public consultation exercise. As the policy development process progresses, legislative requirements will also be identified. It is intended that following completion of the Adult Safeguarding policy for the health sector, any underpinning legislation required to give full effect to the policy will be pursued as appropriate.
Other recommendations included in the Report of the Assembly including those relating to taxation, retirement age and pensions do not fall within the remit of the Department of Health.
145. Deputy Richard Boyd Barrett asked the Minister for Health his plans to allocate additional resources to the health service in view of the recruitment difficulties across the sector; and if he will make a statement on the matter. [18072/19]
View answerThe 2019 National Service Plan set out a budget of over €16 billion for the HSE, the highest budget ever allocated. The Health budget was increased by €848 million on 2018, a substantial additional level of funding. The amount allocated follows an extensive process of engagement between my Department and the HSE, which considers both the funding requirements as submitted by the HSE and the fiscal position. These types of engagements are a normal part of the Budgetary process and happen with agencies across Government. All public bodies put forward spending proposals but all such bodies, including the HSE, are required to operate within the amounts proposed by Government and determined by the Dáil.
In that context, the HSE needs to ensure that affordable and appropriate recruitment decisions are made. Where individual Hospital Groups or CHOs have not demonstrated their ability to do this, the HSE has introduced certain interim measures and controls across these locations.
The intention is for these measures to be in place for a short period of time. The over-riding requirement for the HSE is to prioritise the delivery of safe services within the available resources. However, I have been very clear that those locations which provide credible, balanced plans will be supported. Similarly, locations which do not submit such plans need to be scrutinised.
The services to be provided in 2019 are as set out in the National Service Plan, and levels are typically equal to or higher than planned or delivered in 2018. The additional funding provided in Budget 2019 for new developments will support new or expanded levels of services across priority service areas.
147. Deputy Marc MacSharry asked the Minister for Health if he will increase funding to the HSE social care division CHO 1 to allow for a home support service to be put in place for elderly persons who have already been approved for the service and have been advised that they are on a waiting list until resources become available; his views on whether such a situation is unacceptable; and if he will make a statement on the matter. [20954/19]
View answerImproving access to home support is a priority for Government. Over the past four years we have seen a considerable increase of nearly €140 million in the budget which has grown from €306 million in 2015 to almost €446 million this year.
This year the HSE intends to provide 17.9 million home support hours to 53,000 people and intensive home care packages to 235 people.
Despite this significant level of service provision, the demand for home support continues to grow. The allocation of funding for home supports across the system, though significant, is finite and services must be delivered within the funding available. Preliminary data indicates that at the end of March there were 52,360 people in receipt of home support. During the first quarter of the year 4.2 million hours were delivered nationally, 4,411 new clients commenced the service and 6,238 people have been assessed and are waiting for either new or additional home support services.
I acknowledge that in some cases access to the service may take longer than we would like. However, the HSE has assured my Department that those people who are on a waiting list are reviewed, as funding becomes available, to ensure that individual cases continue to be dealt with on a priority basis within the available resources and as determined by the local front line staff who know and understand the clients’ needs, and who undertake regular reviews of those care needs to ensure that the services being provided remain appropriate.
While the existing home support service is delivering crucial support to many people across the country, it needs to be improved to better meet the changing needs of our citizens. We are developing plans for a new statutory scheme and system of regulation for home support services. This will improve access to the service on an affordable and sustainable basis while also introducing a system of regulation that will ensure public confidence. The Sláintecare Implementation Strategy commits to the introduction of the new scheme in 2021.
In the meantime, the Department and the HSE are continuing to improve existing services, including in 2018 the introduction of a single funding stream for home support services. This is providing significant benefits including making the services easier to understand; streamlining the application and decision-making processes; and facilitating service users to move to changed levels of service as their assessed needs change, without the need for an additional application process.
148. Deputy Catherine Murphy asked the Minister for Health if his attention has been drawn to a petition regarding RehabCare; the level of involvement he will take on this matter; if he has engaged with the HSE on this issue (details supplied); and if he will make a statement on the matter. [20955/19]
View answerThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives.
I want to acknowledge the important services provided by Rehab and the commitment of staff to people with disabilities and their families.
Minister Harris and I held a joint meeting on Tuesday 07 May last, with Rehab and the HSE. Rehab and the HSE committed to working together intensively over the past week with a view to making substantive progress in reaching a solution to the issues. A further meeting is scheduled to take place today, 15 May.
Our collective aim is to ensure service continuity for service users and their families.
149. Deputy Declan Breathnach asked the Minister for Health the obligations on the Medical Council of Ireland to report to An Garda Síochána a medical professional who has been struck off the register for offences that are deemed illegal; if there is no obligation on the Medical Council to report such incidents further, his plans to introduce measures to remedy this anomaly; and if he will make a statement on the matter. [20957/19]
View answerWhere a medical practitioner has been convicted of a criminal offence, it is usual that the practitioner is referred to the Medical Council or the Council takes the initiative when the Council becomes aware that a medical practitioner has been convicted of a criminal offence through another avenue such as a complaint, court report, media, etc.
When the Medical Council becomes aware of serious concerns, which require immediate action in order to protect the public, the Council will contact An Garda Síochána. The Council does not need particular statutory provisions to report something to the Gardaí.
If a registered medical practitioner has been found guilty of professional misconduct concerning a complaint, depending on the circumstances and nature of the complaint, the Medical Council may inform the Garda Vetting Bureau.
150. Deputy Niamh Smyth asked the Minister for Health if home help will be sanctioned and put in place for a person (details supplied); and if he will make a statement on the matter. [20958/19]
View answerAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
151. Deputy Declan Breathnach asked the Minister for Health his views on the process that is followed or guidelines that are given by the Medical Council of Ireland to general practices when vetting or hiring general practitioners who may have been struck off in another jurisdiction; and if he will make a statement on the matter. [20962/19]
View answerTo practice medicine in Ireland a doctor must be registered with the Medical Council. The Medical Council reviews the doctor’s qualifications to ascertain which division on the register the doctor may be registered on as set out in the Medical Practitioners Act 2007. It is the responsibility of the employer to ensure a doctor they are hiring is registered on the correct division of the Medical Council Register for the role they are applying for. The Medical Council has no role in employing doctors.
When applying for registration a doctor must make a number of declarations, including whether or not they have been subject to disciplinary procedures such as Fitness to Practise or have a criminal conviction in another jurisdiction. The Medical Council is also part of the IMI (Internal Market Information) system which means that when a practitioner is sanctioned (including erasure/cancellation) in other EU jurisdictions the Medical Council will receive an alert. If a practitioner is the subject of a notice from an IMI alert is also on the Medical Council's register the Council may decide to take its own disciplinary action. If the Council has strong concerns about a practitioner the Council may use Section 60 of the Medical Practitioners Act 2007 to apply to the High Court to seek an emergency suspension of a practitioner’s registration in order to protect the public, pending the outcome of the disciplinary process as per the Act.
The National Vetting Bureau (Children and Vulnerable Persons) Acts 2012 to 2016 provides a statutory basis for the vetting of persons carrying out “relevant work with children or vulnerable persons”.
Garda vetting is an integral part of the HSE recruitment and selection process for positions which constitute “relevant work” and the onus is on the management of a service to determine if a vetting disclosure is required.
General practitioners are not employees of the HSE they are private contractors providing services under contract on behalf of the HSE. However, the HSE, in compliance with legislation, requires GP contractors to be Garda vetted before a contract is awarded.
As private employers, it is a matter for each GP practice to assess whether its employees would have access or contact with children or vulnerable persons as contemplated by the legislation. If so, they should be Garda vetted. Failing to carry out Garda vetting when it is required is an offence.
