Thursday, 10 Oct 2019

Written Answers Nos. 1-22

Hospital Services

Questions (5)

Catherine Connolly

Question:

5. Deputy Catherine Connolly asked the Minister for Health further to Parliamentary Question No. 1301 of 6 September 2019, the status of the options appraisal for the model 4 hospital at Merlin Park, Galway; if the options appraisal was submitted to the HSE and his Department by the end of September 2019; when the options appraisal will be published; the cost to date of the options appraisal process; the anticipated overall cost of the process; and if he will make a statement on the matter. [41156/19]

Written answers

Minister for Health

As the Deputy is aware, in May 2017, I gave approval to the HSE to conduct an options appraisal for future acute hospital needs in Galway. Following the appropriate procurement process, external consultants were appointed to the project in July 2018.

As part of this project, Saolta University Healthcare Group undertook a planning project to assess the population health needs for the Hospital’s catchment area in order to inform existing and future service needs to ensure the delivery of safe high quality acute, elective and cancer care for patients across the West/Northwest.

Earlier this year, the HSE extended the scope of the appraisal to incorporate interim priority infrastructural requirements. While this prolonged the timeline for delivery of the report, it allowed for a review of the critical areas requiring infrastructure development, as well as a review of the requirements for the elective hospital.

The HSE has advised that the draft report on the options appraisal is undergoing final review at present, including a submission of the draft report to the Saolta Board for consideration. An initial briefing on the draft plan was provided by the HSE to my Department at the end of September.  The costs of the options appraisal process will be available once it is concluded.

I look forward to the formal submission of this report which will allow for a detailed examination of the proposal to ensure it aligns with the Sláintecare vision and provides direction for the provision of health services in the West and Northwest into the future.

Questions Nos. 6 to 12, inclusive, answered orally.

Disabilities Assessments

Questions (13)

Richard Boyd Barrett

Question:

13. Deputy Richard Boyd Barrett asked the Minister for Health the way in which he plans to speed up access to assessment of needs for children to bring it in line with the statutory requirements to ensure the waiting list is no longer than three months and is completed in six months; and if he will make a statement on the matter. [41366/19]

Written answers

Minister of State at the Department of Health

The Disability Act 2005 provides for an Assessment of Need for people with disabilities. Any child thought to have a disability, born on, or after June 1st, 2002 is eligible to apply for an 'Assessment of Need' that will detail his or her health needs arising from a disability.  Since its commencement in 2007, there have been significant year on year increases in the number of children applying both for an 'Assessment of Need' and for disability services generally. Regrettably, these increases have led to the extended waiting periods currently being experienced by children and their families.

In order to improve the 'Assessment of Need' process and ensure that children receive an intervention as soon as possible, the HSE has developed a new Standard Operating Procedure for the Assessment of Need process. This measure will ensure children with disabilities and their families, access appropriate assessment and intervention as soon as possible, while at the same time bringing consistency to the Assessment of Need process in each Community Healthcare Organization of the HSE.

The HSE  is currently concluding a lengthy consultation and Industrial Relations engagement regarding the implementation of this procedure which it hopes to have in place by the first quarter of 2020. In addition, HSE Disability Services is currently engaged in a major reconfiguration of its existing therapy resources for children with disabilities into multi-disciplinary geographically based teams, as part of its National Programme on Progressing Disability Services for Children and Young People (0-18 years).

The key objective of this Programme is to bring about equity of access to disability services and consistency of service delivery, with a clear pathway for children with disabilities and their families to services, regardless of where they live, what school they go to or the nature of the individual child’s difficulties.  Evidence to date from areas where this has been rolled out shows that implementation of this programme will also have a positive impact on waiting lists both for Assessments of Need and therapy provision.

Recently, an increase in therapy posts was identified as a priority requirement to meet current unmet need and projected future needs in children's disability services nationally. In that regard, last year's Budget provided for the recruitment of an additional 100 therapy posts to help reduce the long waiting times for assessment as well as supporting interventions for children who need them. The recruitment process for these posts is well underway and a number of posts have been filled. This welcome new resource will result in additional new therapy posts ranging from Speech and Language Therapy, Occupational Therapy, Physiotherapy, Social Workers and Psychologists.

I am conscious that timely access to assessments and therapies is imperative in a child’s development and I fully understand how delays in accessing the service are a source of great concern for both children and their families and while not addressing all needs, I am confident the initiatives I have outlined will have a significant positive impact in reducing waiting times for Assessment of Need over the course of the next year.

Question No. 14 answered orally.

Hospital Waiting Lists

Questions (15)

Barry Cowen

Question:

15. Deputy Barry Cowen asked the Minister for Health the reason for the large increase in the number waiting more than 18 months for an outpatient appointment in the Midland Regional Hospital, Tullamore since May 2016; and if he will make a statement on the matter. [41200/19]

Written answers

Minister for Health

Reducing waiting times for hospital appointments and procedures is a key commitment of government. While the last 18 months have seen considerable progress in the reduction of waiting times for Inpatient and Daycase treatments, I am conscious that the Outpatient Waiting List remains a significant challenge as demand for acute hospital services continues to grow.

Waiting list figures for the end of September, due to be published by the National Treatment Purchase Fund (NTPF) later this week, show that there are 16,500 people waiting for an outpatient appointment at Midlands Regional Hospital Tullamore. 61% of patients have been waiting less than one year, while 27% (4,500 patients) are currently waiting over 18 months. ENT accounts for 69% (3,080) of all patients waiting for an outpatient appointment over 18 months.

More broadly, the NTPF advise that over recent months they have placed a particular focus on engaging with hospital groups and individual hospitals to identify outpatient waiting list proposals. In addition, my Department has established a Working Group comprised of representatives from the HSE, NTPF, and Departmental officials, to examine ways of improving access for patients waiting for scheduled care. Part of this work includes developing initiatives which will move care to the most appropriate setting, and at the lowest level of complexity. ENT is one of the specialties being examined as part of this process.

Budget 2020 announced that the Government has further increased investment in tackling waiting lists, with funding to the NTPF increasing from €75 million in 2019 to €100 million in 2020. The year-on-year increases to the National Treatment Purchase Fund since Budget 2017 reflect this Government’s priority to improve waiting times for patients to access hospital treatment.

My Department is working with the HSE and NTPF to develop the Scheduled Care Access Plan 2020. In this regard, the HSE National Service Plan 2020 will set out a planned activity level for the year ahead, while the NTPF will work with the hospital system to provide additionality to reduce inpatient/day case waiting lists, with a particular focus on improving access to hospital outpatient services. In 2020, the Department will also be asking the HSE and NTPF to work together with the Sláintecare Implementation Office with the aim of driving sustainable improvements to service provision.

Question No. 16 answered orally.

Home Care Packages Administration

Questions (17)

Timmy Dooley

Question:

17. Deputy Timmy Dooley asked the Minister for Health the action that will be taken to reduce the waiting list for homecare in County Clare in which the number waiting has seen a significant rise during 2019; and if he will make a statement on the matter. [41197/19]

Written answers

Minister of State at the Department of Health

Home supports enable older people to remain in their own homes and communities, as well as facilitating timely discharge from hospital.  At the end of August, the HSE had provided over 312,000 hours of home support in Clare and 1,191 people were receiving the service.  However, I acknowledge that in some cases access to the service may take longer than we would like and there were 466 people waiting for new or additional service. 

In line with commitments given in the Programme for Government we have made improved access to home support services a priority. In 2020 an additional investment of €52 million is being made which will provide over 19.2 million hours of home support. This is 1 million hours more than the 2019 target and represents a substantial increase in service provision.

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. Included in this investment is dedicated funding for the testing of the new statutory home-support scheme in 2020.

The design of the new scheme will involve the establishment of a model of service with a streamlined central system of administration to improve and simplify how people access home-support services. While the administration of the scheme will be centralised, the delivery of services will be co-ordinated at local level in line with a person’s assessed need. A core component of the Scheme and the testing phase will be the implementation of InterRAI, as the standardised assessment tool for determining need under the new scheme.

The testing phase will include a range of services with a focus on improving both cognitive and physical capacity and resilience to support people to live in their homes and in their communities. The core principles of Healthy Ireland, Positive Aging, prevention and early intervention will underpin this approach.

Hospital Overcrowding

Questions (18)

Marc MacSharry

Question:

18. Deputy Marc MacSharry asked the Minister for Health the measures being taken to alleviate overcrowding in Sligo University Hospital in which the figures recorded in September 2019 were the worst recorded for September since an organisation (details supplied) commenced keeping records; and if he will make a statement on the matter. [41230/19]

Written answers

Minister for Health

According to provisional HSE TrolleyGAR data, there was a 2.1% increase in patients counted waiting on trolleys at 8am in Sligo University Hospital ED for the year to date as of the end of September 2019 compared to the same period last year. In the month of September 2019, there were 305 patients counted on trolleys in Sligo, which was a 1% increase compared to the previous month.

I wish to acknowledge the distress overcrowded EDs cause to patients, their families and frontline staff working in very challenging working conditions in hospitals throughout the country. My Department is engaging extensively with the HSE this year to identify mitigating actions to bring down trolley numbers and waiting times in the ED in the face of growing demand. 

Planning for winter 2019/20 has commenced and my Department is working with the HSE to finalise the Winter Plan in the coming weeks. Individual Community Healthcare Organisations (CHOs) and Hospital Groups are preparing Integrated Winter Plans that will focus on demand management and reduction, staffing availability, timely access to the most appropriate care pathway for patients as well as provide appropriate timely egress from acute hospitals. These Integrated Winter Plans will support the development of a single overarching strategic level Winter Plan for the HSE. 

The Integrated Winter Plan for Sligo University Hospital will be delivered by a Winter Action Team whose membership will include the CEO of the Saolta University Health Care Group, the Chief Officer of CHO 1, and the CEO of Sligo University Hospital. 

The Health Service Executive recently published its Capital Plan for 2019-2021 outlining projects to be progressed over the three-year period. The Capital Plan includes a new ward block development and additional bed capacity at Sligo University Hospital.

The HSE has advised that preliminary design work and site investigations have been carried out for this new development at Sligo University Hospital. Planning approval was granted in July 2019 and the project is currently at the detailed design stage.

Disability Support Services Provision

Questions (19)

Margaret Murphy O'Mahony

Question:

19. Deputy Margaret Murphy O'Mahony asked the Minister for Health his plans to increase the number of personal assistance hours being provided to persons with disabilities; and if he will make a statement on the matter. [41186/19]

Written answers

Minister of State at the Department of Health

In line with Government policy, the HSE provides Personal Assistant (PA) Services that are person-centred, equitable and transparent to people with a physical and/or sensory disability.

People with disabilities are now living longer and living with a range of complex needs. In line with national policy implemented under Transforming Lives, the focus in recent years has been to enable people with disabilities to live lives of their choosing. The provision of Personal Assistant hours is an essential component to facilitate this.

The PA works on a one to one basis, in the home and the community, with a person with a physical or sensory disability. A vital element of this personalised support is the full involvement of the service user in planning and agreeing the type and the times when support is provided to them. Supporting independent living must enhance the person’s control over their own life.

PA Services are mainly provided through a range of voluntary service providers. The need for increased services is acknowledged and the HSE continues to work with agencies to explore various ways of responding to this need within the budget that is available.

The HSE has consistently, year on year, increased the number of hours of PA Service delivered, resulting in the overall number of personal assistance hours increasing by 26% between 2013 and 2018, an increase in real terms of  340,000 hours. Over the same period the number of people receiving PA Services increased by approximately 480 to 2,535.

The increase in PA support over the years reflects the increased provision of ‘in-home’ respite using enhanced PA, in comparison with residential respite.

The HSE's 2019 National Service Plan is committed to providing 1.63 million hours of personal assistance to people with disabilities, which represents an increase of 170,000 hours over the 2018 target. This year, PA Services have been delivered to over 2,550 people with a disability.  

In the normal course of service delivery, an individual's requirements are constantly reviewed to ensure services meet changing need.  An individual’s Personal Assistant hours may be adjusted following a service review where demand can result in one individual’s hours being reduced in order to address priority needs of other people with disabilities within that community.

This much needed flexibility gives local Community Healthcare Organisations the freedom to target Personal Assistant hours to maximum effect within their area.

Proposed Legislation

Questions (20)

Martin Heydon

Question:

20. Deputy Martin Heydon asked the Minister for Health the status of the legislative changes to the fair deal scheme for farmers and small business owners; and if he will make a statement on the matter. [41369/19]

Written answers

Minister of State at the Department of Health

The proposed policy change to the Nursing Homes Support Scheme (NHSS), to cap contributions based on farm and business assets at 3 years where a family successor commits to working the productive asset, has been approved by Government. The Department developed draft Heads of Bill while considering a number of complex ancillary policy and operational matters which may need to be addressed in the proposed legislation.

The General Scheme of Bill for the NHSS was approved by Government on the 11th June 2019 and subsequently published. The changes to the Scheme will come into effect as soon as the legislative process is successfully complete. The Department will progress this as quickly as possible, however, the timeline for completion of the legislation will also depend on how it passes through the Houses. The General Scheme has been sent to the relevant Joint Committee and the Department will participate in pre-legislative scrutiny when the Committee sets a date in the coming months. 

It is intended that this proposed policy change, the 3 year cap, will be extended to eligible existing participants in long term residential care so that they are not disadvantaged, but that there would be no retrospective recoupment of contributions for those who have paid contributions over and above the 3 year period.

Health Strategies

Questions (21)

Thomas Byrne

Question:

21. Deputy Thomas Byrne asked the Minister for Health the strategies in place for developing health services on third level campuses; and if he will make a statement on the matter. [41215/19]

Written answers

Minister of State at the Department of Health

My Department and the HSE are not directly responsible for the provision of routine health services on campuses. However, a number of on-campus programmes to promote health and wellbeing amongst students take place with the involvement of my Department and the HSE. These include initiatives around sexual health, mental health and awareness of the risks around tobacco, alcohol and substance misuse.

In terms of sexual health, the HSE Sexual Health and Crisis Pregnancy Programme collaborate with the Union of Students in Ireland on the Sexual Health Awareness and Guidance (SHAG) campaign every year. The campaign focusses on STI awareness and prevention, consent, contraception, unplanned pregnancy and promotion of the HSE MyOptions service.

The National Condom Distribution Service functions as a central point for distributing free condoms and lubricant sachets to HSE services and other organisations working directly with individuals and groups who may be at increased risk of negative sexual health outcomes, including young people.

Further development and expansion of this initiative will be implemented across third level college and university access points in late 2019.

Mental Health services for third level students are led by the Higher Education Authority. However, students can avail of all HSE mental health services during their time at third level institutions.

The Department of Health and HSE have been promoting the development of a number of digital mental health supports, apps such as +connections, telephone and text services, and pilots for on-line counselling and cognitive behavioural therapy services. The HSE also supports student mental health and wellbeing campaigns such as ReCharge, which was launched by Minister Daly in November of last year.

The HSE Tobacco Free Ireland Programme was launched in 2013, with the aim of Ireland being tobacco free (use among less than 5% of the population) by 2025. One of the policies aimed at the de-normalisation of smoking is to promote tobacco free campuses for all third-level institutions in consultation with key stakeholders.

The HSE continues to engage with tobacco stakeholders through a Partners Group and has provided supports in terms of Tobacco Free Campus implementation from various third level institutions. The HSE has a website, askaboutalcohol.ie, which provides advice to young people with regard alcohol consumption.

Reducing the harms caused to individuals, families and communities by substance misuse is a core goal of the National Drugs Strategy. 'Reducing Harm, Supporting Recovery’.

The HSE, in partnership with the Union of Students in Ireland earlier this year launched a harm-reduction information campaign, called #SaferStudentNights and has also run initiatives over the summer to counteract drug taking. These include harm reduction stands at three university events to discuss end of academic year celebrations and festivals and a campaign through drugs.ie aimed at university students and festival goers.

A Healthy Ireland Healthy Campus initiative is currently being developed in consultation with the third level sector and is likely to be formally launched in the near future. The Healthy Campus initiative will provide a collaborative platform to deliver health and wellbeing initiatives across campuses in a consistent manner and provide a platform for sharing best practice on implementation.

Healthcare Infrastructure Provision

Questions (22)

Michael Moynihan

Question:

22. Deputy Michael Moynihan asked the Minister for Health if he will provide a report on the works at Kanturk Community Hospital; the timeframe for their completion; and if he will make a statement on the matter. [41231/19]

Written answers

Minister for Health

The Health Service Executive recently published its Capital Plan for 2019-2021. The plan includes capital funding for the Community Nursing Unit programme and also sets out the current status of all projects within the programme, including the refurbishment and extension of Kanturk Community Hospital, County Cork.

The Health Service Executive is responsible for the delivery of public healthcare infrastructure projects and has advised that the project is currently at design stage. The planning application for the extension to Kanturk Community Hospital was lodged with Cork County Council in August. 

It is important to recognise that all capital development proposals must progress through a number of approval stages, in line with the Public Spending Code, including detailed appraisal, planning, design and procurement, before a firm timeline or funding requirement can be established.

The delivery of capital projects is a dynamic process and is subject to the successful completion of the various approval stages, which can impact on the timeline for delivery.