Tuesday, 26 Nov 2019

Written Answers Nos. 112-126

Respite Care Services Provision

Questions (112)

Eamon Scanlon

Question:

112. Deputy Eamon Scanlon asked the Minister for Health his plans to provide respite services on a seven day a week basis in the north west; and if he will make a statement on the matter. [48869/19]

Written answers

Minister of State at the Department of Health

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.

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

Medical Card Administration

Questions (113)

Declan Breathnach

Question:

113. Deputy Declan Breathnach asked the Minister for Health the action being taken to expedite the provision of medical cards for cancer patients. [48857/19]

Written answers

Minister for Health

The HSE's Expert Group on Medical Need and Medical Card Eligibility examined the issue of awarding medical cards on the basis of illness and concluded that it was not feasible, desirable, nor ethically justifiable to list medical conditions in priority order for medical card eligibility. The Expert Group also concluded that a person’s means should remain the main qualifier for a medical card. This position remains unchanged.

However, every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. The HSE may exercise discretion and grant a medical card, even though an applicant exceeds the income threshold where they face difficult financial circumstances, such as extra costs arising from an illness. Social and medical issues are also considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services.

With regard to persons suffering from cancer and other serious medical conditions the HSE also has a system in place for the provision of medical cards in response to emergency situations i.e. in circumstances where persons are in need of urgent or on-going medical care that they cannot afford and also for persons in palliative care who are terminally ill. These medical cards are promptly issued on receipt of an application, which should include a medical report from a health care professional involved in the person’s care. In addition, since 1 July 2015, the HSE adopted the position that all children under 18 years of age with a diagnosis of cancer are awarded a medical card. This card is valid for a period of 5 years.

HSE Investigations

Questions (114)

Catherine Connolly

Question:

114. Deputy Catherine Connolly asked the Minister for Health the investigation that has taken place of the injuries sustained by a patient subsequent to an incident while in the care of Galway University Hospital on 19 and 20 September 2019; when it commenced; when it will conclude; the person or body undertaking the investigation; the engagement with the family of the patient; and if he will make a statement on the matter. [48888/19]

Written answers

Minister for Health

As this is a service matter, I have asked the Health Service Executive to respond to you directly, as soon as possible.

National Children's Hospital Expenditure

Questions (115)

Stephen Donnelly

Question:

115. Deputy Stephen Donnelly asked the Minister for Health the categories of cost escalations in regard to further potential cost escalations for the building and commissioning of the national children’s hospital; the provisional amounts being allocated for each category; the estimated amount or potential range of cost escalation for each category; and if he will make a statement on the matter. [48853/19]

Written answers

Minister for Health

I advised Government in December 2018 that the final cost of the design, build and equipment programme for which the National Paediatric Hospital Development Board is responsible was estimated to be €1,433 million. There has been no change to this figure advised to Government.

An independent review into the cost escalation associated with the new children’s hospital construction project was commissioned by the HSE and carried out by PwC. The PwC report makes clear that the Guaranteed Maximum Price established through the two-stage tender process does not provide a contractual ceiling on the project’s cost and significant residual risks remain. These include national construction inflation in excess of 4%, any changes in scope, legislative changes and the Sectoral Employment Order.

The National Paediatric Hospital Development Board manages the project, actively monitoring the performance of the contract. It also has a focus on identifying and managing risks, preventing further cost increases to the greatest extent possible. It has, for example, a robust process in place for the assessment of claims by the Contractor in accordance with the Construction Contract. All claims are independently assessed and determined by the Employers Representative. Where there is a dispute on the validity of a claim, the Construction Contract sets out the dispute management process.

As the National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for planning, designing, building and equipping the new children's hospital, I have referred the further parts of your question to the NPHDB for direct reply.

Question No. 116 answered with Question No. 98.

Healthcare Infrastructure Provision

Questions (117)

Alan Kelly

Question:

117. Deputy Alan Kelly asked the Minister for Health his plans to build a new elderly care home in Roscrea, County Tipperary, to replace the Dean Maxwell home. [48826/19]

Written answers

Minister for Health

As 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.

Hospital Waiting Lists Action Plans

Questions (118)

Aindrias Moynihan

Question:

118. Deputy Aindrias Moynihan asked the Minister for Health the steps being taken to reduce the waiting list for ophthalmology treatment in County Cork; and if he will make a statement on the matter. [48862/19]

Written answers

Minister for Health

Reducing waiting time for patients for hospital operations and procedures is a key priority for Government. In recent years, my Department has worked with the HSE and National Treatment Purchase Fund and made considerable improvements to improve access for patients waiting for high volume procedures and life limiting procedures including cataracts.

At the end of July 2017, the number of people waiting for a cataract procedure was 10,024. Since then the numbers waiting have consistently improved and at the end of October 2019 they stand at 4,480. Of these, 494 patients are waiting over 9 months which represents a reduction of 90% when compared to July 2017, when the number waiting over 9 months stood at 4,371.

A key development to improve access to Ophthalmology services was the opening of a stand-alone high-volume consultant-led cataract theatre by the University of Limerick Hospital Group in Nenagh Hospital in 2018, with the intention that it would facilitate patients from surrounding geographical areas to avail of their treatment there. In this context, the HSE has advised that University of Limerick Hospital Group is working collaboratively with the South South-West Hospital Group to review over 1,000 patients on Ophthalmology waiting lists that may be suitable for cataract procedures in Nenagh.

More broadly, Budget 2020 announced that the Government has further increased investment in tackling waiting lists, with funding to the National Treatment Purchase fund increasing from €75 million in 2019 to €100 million in 2019. 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. The Department of Health is working with the HSE and National Treatment Purchase Fund to develop the Scheduled Care Access Plan 2020, which will include ophthalmology services.

In this regard, I would encourage all hospital groups and individual hospitals to engage with the NTPF to identify waiting list proposals for the remainder of this year and for 2020.

Emergency Departments Services

Questions (119)

Timmy Dooley

Question:

119. Deputy Timmy Dooley asked the Minister for Health the action being taken to address the persistent overcrowding in the emergency department in University Hospital Limerick. [48782/19]

Written answers

Minister for Health

I acknowledge the challenges facing the emergency departments in our hospitals.

According to HSE TrolleyGAR data, there was a 16% increase in patients counted waiting on trolleys at 8am in University Hospital Limerick ED this year up to the end of October 2019 compared to the same period last year. My Department has engaged 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.

The HSE Winter Plan was launched on Thursday 14 November in preparation for the anticipated increase in demand over the winter period. The Government allocated an additional €26m to fund the implementation of the Plan. Nine Winter Action Teams, each aligned to a Community Healthcare Organisation and associated acute hospitals and Hospital Groups, have prepared Integrated Winter Plans. These plans focus on demand management and reduction, staffing availability, timely access to the most appropriate care pathway for patients, and appropriate timely discharge from acute hospitals.

Each Action Team has set out a range of initiatives it will undertake within its area to implement the Plan. The Integrated Winter Plan for University Hospital Limerick will be delivered by Winter Action Team 3 (WAT 3). The initiatives for WAT 3 include:

- additional home support hours to facilitate early hospital to community transfers;

- additional aids and appliances to facilitate early hospital discharges and ED avoidance;

- mobile doctor service units to manage increase demand for home visits and facilitate ED avoidance;

- low level Domiciliary Rehab team in Limerick city to facilitate early discharge and ED avoidance;

- added Triage nursing support in Shannondoc to support ED avoidance;

- added Registrar in UHL to assist in addressing workflow and improve PET times;

- added Health Care Assistants support in UHL to provide staffing at ward level to support additional surge patients.

It should also be noted in relation to UHL a capital budget of €19.5 million has been approved for the provision of a modular 60-bed inpatient ward block at the Hospital, with funding of €10 million allocated in 2019. The HSE have advised that the enabling works are complete, and the main contractor is now commencing work. This important project will go some way towards addressing the acknowledged lack of bed capacity in the region

In addition to the immediate measures being undertaken in the Winter Plan the Government through the Sláintecare Strategy is addressing the issues of access to healthcare. The Sláintecare Action Plan for 2019 has a specific workstream on access and waiting lists. The Government is also increasing investment in health infrastructure and capacity in the system in line with Project Ireland 2040.

I am confident that together with the more immediate measures being undertaken under the Winter Plan and the strategic approach undertaken by the Government under Sláintecare that progress will be made in addressing the difficulties in the emergency departments.

Hospital Car Parks

Questions (120)

Fiona O'Loughlin

Question:

120. Deputy Fiona O'Loughlin asked the Minister for Health the status of the pay parking review that was being carried out in hospitals nationwide; and if he will make a statement on the matter. [48734/19]

Written answers

Minister for Health

Hospitals which charge parking fees are cognisant of the financial implications parking costs can have on patients and their families, particularly those with long-term illnesses. Some hospitals have introduced a maximum daily fixed parking charge, thus capping this expense. I understand that some hospitals also provide reduced rate parking for long-term patients and visitors for whom the payment of the full rate would cause hardship.

I have made it clear I want to see progress made in this area and I am working with my Department and the HSE in this regard. As such, I requested the HSE to conduct a review of hospital car parking charges with a view to establishing clear national guidelines in the area. My Department and the HSE are currently engaging on a draft implementation plan to accompany the review report.

Disability Services Provision

Questions (121)

Joan Collins

Question:

121. Deputy Joan Collins asked the Minister for Health the reason a person (details supplied) who needs supported living is still in St. James's Hospital, Dublin, five weeks after being admitted. [48615/19]

Written answers

Minister of State at the Department of Health

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 a service issue, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.

Mental Health Commission Reports

Questions (122)

Mary Butler

Question:

122. Deputy Mary Butler asked the Minister for Health the action being taken to ensure that the findings of the Inspector of Mental Health Services report on Waterford department of psychiatry published in October 2019 are acted upon. [48765/19]

Written answers

Minister of State at the Department of Health

As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.

Hospital Services

Questions (123)

Pat the Cope Gallagher

Question:

123. Deputy Pat The Cope Gallagher asked the Minister for Health his plans for Letterkenny University Hospital in the winter strategy and the need to provide additional bed capacity at the hospital; his views on the number of vacant posts within the CHO 1 area and the impact the embargo is having on staffing numbers; the steps he will take to deal with the waiting lists at the hospital; and if he will make a statement on the matter. [48526/19]

Written answers

Minister for Health

The number of patients attending emergency departments across the hospital system continues to increase annually, with the result that the system is currently operating at close to full capacity. I acknowledge the challenges that this poses to the emergency departments in our hospitals.

The HSE Winter Plan was launched on Thursday 14 November in preparation for the anticipated increase in demand over the winter period. The Government allocated an additional €26m to fund the implementation of the Plan. Nine Winter Action Teams, each aligned to a Community Healthcare Organisation and associated acute hospitals and Hospital Groups, have prepared Integrated Winter Plans. These plans focus on demand management and reduction, staffing availability, timely access to the most appropriate care pathway for patients, and appropriate timely discharge from acute hospitals. Each Action Team has set out a range of initiatives it will undertake within its area to implement the Plan. The Integrated Winter Plan for Letterkenny University Hospital will be delivered by Winter Action Team 1 (WAT 1).

The specific initiatives for WAT 1 include:

- added Medical Registrar for improved medical cover;

- rapid flu testing to reduce turnaround time to 2 hours;

- additional cleaning services to improve bed turnaround time out-of-hours;

- a reablement programme to decrease presentations and admissions;

- additional aids and appliances to facilitate timely discharge; and

- hospital avoidance measures to reduce the number of patients admitted for assessment.

The Health Service Capacity Review published last year was clear on the need for a major investment in additional capacity in both hospital and community services combined with a widescale reform of the manner and the location of where health services are provided.

Progress has been made on increasing capacity. An additional 267 acute hospital beds opened under the Winter Initiative 2017/2018.

The provision of an additional 75 acute beds and 70 community beds was a component of the Winter Plan 2018/19, including 5 additional beds in Letterkenny University Hospital.

There has been a sustained increase in the number of staff in the HSE in the last couple of years with approximately 10,000 more staff working in the HSE than in the same period three years ago. With regard to CHO1 specifically, employed numbers stand at 5,459 WTEs in September 2019. This is an increase of +66 WTEs since the same period last year. With regard to Letterkenny University Hospital specifically, employed numbers stand at 1,599 WTEs in September 2019. This is an increase of +29 WTEs since the same period last year. This hospital falls within the Saolta Hospital Group which has current staffing at 9,297 WTEs in September 2019. This is an increase of +214 WTEs since the same period last year.

The Government is tackling the challenges that are facing the emergency departments in our hospitals. In addition to the immediate measures being undertaken in the Winter Plan, the Government through the Sláintecare Strategy and the investment being made in accordance Project Ireland 2040, is addressing the issues of access to healthcare and capacity in the system.

I am confident that together with the more immediate measures being undertaken under the Winter Plan and the strategic approach undertaken by the Government under Sláintecare and Project Ireland that progress will be made in addressing the difficulties in the emergency departments.

Question No. 124 answered with Question No. 106.

General Practitioner Services Provision

Questions (125)

Paul Murphy

Question:

125. Deputy Paul Murphy asked the Minister for Health his plans to ensure that all communities have local access to general practitioner services. [48838/19]

Written answers

Minister for Health

The Government is aware of the workforce issues facing general practice, including the difficulties in filling certain GMS vacancies. I would like to assure the Deputy that the Government is committed to the continued development of GP capacity to ensure that patients across the country continue to have access to GP services and has taken a number of measures to improve GP recruitment.

The recent Agreement on GP contractual reforms will see an increase in expenditure on GP services of €210 million annually by 2023, providing significant increases in capitation fees for participating GPs, and increases in supports for rural practices and practices in urban areas of deprivation.

Improved family friendly arrangements are also an important feature of the revised contractual arrangements, with an increase in the locum rate for maternity and paternity cover, and an increase in the paternity leave allowance from 3 days to 2 weeks. This is in recognition of the need to ensure that general practice is compatible with doctors’ family commitments.

In addition, the number of medical graduates undertaking GP training has increased from 120 in 2009 to 192 filled places in 2019, with a further increase expected next year. In a recent press release, the Irish College of General Practitioners stated it had received the highest ever number of applications for its 2020 GP training programme.

I am confident that the measures outlined in the Agreement with GPs on contractual reform and service developments will make general practice more sustainable and a more attractive career option for doctors, thus increasing GP capacity and helping to ensure that all patients have access to GP services.

Cancer Screening Programmes

Questions (126)

Bríd Smith

Question:

126. Deputy Bríd Smith asked the Minister for Health if the review of the Royal College of Obstetricians and Gynaecologists of the history of over 1,000 women with the CervicalCheck screening programme will detail the discordant reviewed slides with a breakdown as to the laboratory they originated from; and if he will make a statement on the matter. [48815/19]

Written answers

Minister for Health

As the Deputy will be aware, the purpose of the Independent Clinical Expert Review being conducted by the Royal College of Obstetricians and Gynaecologists (RCOG) is to provide women, or their next of kin, with independent clinical assurance about the timing of their diagnosis and treatment. This is reflected in the Terms of Reference for the Review, which are published on the website of my Department.

Every woman who has been diagnosed with cervical cancer since September 2008 whose cancer was registered with the National Cancer Registry of Ireland before 5 May 2018, and who has had one or more tests under the CervicalCheck programme, was offered a review of her case.

Where the expert panel opinion of cytology results differs to the original results provided by CervicalCheck, the panel endeavoured to determine, wherever possible, any failures to prevent cancer or to intervene at an earlier stage, and the panel has prepared individual reports for those affected, setting out the facts and their expert and independent assessment of those facts.

As set out in the TOR, the Review will also produce an aggregate report, which shall include recommendations where appropriate, with the aim of improving care for women. While the aggregate report has not yet been received, the Royal College wrote to me in September 2019 and advised that, based on the provisional findings of its Review, the performance characteristics of the CervicalCheck Screening Programme that fall within the scope of the Review appear to be broadly in line with experience in the UK.