Written Answers Nos. 908-925
908. Deputy Bernard J. Durkan asked the Minister for Health his plans to further increase the number of hospital consultants throughout the country with a view to ensuring an adequate spread of skills throughout the regions; and if he will make a statement on the matter. [8419/22]
View answerGiven its statutory functions in relation to medical training and approval of consultant posts I have asked the HSE to reply to the Deputy concerning these issues.
It is recognised that there are particular challenges in filling posts in certain specialties, including psychiatry and paediatrics, and in certain locations. The Government is committed to continuing to grow consultant numbers in accordance with established health policy. The number of training places have been increased to support further growth and to address challenges in particular specialties.
Over the past year (to 31 December 2021) 150 additional consultant posts have been filled. In that time the number of consultant (whole time equivalents) has increased from 3,458 to 3,608. Over the past 5 years numbers employed have increased by 750.
910. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he and his Department will engage with paediatric specialists involved in treating scoliosis, spina bifida and other associated conditions with a view to ensuring the elimination of waiting lists and the suffering of patients; and if he will make a statement on the matter. [8421/22]
View answerI acknowledge that waiting times for many hospital procedures and appointments are unacceptably long. It is of particular regret that children can experience long waiting times for orthopaedic treatment, especially for time sensitive procedures, and I remain acutely aware of the impact that this has on children and their families. I remain committed to working to reduce waiting times for patients.
Children with a range of needs rely on the orthopaedic service of Children’s Health Ireland, for example children with Spina Bifida, hip deformity, and other orthopaedic needs. The complex patient needs of these children remains at the forefront of service provision.
Two months ago, I met with the Scoliosis Co-Design Group. This is a well-established and successful group which facilitates a multidisciplinary approach to service improvement. The group includes members from advocacy groups, as well as orthopaedic consultants from Children's Health Ireland, and senior management from across the CHI sites. Further to this meeting I requested that Children's Health Ireland (CHI) draw up a plan to improve waiting times for orthopaedic services, particularly for those children with conditions such as scoliosis and Spina Bifida where time is a crucial factor in ensuring that these children have a positive outcome from their surgeries.
Last week I convened a meeting with the clinical teams from Crumlin, Temple Street, and Cappagh Orthopaedic Hospital, along with senior management from these hospitals and the HSE. The purpose of this meeting was to discuss the draft orthopaedic waiting list plan and to ensure that an appropriate plan with ambitious and attainable activity levels was being produced. The plan will be funded in the context of the wider waiting list action plan for 2022 and will include additional activity to reduce the spinal orthopaedic waiting list through the use of theatres at Crumlin, Temple Street, and Cappagh. In the context of the waiting list action plan additional capacity will also be sought in the private sector to work towards reducing paediatric orthopaedic waiting times.
In terms of broader services for children with Spina Bifida, CHI have advised the Department of Health that CHI at Temple Street has doubled capacity from 2 Multidisciplinary (MDT) clinics to 4 MDT outpatient clinics per month. This will improve access to specialists in the area of Neurodisability, Neurosurgery, Orthopaedics, Urology, Occupational therapy, Physiotherapy, and Neuropsychology. The clinics also provide access to a Medical Social worker and a Clinical Nurse Specialist. CHI has advised the Department that this capacity increase is expected to provide each child with an annual review and will reduce the waiting time for follow up appointments.
The 2022 waiting list action plan, which I will be bringing to Government shortly, builds on the successes of the short-term 2021 plan that ran from September to December last year. The 2021 plan was developed by my Department, the HSE and the National Treatment Purchase Fund (NTPF) and was driven and overseen by a senior governance group co-chaired by the Secretary General of my Department and the CEO of the HSE and met fortnightly. This rigorous level of governance and scrutiny of waiting lists has continued into this year with the oversight group evolving into the Waiting List Task Force. It has produced a comprehensive 2022 waiting list action plan which will set out high-level targets for waiting list improvement including dedicated funding for service reform, patient pathway improvement, and important significant additionality to substantially reduce the backlog of patients waiting. The Task Force will meet regularly to drive progress of the 2022 plan.
This is the first stage of an ambitious multi-annual Waiting List plan, which is currently under development in my Department. Between them, these plans will work to support short, medium, and long term initiatives to reduce waiting times and provide the activity needed in years to come.
911. Deputy Bernard J. Durkan asked the Minister for Health the extent to which adequate provision can be made in the short term to deal with various aspects of women’s health with a view to ensuring minimum waiting times, early diagnosis and a rapid response; and if he will make a statement on the matter. [8422/22]
View answerImproving women’s health outcomes is a key priority for me and this Government. We made a strong commitment to Promoting Women’s Health in the Programme for Government and are fully committed to the development and improvement of Women’s Health services and to working with women and girls to improve their health across the whole life cycle.
The commitment to Women’s Health has been reflected within Budget 2022, in the allocation of €31 million for new development funding to specifically support women’s health.
Budget 2022 will:
- Invest almost €9 million additional funding to ensure continued implementation of the National Maternity Strategy into 2022 and beyond, building on the significant investment in 2021
- Continue improvements in our gynaecology services by establishing a further 6 ambulatory gynaecology "see and treat" clinics, bringing the total to 20 clinics nationally. This will complete the implementation of the Ambulatory Gynaecology Model of Care.
- Investment to fund access to contraception for women aged 17-25
- Support further developments in menopause care by increasing the number of specialist menopause clinics from 1 clinic to 4 clinics nationally
- Increase investment in sexual assault treatment units
- Invest in tackling period poverty for the first time
- Funding for the establishment of a new Obstetric Event Support Team
- Funding to establish a perinatal genetics service
- Build on initiatives started in 2021, by further expanding specialist endometriosis services for more complex cases across two centres
- Invest an additional €5 million into the Women’s Health Fund to fund innovative new approaches to women’s health services nationwide
In addition, a further €16m in other measures to support women's health has been embedded within other new measures for 2022 within the Health Vote in areas such as cancer, mental health and social inclusion budgets, bringing the overall investment in women's health to €47m in additional funding provided for 2022.
A Women’s Health Action Plan for 2022-2023 is currently being finalised and is expected to be brought before Government in the coming weeks.
The Women’s Health Fund was established in 2020 with a €5 million allocation in Budget 2021. The additional €5 million funding allocated to this Fund in Budget 2022 will allow us to continue to provide specific targeted funding on improving women’s health outcomes and experiences in Ireland.
In 2021, the Women’s Health Fund invested in a number of projects with this aim, including:
- Establishment of two ‘see-and-treat- Ambulatory Gynaecology Clinics under the governance of Tallaght University Hospital and University Maternity Hospital Limerick, respectively.
- Expansion of the pre-existing Endometriosis Clinic in Tallaght University Hospital
- Expansion of the Pelvic Floor Centre in St. Michael’s Hospital.
- The recruitment of an additional Advanced Nurse Practitioner in the Rotunda Hospital.
- Establishment of a Specialist Menopause Clinic in the National Maternity Hospital, Holles Street.
- Additional expertise to be resourced for Specialist Eating Disorder Supports Teams in Dublin, Cork and Kerry.
- Enhanced Specialist Perinatal Mental Health Supports across maternity hospitals nationally.
This complements existing activity underway within my Department which proactively supports women’s health and access to service both in general and targeted ways:
- The Sláintecare Implementation Strategy & Action Plan 2021-2023 was approved by Government in May 2021. The new Strategy builds on the progress of Sláintecare reform to date and on the lessons learned from COVID-19. It aims to ensure that people can get timely care as close to their own homes as safely as possible and will focus on prevention initiatives to promote health and well-being. It will also support those requiring more targeted health and social care interventions through a population planning approach and will progress the vision of universal healthcare. A mid-year progress report on implementation of the Strategy & Action Plan was published on 10 September 2021.
- On 11th May 2021, funding of €1.58m was announced to provide an additional 24 Lactation Consultants across hospital and community settings, that are required to implement the National Breastfeeding Action Plan and ensure timely skilled assistance for mothers who wish to breastfeed.
- Four of the six new Regional Fertility Hubs under Phase One of the Model of Care for Infertility are operational, with the final two due to become operational in 2022.
- In 2021, Sláintecare and Healthy Ireland, working with the HSE and local authorities and community agencies, launched the Sláintecare Healthy Communities Programme to provide increased health and well-being services in 19 community areas across Ireland where health and well-being risk factors may be particularly concentrated.
912. Deputy Bernard J. Durkan asked the Minister for Health if cervical health checks will be repeated every two years in order to ensure best opportunities for early diagnosis; and if he will make a statement on the matter. [8423/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
913. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the BreastCheck service will be extended with a view to early detection and diagnosis of particular reference to younger women with a medical history in respect of breast cancer in their families; and if he will make a statement on the matter. [8424/22]
View answerBreast cancer is the most common invasive cancer diagnosed in women in Ireland, and breast cancers related to a familial risk can arise at a younger age than in the general population.
The HSE’s National Cancer Control Programme (NCCP) established a Hereditary Cancer Programme in 2012 in response to advances in diagnostics and an increasing demand for services. St. James’s Hospital and Crumlin Children’s Hospital provide risk assessment, genetic counselling and genetic testing services for patients with a possible cancer predisposition gene, including the BRCA (BReast CAncer) gene.
The majority of referrals to this service are healthy individuals concerned about their genetic predisposition to cancer. Those who are tested and found to carry a gene mutation are offered strategies to reduce their risk. Depending on the type of cancer, this may involve surveillance, drug treatment, surgery, or a combination of these.
Furthermore, the NCCP has established a Family History of Breast Cancer working group. The aim of this working group is to develop a standardised national approach to the management of people who have a family history of breast cancer. This will include referral from primary care, assessment of the patients’ individual risk based on their family history, and a recommended surveillance schedule.
With regards to the BreastCheck screening programme, it is important to emphasise that screening is for healthy people who do not have symptoms. People who are between screening appointments, or who are waiting for a rescheduled appointment, are aware of symptoms, or if they have concerns or worries, are advised to contact their GP, who will arrange appropriate follow-up care.
914. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he will ensure the replacement of vacancies throughout the health service at consultant, doctor or general practitioner levels; and if he will make a statement on the matter. [8425/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy, as soon as possible.
915. Deputy Bernard J. Durkan asked the Minister for Health the extent to which it is expected to fill all vacant nursing posts in the near future with particular reference to posts becoming available through retirement, resignations or otherwise; and if he will make a statement on the matter. [8426/22]
View answerIn relation to the particular query raised, as this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
916. Deputy Bernard J. Durkan asked the Minister for Health the total number of nurses currently employed throughout the health services; the extent to which this compares with international norms per thousand of the population; and if he will make a statement on the matter. [8427/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy, as soon as possible.
917. Deputy Bernard J. Durkan asked the Minister for Health the total number of general practitioners currently employed throughout the health services; the extent to which this compares with international norms per thousand of the population; and if he will make a statement on the matter. [8428/22]
View answerGPs are self-employed private practitioners. While no central register exists specifically for GPs working in Ireland, all doctors in practice in Ireland must be registered with the Medical Council. As of January 2022, there are 4,319 doctors on the Medical Council's Specialist Register in the speciality of General Practice. However, holding registration does not necessarily mean that a medical practitioner is active in general practice. The ICGP estimates that there were 3,466 GPs working in the State in 2021.
Under the GMS scheme, the HSE contracts GPs to provide medical services without charge to medical card and GP visit card holders. Currently 2,539 GPs hold GMS contracts. Many GPs also hold contracts with the HSE to provide services under other state schemes, e.g. the Primary Childhood Immunisation Programme, National Cancer Screening Service, Methadone Treatment Scheme etc. There are a further 533 GPs without GMS contracts who hold other such contracts with the HSE, bringing the total number of GPs contracted by the HSE at present to 3,072.
Eurostat, the statistical service of the European Union, provides data on the number of doctors in various medical specialties over time and across European countries. For 2019, the latest available data, it reports 0.822 doctors classified as general practitioners per 1,000 inhabitants in the State, above the mean of 0.797 per 1,000 inhabitants across all reporting countries. Further information is available through the Eurostat website.
918. Deputy Bernard J. Durkan asked the Minister for Health the total number of consultants currently employed throughout the health services; the extent to which this compares with international norms per thousand of the population; and if he will make a statement on the matter. [8429/22]
View answerAs this is a service matter, I have asked the Health Service Executive to respond directly to the Deputy, as soon as possible.
919. Deputy Bernard J. Durkan asked the Minister for Health the extent to which ongoing progress is being made is respect of the development of Sláintecare; and if he will make a statement on the matter. [8430/22]
View answer920. Deputy Bernard J. Durkan asked the Minister for Health if specific obstructions to Sláintecare have been identified within the health services; if so, the action he will take as a response to same; and if he will make a statement on the matter. [8431/22]
View answerI propose to take Questions Nos. 919 and 920 together.
The Sláintecare Implementation Strategy & Action Plan 2021-2023 was approved by Government in May 2021. A mid-year progress report was published in September 2021 and an end-of-year Progress Report is expected to be published in the near future.
The Government’s commitment to Sláintecare reform and to ensuring every patient receives the right care, in the right place, at the right time is absolute and unwavering. €1.235 billion was allocated to ‘pure’ Sláintecare initiatives in Budget 2021 enabling and supporting major milestones in the Sláintecare Implementation Strategy and Action Plan 2021-2023 to be reached and funding is continuing at historically levels in Budget 2022.
The implementation of Sláintecare continued despite challenges of the major cyberattack on our health services and the ongoing COVID-19 pandemic. Substantial key achievements included progressing plans for new, elective hospitals in Cork, Galway and Dublin; establishing the Regional Health Areas Advisory Group to support the alignment of community and hospital services based on defined population need; and mainstreaming innovation through the Sláintecare Integration Fund.
New governance structures have been put in place, including the new Sláintecare Programme Board, co-chaired by the Secretary-General of the Department of Health and the Chief Executive Officer of the HSE, to ensure that implementation of Sláintecare is fully embedded and owned across the Department of Health and the HSE.
Work is also progressing on a detailed Action Plan in order continue to deliver on our Sláintecare commitments in 2022 and this will be published in the near future.
921. Deputy Bernard J. Durkan asked the Minister for Health if he will report on the progress on the National Children’s Hospital; the anticipated completion date; and if he will make a statement on the matter. [8432/22]
View answerThe new children’s hospital (NCH) project comprises the main hospital on a shared campus at St James’s, and two paediatric Outpatient and Urgent Care Centres at Connolly Hospital, Blanchardstown, and Tallaght University Hospital.
In September 2021, the main contractor on the NCH project, BAM Ireland, substantially completed and handed over the paediatric outpatient and urgent care centre at Tallaght, in line with the contractor's schedule, and the facility opened on 15 November 2021, following a period of operational commissioning. The new facility will accommodate up to 17,000 additional outpatient appointments (General Paediatrics, Specialist and Orthopaedic clinics) and we expect to see more than 25,000 Emergency Care attendances annually based on 2021 activity.
Together with “CHI@ Connolly”, which opened in July 2019, these new facilities will improve access to urgent and outpatient care for a significant number of children. In 2021, there were over 11,000 outpatient attendances at CHI@Connolly and almost 11,300 patients presented for urgent care. More than 95% of those presenting for urgent care at Connolly are able to go home after treatment and waiting lists for general paediatrics significantly reduced within a year of opening.
On the St James’s site, work is ongoing with major milestones reached in 2021, including completion of the concrete frame with over 150,000 cubic metres of concrete poured (weighing over 360,000 tonnes), the topping out of the building (where the highest point on the building was completed- a significant milestone in any construction project), the infill concrete slabs over the steelwork frame, closing in the concourse and, by the end of 2021, the building was largely weather-tight with approximately 17,000 square metres of glazing and 5,800 square metres of external façade installed.
The exterior of the building demonstrates the significant progress made on the project to date. Inside the NCH, 26 kilometres of internal partitions were installed in 2021, with the fit out of most internal areas now underway, including the south fingers comprising Outpatients, Cardiology Wards, and Therapies spaces, and the ‘Hot Block’ comprising Emergency Department, Critical Care and Theatres. However, the fit out and installation of services in over 6,000 spaces within the building mean that there remains a substantial and complex body of work to be completed.
The NPHDB has advised that the main contractor’s current programme schedule outlines completion can be achieved by December 2023 which would mean the NCH at St James’s could open in the second half of 2024, after the necessary commissioning period. The NPHDB is working to ensure that contractor will meet its own schedule.
923. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the management and-or termination of pregnancies as anticipated in the Health (Regulation of Termination of Pregnancy) Act 2018 has been observed by various practitioners at various levels throughout the country; if this is in accordance with the Act in terms of the availability of services to women; and if he will make a statement on the matter. [8434/22]
View answerAs part of the Deputy’s question relates to a service area, I have referred this question to the HSE for direct response.
The review will comprise a three-part approach to appraise the operation of the Act, with strands focusing on service users, service providers and a public consultation. Independent research commissioned to inform the service user and service provider strands will form key elements of the review.
Research to inform the service user strand is being carried out by Dr Catherine Conlon, Associate Professor, Trinity College, who is progressing a large qualitative study to analyse unplanned pregnancy and abortion care. The study, which was commissioned by the HSE’s Sexual Health and Crisis Pregnancy Programme in September 2019, will generate an in-depth understanding of the experiences of women who have accessed abortion care services since the commencement of the Act.
Independent research is also being commissioned on service providers’ views on the operation of the legislation. The tender application process for this research closed in January 2022.
924. Deputy Róisín Shortall asked the Minister for Health if he will arrange with the HSE to publish a list with contact details of all dentists in each CHO who currently accept medical card patients; if he will ensure that this list is routinely updated.; and if he will make a statement on the matter. [8438/22]
View answerAs this is a service matter I have asked the HSE to respond directly to the Deputy, as soon as possible.
925. Deputy Róisín Shortall asked the Minister for Health the way that his Department and the HSE monitors the extent of availability of dentists to medical card holders; the details of the latest data collected on dentist availability broken down by area; the way that this compares with previous data collected; the way that his Department and the HSE are dealing with the shortage of dentists for medical card patients and ensuring reasonable access for medical card patients; and if he will make a statement on the matter. [8439/22]
View answerThe Dental Treatment Services Scheme (DTTS) is available to medical card holders aged 16 and over. The dental care is provided by independent dental practitioners who have a contract with the HSE. Patients may choose to have their treatment undertaken by any dentist who participates in the Scheme.
The HSE monitors data on the number of contractors in each Local Health Office (LHO) area and the number of contractors actively making claims though the DTSS each month. The HSE also monitors data on the number of new Dentists entering and exiting the DTTS in each LHO on a monthly basis.
In addition to the on-going management of DTSS contracts locally, the HSE from time to time conducts a national exercise to ensure that DTSS contract holders who are included in the Primary Care Reimbursement Scheme list as participating in the DTSS scheme, but are no longer active and have exited the scheme, are removed from the list of current contractors.
The HSE National Oral Health Office also liaises with Principal Dental Surgeons in each HSE dental area regarding access issues for medical card holders to the DTSS. At the end of January 2022 there was 1,146 private dentists contracted to the DTSS. A breakdown by Local Health Office is detailed in Appendix A.
I fully acknowledge the need to align the DTSS, with best international evidence and practice, as outlined in Smile agus Sláinte, the National Oral Health Policy, and I have given a commitment to the Irish Dental Association to begin substantive discussions by the second quarter of this year.
My immediate priority is to seek to address the current situation of medical card patients experiencing problems in accessing treatment.
In that respect, officials from my Department and from the HSE have held two rounds of discussions with the IDA, the most recent on 17 December last when my Department and the HSE presented proposals to invest additional resources in the Dental Treatment Services Scheme, including €10m provided in the Budget, on top of the 2022 Estimate allocation of €56 million.
The Department/HSE has offered increased fees across a number of items and proposed the reintroduction of the Scale and Polish item.
These proposals were expedited to address not only the problem of access for patients, but also concerns expressed by dentists about the viability of the DTSS, and to some extent, to bring about alignment with the Dental Treatment Benefits Scheme, which is widely operated by dentists for PRSI patients.
The Department is anxious to move the process on, in the interests of patients, and is hoping to meet the Irish Dental Association again in the next couple of weeks to progress matters.
In the meantime, I have been assured that the HSE Public Dental Service is seeking to provide emergency cover for any medical card patients who are experiencing problems in accessing a service.
