Written Answers Nos. 276-294
276. Deputy David Cullinane asked the Minister for Health if he will provide details of the expansion of public activity in public hospitals that has occurred since the adoption of Sláintecare, by area, year and speciality; the total cost of such expansion; and if he will make a statement on the matter. [17870/20]
View answerThe HSE's Monthly Performance Reports provide an overall analysis of key performance data from Divisions, including Acute services. The activity data reported is based on Performance Activity and Key Performance Indicators outlined in the current National Service Plan. The Performance Reports also provides an update to the Department of Health on the delivery of the NSP. The 2019 reports are available at the following link:
https://www.hse.ie/eng/services/publications/performancereports/2019-performance-reports.html
As this is a service-related query, I have asked the HSE to respond directly to the Deputy.
278. Deputy David Cullinane asked the Minister for Health if a rapid review of cancer services will be performed to assess capacity and demand in view of Covid-19; and if he will make a statement on the matter. [17872/20]
View answerThe National Action Plan on Covid-19 identified the continued provision of cancer care as a priority, through ensuring the delivery of national specialities and maintaining urgent activity.
Symptomatic Breast Disease Clinics continued, though the number of referrals was down and urgent cases were prioritised. Rapid Access Clinics for lung and prostate cancer also continued, again with less people being referred. These clinics are returning towards normal levels of attendance. However, capacity will be impacted by the need for physical distancing and other infection protection and control measures.
Urgent cancer surgery and medical oncology also continued, following the consideration of the risk:benefit ratio of treatment of individual patients, the prioritisation of time-sensitive treatment and the review of the location of the delivery of cancer services across all cancer clinical programmes. Radiation Oncology services are also being maintained, though referrals are somewhat reduced. Again, capacity for all these services will be impacted by the need for physical distancing and other infection protection and control measures.
The HSE's National Cancer Control Programme (NCCP) are assessing the capacity needs of cancer services in the coming period as part of the overall Capacity Plan being prepared by the HSE.
279. Deputy David Cullinane asked the Minister for Health the additional capacity he plans to make available in healthcare to facilitate a health catch up programme; if it will involve additional and immediate investment in temporary builds; the additional funds that will be made available to facilitate the programme; and if he will make a statement on the matter. [17873/20]
View answerThe Health Service Executive is responsible for the delivery and management of healthcare infrastructure.
At present the draft Capital Plan 2020 is being reviewed and revised to take account of the impact of Covid-19, which has resulted in delays on many projects, and the funding of an emergency Covid-19 programme of works. The draft capital plan includes a number of additional capacity developments, including at University Hospital Limerick (60-Bed Ward Block and a 24-Bed Unit); Mercy University Hospital, Cork (40-Bed Unit); Sligo University Hospital (48-Bed Unit) and Mayo University Hospital.
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.
This new Capital Plan will outline the continued investment taking place in our health service. Once the HSE has finalised its Capital Plan for 2020, it will then be submitted to me for consideration.
280. Deputy David Cullinane asked the Minister for Health his plans to expand cancer services here including additional investment in oncology day wards, operating theatres, community diagnostics, elective only hospitals and a comprehensive cancer centre; and if he will make a statement on the matter. [17874/20]
View answerThe way forward in relation to the development of cancer services is set out in the National Cancer Strategy 2017-2026. Improvements in cancer services will be achieved on an incremental basis over the period of the Strategy. This will involve a mix of current and capital initiatives.
Improvements in oncology day wards, as well as in community diagnostics for cancer patients, will be addressed in this context. The Strategy commits to the development of a Comprehensive Cancer Care Centre by the end of the Strategy period, and such development is included in the National Development Plan 2018-2027. Investment in operating theatres would be considered in the context of the wider health needs. The National Development Plan 2018-2027 also outlines that new dedicated ambulatory/elective-only hospital facilities will be delivered to tackle waiting lists for scheduled care procedures. This work is being directed through Sláintecare by the Elective Hospitals Oversight Group.
Meanwhile, he HSE's National Cancer Control Programme (NCCP) is assessing the capacity needs of cancer services in the coming period in view of the Covid pandemic as part of the overall Capacity Plan being prepared by the HSE.
281. Deputy David Cullinane asked the Minister for Health the additional funding that will be made available to resource diagnostic, radiology and laboratory departments; and if he will make a statement on the matter. [17875/20]
View answerThe adjustment to the Health Vote Revised Estimate for 2020 in relation to the COVID-19 Action Plan is €1,997m. The Revised Estimates Volume for the Health Vote (Vote 38) was passed by the Dáil on Tuesday 30th June.
In accordance with Section 30A(1) and Section 33(B)(1) of the Health Act 2004 (as amended) the Department will shortly issue a revised letter of determination adjusting the maximum amount of non-capital and capital expenditure that can be incurred by the HSE in the financial year 2020.
The funding had been determined based the projected cost for the delivery of the following Actions under Ireland’s National Action Plan
- Cross cutting actions ( including ICT, Testing)
- Communications
- Community Care (including Vulnerable Groups)
- Caring for People in Acute Services
- Expanding Critical Physical Capacity
- Expanding and protecting our Health Workforce
- Maintaining Access to essential health products and equipment
On receipt of the revised allocation for the year the HSE will commence the process of allocating the funding against the expenditure incurred to date in relation to the emergency response measures implemented since March including the GP Covid services, the Temporary Assistance Payment Scheme to Private Nursing Homes, Private Hospital Additional Capacity and Testing. In the context of the emergency response measures the main area of additional allocation to diagnostics and laboratory resourcing is in relation to testing. Within the €1,997m, €208m has been allocated to testing and contact tracing.
The Covid-19 pandemic has led to an unprecedented interruption to normal healthcare, with both community and acute settings affected. Across the Health sector, services have been postponed or reduced, although some services have been maintained or restructured to cope better with the COVID Environment.
The HSE launched its Strategic Framework for Service Continuity in a Covid Environment on 24 June to guide the reintroduction of services. The Framework incorporates guiding principles for the re-introduction of services (e.g. safety, equity, patient need) and references a clinical prioritisation hierarchy which has been developed to categorise conditions, treatments and interventions, based on their impact on patients and service users, providing a roadmap to enable a phased approach to the reintroduction of healthcare services.
The HSE will be considering the application of any additional funding to diagnostics, radiology and laboratory resourcing as part of the re introduction of services in line with its Strategic Framework.
282. Deputy David Cullinane asked the Minister for Health his plans to fill the 500 vacant consultant posts; the timeline to achieve same; the estimated cost to fill 500 posts; and if he will make a statement on the matter. [17876/20]
View answerI have asked the HSE to reply directly to the Deputy on this matter. It is noted that many of the consultant posts described as vacant are filled in an interim basis, including agency, locum, or fixed term contracts.
283. Deputy David Cullinane asked the Minister for Health the additional communications campaigns that will be rolled out regarding the signs and symptoms of cancers; and if he will make a statement on the matter. [17877/20]
View answerThe National Action Plan on COVID-19 identified the continued delivery of cancer care as a priority, through ensuring the delivery of national specialities and maintaining urgent activity.
The numbers of patients presenting to health services were significantly reduced in the late March - early May period. This trend was reflected in cancer services, with a lower number of GP referrals of cases of suspected cancer to Symptomatic Breast Disease Clinics and Rapid Access Lung and Prostate Clinics.
The National Cancer Control Programme, in collaboration with HSE Communications and with the support of various stakeholders, commissioned a communications campaign on cancer detection. The video involved, which detailed the signs and symptoms of cancer, aimed to assure the public that cancer diagnostic services remained open, and to encourage people to call their GP, or other health services, if they had any concerns. It was launched in early May and featured on social media. It was also disseminated through various cancer stakeholders.
A second video was targeted at ensuring that current cancer patients undergoing treatment continued to attend their appointments. The campaign aimed to reassure patients that, although some aspects of their treatment may have changed (location or frequency of attendance), they would continue to be treated safely in the context of Covid-19.
The most recent data shows that referrals for breast clinics are now similar to pre-Covid rates, while referrals for prostate and lung Rapid Access Clinics, as well as to other symptomatic cancer services, are increasing.
284. Deputy David Cullinane asked the Minister for Health the number of referrals for all cancers to acute hospitals for the first six months of 2018, 2019 and 2020, respectively; and if he will make a statement on the matter. [17878/20]
View answerAs the deputy's question relates to operational matters, I have referred it to the HSE for direct response.
285. Deputy David Cullinane asked the Minister for Health his plans to expand national psycho-oncology services to meet demand; and if he will make a statement on the matter. [17879/20]
View answerThe National Cancer Strategy 2017-2026 emphasises psycho-oncology services as a core part of complete cancer care and recommends the establishment of multi-disciplinary psycho-oncology teams in each designated cancer centre to deliver a comprehensive hospital-based clinical service.
A Clinical Lead for Psycho-Oncology was appointed in December 2018 and she is engaging with the designated centres with a view to establishing these teams.
Funding has been allocated this year to follow up on the outcomes of the National Survivorship Needs Assessment and to advance the development of psycho-oncology services.
Furthermore, a Together 4 Cancer Concern initiative was launched in April as a collaboration between the National Cancer Control Programme, the Irish Cancer Society and Cancer Care West. This initiative provides a range of support to cancer patients and their families during the Covid-19 period, ranging from a dedicated support phoneline to psychological assessment and intervention.
286. Deputy David Cullinane asked the Minister for Health the wait times for colonoscopies for the first six months of 2018, 2019 and 2020, by hospital, hospital group and by wait times up to 28 days and 28 days or more in tabular form; and if he will make a statement on the matter. [17880/20]
View answerI am conscious that waiting times are often unacceptably long and of the burden that this places on patients and their families. In response to the Covid-19 pandemic the HSE had to take measures to pause most elective scheduled care activity with effect from the end March 2020. This was to ensure patient safety and that all appropriate resources were made available for Covid-19 related activity and time-critical essential work. This decision was in line with the advice issued by National Public Health Emergency Team (NPHET) and in accordance with World Health Organisation guidelines, and the National Action Plan.
To ensure services are re-introduced in a safe, clinically-aligned and prioritised way, the HSE launched its Strategic Framework for ‘Service Continuity in a Covid Environment’ on 24 June. Its implementation will ensure service resumption is done in an integrated way. The Framework will also consolidate new ways of working and build on international knowledge.
“A Safe Return to Health Services – Restoring health and social services in a Covid environment”, published by the HSE on 22 July 2020, gives an overview of services to be resumed, the target times for their safe return, and some detail on the conditions and challenges that will have to be met.
As the system continues to deliver Covid-19 and non Covid-19 care side-by-side over a more prolonged period, my Department and the HSE will continue to work closely together to protect essential non Covid-19 acute care and progress the provision of more routine non Covid-19 care.
As regards the specific details you have asked for, as this is a service matter, I have asked the Health Service Executive to respond to you directly, as soon as possible.
287. Deputy David Cullinane asked the Minister for Health his plans to award consultant contracts to specialists in public health medicine in line with their specialist training and experience; the number of such contracts that will be awarded in 2020; and if he will make a statement on the matter. [17881/20]
View answerIt is my intention that Specialists in Public Health Medicine will be awarded consultant status, taking account of related proposals in Sláintecare, in the Scally Report (Cervical Check) and the Report of Crowe Horwath on the Specialty. It is also consistent with the Programme for Government commitment to reshape our public health system.
This issue was being progressed as part of a body of work being led by the HSE’s leadership team and CMO’s Office to finalise future structures for Public Health in Ireland to enable Sláintecare. This work was impacted by the need to focus on addressing COVID-19 in recent months. However, the HSE has now resumed consideration, focusing on health protection in the first instance.
I am committed to awarding consultants status to the Specialists as soon as it is feasible to do so. It is not possible to be definitive in terms of a timeline, given that consideration of the new structures has to take account of the changed circumstances brought about by COVID-19. Also, similar to new entrant consultants taking up the Slaintecare Contract, it will be necessary to amend the FEMPI Acts to enable pay increases for the Specialists, given that they currently prohibit pay increases for serving public servants.
288. Deputy David Cullinane asked the Minister for Health his plans to invest in additional public acute bed capacity in 2021 and 2022; the number of additional beds planned; the estimated cost of an acute care bed; and if he will make a statement on the matter. [17882/20]
View answerThe Programme for Government, Our Shared Future, commits to continuing investment in our health care services in line with the recommendations of the Health Service Capacity Review and the commitments in Project Ireland 2040.
The Health Service Capacity Review 2018 found that the net requirement in combination with health system reform is for an additional 2,590 hospital beds by 2031 (inpatient, day case, critical care). The Review identified an immediate requirement for 1,290 beds to address overcrowding and to ensure hospitals operated at 85% occupancy in line with other OECD countries. Approximately 770 additional beds have been provided to date. The National Development Plan provides for the addition of the full 2,590 beds by 2027.
The future opening of additional acute bed capacity will be considered in the context of the Estimates discussions for the years concerned and on the priorities in the HSE's National Service Plans for those years.
In relation to the question of the estimated cost of an acute care bed, I have asked the HSE to provide a response to the Deputy directly.
290. Deputy David Cullinane asked the Minister for Health his plans to end the two-tier nature of consultant pay; the way in which he plans to address same; the time frame for same; and if he will make a statement on the matter. [17884/20]
View answerAt present 'new entrant' consultants recruited since 1 October 2012 are on lower pay scales than those recruited prior to that date.
The De Buitléir Group established to examine how to give effect to the Sláintecare recommendation on the removal of private practice from the public hospital system recommended the introduction of a Sláintecare 'public only' Contract going forward, with pay parity confined to consultants who would take up this contract. It specifically recommended that the contract be made available to any serving consultants who would choose to move to it in addition to all future recruits.
The Programme for Government provides for the finalisation of the new Sláintecare Consultant Contract and the introduction of related legislation to support 'public-only work' in public hospitals. The FEMPI Acts currently prohibit pay increases for serving public servants and will require amendment to enable pay increases for serving consultants who move to the Slaintecare 'public only' Consultant Contract.
It is my intention to commence engagement with the representative bodies in relation to this Programme for Government commitment as a matter of priority in the coming weeks. It is through this engagement that all matters relating to consultants terms, conditions and additional supports will be considered.
291. Deputy David Cullinane asked the Minister for Health his plans to reopen AMUs and ASUs; his further plans to improve linkages with general practitioners in this regard; and if he will make a statement on the matter. [17885/20]
View answerI can assure the Deputy that AMAUs and ASAUs continue to operate where local circumstances have allowed. In some cases, AMAUs and ASAUs are supporting Emergency Departments by reducing the potential for overcrowding. Current arrangements between acute hospitals and GPs continue and any changes to referral pathways to AMAUs and ASAUs continue to be notified to GPs.
292. Deputy David Cullinane asked the Minister for Health his plans to increase the number of rehabilitative care beds in the public system; and if he will make a statement on the matter. [17886/20]
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.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
293. Deputy David Cullinane asked the Minister for Health his plans to increase homecare supports and intensive homecare packages; the additional funding that will be made available for same; and if he will make a statement on the matter. [17887/20]
View answerThe Health Service Executive National Service Plan provides for 18.9 million home support hours to be delivered to 53,700 people and to provide a further 360,000 hours through intensive home care packages to 235 people.
COVID-19 is posing significant challenges for many areas of our Older People Services, including Home Support Services. In light of these unprecedented challenges, the HSE, at the outset, had to reassess its operation of Home Support Services nationally, to ensure that the assessed needs of those clients with the highest priority were and still are being met. The HSE, working with its approved home support service providers are endeavouring to maintain essential support services during this unprecedented public health emergency. In this context, the HSE has set out a prioritisation process for home support, which looks at delivering a service based on priority need across 4 priority categories.
As a result of that review of prioritisation, a number of clients with lower priority needs had their home support service temporarily ceased or reduced with the support of family members and/or alternative forms of volunteer provided local supports. In these cases, each client was contacted to advise of the assessment and decision, alternative support available and assistance given to ensure that essential requirements continue to be provided. The HSE continues to review both those clients whose home support service may have been temporarily suspended and those clients of higher priority currently in receipt of home support services.
The HSE is in the process of restoring services, where capacity exists. In order to maximise the capacity available, consideration has to be given to balancing delivery of service against suspended clients, clients assessed and waiting on commencement of home support services and the continued requirement to meet the needs of higher priority clients currently in receipt of services.
The level of funding available for the Department of Health in 2021 and the quantum of services to be provided by the HSE, including home support will be considered as part of the national Estimates and budgetary process and National Service Planning.
294. Deputy David Cullinane asked the Minister for Health his views on clinical governance in private nursing homes; his plans for reform in this area; and if he will make a statement on the matter. [17888/20]
View answerHIQA is the independent statutory authority responsible for regulating residential care services for older people, whether delivered in a nursing home managed by the HSE or a private provider. Services are only allowed to operate if they are registered with HIQA and they are inspected regularly to ensure that they maintain a high level of care. HIQA has significant and wide-ranging powers, up to and including, the cancellation of the registration of a nursing home, where it has significant concerns about the quality of governance and oversight in such services.
It should be noted that registered providers must provide appropriate medical and health care, including a high standard of evidence-based nursing care in accordance with professional guidelines. Furthermore, regulations provide that a nursing home must have a person in charge. In cases where the person in charge is also the registered provider, that person may be a registered medical practitioner with required experience. Where the registered provider is not the person in charge, the person in charge must be a registered nurse with the required qualifications and experience.
Notwithstanding the fact that the primary legal responsibility lies with individual providers, as recommended by the National Public Health Emergency Team (NPHET) on 31 March 2020, the HSE has further strengthened its national and regional governance structures to support the response of nursing homes to COVID-19. The HSE has established 23 COVID-19 response teams at CHO level, which are providing nursing homes with medical, nursing, staffing and other supports. The teams are composed of consultant geriatricians, clinicians, infection prevention control experts and senior nurses.
Finally, on foot of a NPHET recommendation, on 23 May 2020, a COVID-19 Expert Panel on Nursing Homes has been established. The purpose of the Panel is to examine the national and international responses to COVID-19 and provide immediate real-time learnings and recommendations in light of the expected ongoing impact of COVID-19 over the next 12-18 months. On 13 July I published the Panel’s interim report. I expect to receive the Panel's final report this month.
