Written Answers Nos. 305-328
305. Deputy Denis Naughten asked the Minister for Health when the new digital healthcare framework will be published; the current status of the roll-out of the electronic health record system; and if he will make a statement on the matter. [30306/23]
View answerThe development of a new Digital Health and Social Care Strategic Framework (2023-2030) is due to be completed in the coming weeks. In parallel, we are collaborating with the Health Service Executive, who will produce a corresponding implementation plan. The framework also aligns with the Government’s digital health strategy “Harnessing Digital”.
The objective of this framework is to provide a ‘north star’ to guide investment in digital health from now to the end of this decade, to ensure maximum benefit to patients and healthcare professionals and to enable those responsible for the management of the health service to do so with better data and greater insights.
The key goal of the framework is to support reform of the health service through streamlined processes, modernisation of patient facing health services and to provide patients and healthcare professionals with access to digital health records with the aim to increase health outcomes for all. The framework puts a greater focus on empowering patients to take greater control of their own health and wellbeing, enabling staff to do their jobs by providing them with digital skills and toolsets in a modern digital environment, investing in core clinical and corporate systems that are joined up, supporting innovation, and ensuring that this is all built on a robust and secure foundation.
The level of investment, expertise and resources needed to implement the new framework and associated implementation plan is expected to be considerable. Significant political support, oversight and governance will be required to successfully deliver on this challenging programme.
Our next steps are to finalise the draft strategic framework and roadmap, to continue engagement with key stakeholders and submit a memo to Government confirming the finalised framework.
Included in the new Digital Health and social care Strategic Framework 2023-2030 and associated implementation plan, is a roadmap which guides the programme of work required to deliver on eHealth initiatives including a national electronic health record. It outlines how digital records will be introduced on a phased basis starting with the roll-out of summary care records, shared cared records and building on both of those initiatives to work towards a national electronic health record.
Our engagement with other countries internationally and those who are considered leaders in digital health and have considerable experience in deploying EHRs, indicate that deploying electronic health records is a complex undertaking that requires enablers including ? clinical leadership, strategy, policy and legislation, robust governance, sustained commitment, significant resources, and expertise in technology.
The rollout of digital health record solutions will complement the existing work being undertaken to progress more extensive EHR deployments such as those at St. James Hospital, our maternity hospitals, the new children’s hospital, the national rehabilitation hospital and the national forensics hospital. Progress has been made to procure a similar solution that is suitable for deployment in the community healthcare setting.
The New Children’s Hospital hospital-wide electronic health record is underway with a contract now in place and staff being recruited to support its roll-out. When complete, this will be the most extensive EHR deployment in Ireland to date. The New Children’s Hospital has been designed as a digital hospital and requires a functional electronic health record as a core element of its operations. The deployment of electronic health records at the New Children’s Hospital builds on the success of other major eHealth programmes such as the EHR deployment at St James Hospital ? the largest acute hospital in Ireland ? which has an electronic health record system in place since 2018 and is now embedded in how care is delivered to patients at St James. With the aim of reducing risk to new-born babies and their mothers, there is now an electronic health record deployed across three major maternity hospitals (plus the maternity unit at University Hospital Kerry), with plans to cover the two remaining large maternity hospital by 2024. By 2024, 70% of babies will have an electronic health record assigned at birth.
Importantly, electronic health record deployments are part of a much wider network of digital health projects, with 700 funded eHealth projects currently underway across acute, community and primary care settings.
The Department of Health is now working closely with the HSE, given the emergence of the Regional Health Areas, to develop a procurement approach, a phased deployment plan and a hosting model, suitable for the deployment of EHRs.
306. Deputy Cormac Devlin asked the Minister for Health to provide an update on efforts by officials to restore the supply of basic medications as listed by the HPRA; if he will consider reviewing regulations to allow Irish pharmacists to substitute prescribed items and-or Irish residents to access the online services of UK or EU-based pharmacies; and if he will make a statement on the matter. [30310/23]
View answerThank you for your question which to my mind contains three distinct elements which I will address separately as follows;
Firstly, medicine shortages are a feature of modern health systems worldwide and a global health problem, not unique to Ireland, with increases in demand for medications, and medicines shortages observed in the UK, throughout the EU and across the world in recent months.
Ireland experienced some shortages of antibiotics earlier this year – as did most other European countries following a surge in winter illnesses. Shortages have not disappeared, but there are factors, such as the winter surge, that can put additional pressure on a health system and on medicine supply. It takes time for supply chains to stabilise following this period of excess demand.
Whilst individual brands or strengths of a medication may be temporarily unavailable, for the vast majority of medicines supplied in Ireland, there are alternatives, such as different strengths, brands, or similar classes, to ensure continuity of care.
Medicines shortages are managed through the Medicines Shortages Framework and immediate actions are taken by relevant stakeholders to mitigate the impact on patients. Ireland has a multi-stakeholder medicine shortage framework in place, coordinated by the HPRA, to prevent, wherever possible, and to manage medicine shortages when they occur. Based on an analysis of data reported by the pharmaceutical industry over several years, the reasons for shortages vary and are primarily due to manufacturing issues The Department of Health maintains regular contact with the HPRA regarding medicines shortages.
The HPRA publishes a list of medicines currently in short supply on its website (Medicines Shortages (hpra.ie) with the reason for the shortage and expected dates for the return of supply. The information is available to assist healthcare professionals in managing medicine shortages when they arise and reduce their impact on patients.
Secondly, I am aware of actions taken in other jurisdictions where Serious Shortages Protocols (SSP) are used to facilitate community pharmacists to supply either an alternative quantity, strength, pharmaceutical form, or medicine. Legislation in Ireland already allows for generic substitution (alterative strengths, quantity and forms) but does not allow for therapeutic substitution. Shortages protocols are product specific and are only used in very limited situations. For example, in the UK every draft SSP is reviewed by NHS England’s National Medical Director and Chief Pharmaceutical Officer, who can suggest amendments and raise any potential safety concerns, and Ministerial authorisation is necessary to give effect to the protocol. Each SSP is time limited.
Consideration is being given as to what legislative amendments are required to institution a similar framework to allow pharmacists to supply prescription controlled medicines in accordance with the specific protocol in the event of a serious shortage, rather than supply in accordance with a prescription, for the purposes of mitigating current and future challenges arising nationally in the availability and supply of medicines. This would negate the need for patients to be referred back to their prescriber to amend the original prescription, thus saving time and reducing inconvenience to patients, GPs and Pharmacists.
Improving the availability of authorised medicines is a key priority in ensuring optimal patient care. It is anticipated that a Medicines Substitution Protocol (MSP) could be a useful tool to alleviate the pressure the medicines shortages cause to Pharmacists, GP’s, hospital emergency departments and patients by allowing pharmacists to make certain changes to prescribed medicines that are the subject of a serious shortage.
Consideration on how to institute MSPs involving relevant stakeholders is in progress. There are risks associated for both the pharmacist and patient with substituting prescriptions and the Department will need to be satisfied that these risks are addressed. Work is ongoing to anticipate the governance, legal, training and patient safety aspects of this proposal which will be required. The Department will engage with key stakeholders as this policy is developed.
Finally, the issue of Irish patients accessing the online services of UK or EU-based pharmacies which is known as “mail order supply” is prohibited under the current relevant medicines legislation. The use of the appropriate medication at the right time in the right way by the right patient is one of the most effective health care interventions available and empowers patients to live healthier lives. The use of medicines is complex, and medicines are not ordinary items of commerce but are subject to a rigorous assessment and regulatory safety regime prior to them being made available to any patient. Furthermore, the supply of any prescription medicine is subject to a legislative safety framework whereby a registered pharmacist is required to review any prescription dispensed, to assess the pharmaceutical and therapeutic appropriateness of the product for the patient, and offer to counsel the patient. This system of face-to-face interaction between pharmacists and their patients is in place to promote and conserve patient safety and well being where a patient obtains a regulated medicine from a regulated supplier underpinned by a clinical care regime. There are currently no plans to review this system of medicines supply.
307. Deputy Éamon Ó Cuív asked the Minister for Health whether he intends extending the existing private hospital claims cover for compensation claims over €1.3 million to outpatient clinics providing private health services in order to reduce the hospital waiting lists for such services; and if he will make a statement on the matter. [30314/23]
View answerI do not have any current plans to extend the Clinical Indemnity Caps Scheme, referred to by the Deputy, beyond the existing arrangements. However, my Department will continue to keep the matter under review.
309. Deputy Peter Burke asked the Minister for Health if there are any plans to provide specialised Parkinson's nurse specialists into the communities to work alongside community nurses. [30322/23]
View answerAs this is an administrative matter for the Health Service Executive, the HSE has been asked to respond directly to the Deputy.
310. Deputy David Cullinane asked the Minister for Health to outline the total capital spend at each level 4 hospital from 2016 to 2022, broken down by year and by hospital; and if he will make a statement on the matter. [30325/23]
View answerAs the Health Service Executive is responsible for the delivery of public healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.
311. Deputy David Cullinane asked the Minister for Health to outline all capital projects to be either partially or fully funded by the HSE for primary, community and acute health services for Waterford into the future, as in plans submitted; what stage the project is at; and if he will make a statement on the matter. [30326/23]
View answerAs the Health Service Executive is responsible for the delivery of public healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.
312. Deputy Michael Healy-Rae asked the Minister for Health if financial assistance can be given to a person (details supplied); and if he will make a statement on the matter. [30327/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
313. Deputy David Cullinane asked the Minister for Health the number of nursing homes operating in this State, broken down by publicly run HSE facilities, community nursing units, not-for-profit organisations and private providers, in tabular form; and if he will make a statement on the matter. [30328/23]
View answer314. Deputy David Cullinane asked the Minister for Health the number of nursing homes operating in this State as of 1 May 2019, 2020, 2021 and 2022, broken down by publicly run HSE facilities, community nursing units, not-for-profit organisations and private providers, in tabular form; and if he will make a statement on the matter. [30329/23]
View answer315. Deputy David Cullinane asked the Minister for Health the number of registered nursing home beds in this State in 2019 and to date, further broken down by categories, that is, publicly run HSE facilities, community nursing units, not-for-profit organisations and private providers, in tabular form; and if he will make a statement on the matter. [30330/23]
View answer367. Deputy David Cullinane asked the Minister for Health to outline the number of public, private or voluntary nursing homes that have closed since 2016; the number of beds per home lost, further broken down by county; and if he will make a statement on the matter. [30382/23]
View answerI propose to take Questions Nos. 313 to 315, inclusive, and 367 together.
The Health Information and Quality Authority's older people's services inspection team is legally responsible for the monitoring, inspection and registration of designated centres for older people, such as nursing homes, in Ireland.
The tables at the link sets out the numbers of nursing homes and beds registered in the state between 2019 to 2022 and the position as of 8 June 2023.
316. Deputy David Cullinane asked the Minister for Health the estimated cost of increasing NTPF funding to private nursing homes under the fair deal and nursing home support scheme by 10%, by 20% and by 30%, excluding any increase in contributions by residents; and if he will make a statement on the matter. [30331/23]
View answer364. Deputy David Cullinane asked the Minister for Health to outline, in tabular form, the cost of increasing funding to the NTPF to ensure a 10%, 20% and 30% increase in the fair deal and nursing home support scheme above current funding, broken down by public, private and voluntary providers; and if he will make a statement on the matter. [30379/23]
View answerI propose to take Questions Nos. 316 and 364 together.
The Nursing Home Support Scheme (NHSS), commonly referred to as 'Fair Deal', is a system of financial support for people who require long-term residential care. The primary legislation underpinning the NHSS is the Nursing Home Support Scheme Act 2009. Participants in the NHSS contribute to the cost of their care according to their means while the State pays the balance of the cost. The Scheme aims to ensure that long-term nursing home care is accessible and affordable for everyone, and that people are cared for in the most appropriate settings.
The NHSS supports about 22,500 people. Around 80% of those are supported in private nursing homes, with the remainder in public HSE-run facilities (both systems are funded through the NHSS). There is a total scheme budget of approximately €1.5 billion for 2023. This 2023 figure is a projected figure and, as such, difficult to determine at this point in time but it is anticipated they will be significantly greater than 2022.
Residents in public HSE-run Community Nursing Units (CNU’s) represent approximately 20% of Fair Deal scheme participants (4,500 residents were in CNUs last year).
In March 2022 the HSE published its annual updated cost of providing care in its public residential care centres for older people.
The report gives detailed cost of care in public nursing homes. It shows that the cost of care has increased from €1,674 per week in 2021 to €1,698 per bed per week in 2022. The 1.4% increase can in large part be attributed to pay increases provided under the Lansdowne Road Agreement (funded separately to Nursing Homes Support Scheme (NHSS) funds allocated within the HSE Service Plan 2022).
It is important to note that these costs do not relate to the amount a person will pay towards their care under the NHSS (Fair Deal) and that regardless of whether a nursing home resident is in a private, voluntary or public nursing home their contribution to the cost of their own care remains the same.
Data from the HSE indicates that in 2022, the cost to the State in providing care to residents in CNU’s was €360.3m, inclusive of client contributions of approximately €65.9m. Data from the HSE also indicates that in 2022 the cost to the State in providing care to private and voluntary nursing homes, inclusive of client contributions of approximately €295.7m, was €1.033bn.
The table below shows the cost of care exclusive of client contributions with 10%, 20% and 30% increase.
|
- |
2022 |
+10% |
+20% |
+30% |
|
Public |
€294.4m |
€323.8m |
€353.3m |
€382.7m |
|
Private & Voluntary |
€707.6m |
€778.4m |
€849.1m |
€919.9m |
The table below shows the cost of care, inclusive of client contributions, with 10%, 20% and 30% increase.
|
- |
2022 |
+10% |
+20% |
+30% |
|
Public |
€360.3m |
€396.3m |
€432.6m |
€468.4m |
|
Private & Voluntary |
€1.003bn |
€1.103bn |
€1.204bn |
€1.304bn |
317. Deputy Duncan Smith asked the Minister for Health how many workers who are eligible for the pandemic payment are still waiting to receive payment; and if he will make a statement on the matter. [30332/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly.
318. Deputy Duncan Smith asked the Minister for Health when catering and cleaning staff in a facility (details supplied) will be paid their pandemic payment. [30333/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly.
I would also like to remind the Deputy that it is against Department policy to comment on individual cases.
319. Deputy David Cullinane asked the Minister for Health the estimated completion date and cost estimate for the national children's hospital; and if he will make a statement on the matter. [30334/23]
View answerThe New Children’s Hospital (NCH) project comprises the main hospital on a shared campus at St James’s, and two Outpatient and Urgent Care Centres at Connolly and Tallaght hospitals. Both satellite centres are now open and successfully delivering a new model of ambulatory and urgent care for children and adolescents in the Greater Dublin Area.
Works have progressed on the main site to the extent that the construction and equipping phase is now approximately 85% complete against contract value. The large glass biome, that envelopes the panoramic lifts providing intuitive access to all areas of the building, is complete, as well as the rooflights and ward end glazing to the Level 4 Rainbow Garden. Landscaping and tree planting is underway in the outdoor areas. The elevated helipad space is progressing into the final stages of assembly, with helipad structure completed. The major focus in 2023 continues to be the internal fit-out and commissioning of mechanical and electrical services.
The contractor’s most recent construction programme was received in September 2022. It outlined that substantial completion could be achieved by March 2024. This programme was subsequently deemed non-compliant by the Employer’s Representative.
BAM’s most recent monthly report for February 2023, issued in April 2023, included a programme update with a substantial completion date for the new children’s hospital of May 2024. Substantial completion is informed by the main contractor’s programme of works.
The National Paediatric Hospital Development Board (NPHDB) continues to engage with the contractor to secure an updated and compliant programme, as required under the construction contract, to get certainty on this substantial completion date and to focus on ensuring that everything possible is being done to complete the construction project as soon as possible.
Following substantial completion, the hospital will be handed over to Children’s Health Ireland (CHI) for a period of operational commissioning. Planning for the complex process of commissioning over 6,150 spaces to be ready to accommodate services for patients, post substantial completion, is well advanced.
There remain risks beyond the control of the NPHDB and the contractor to the timeline, arising from Brexit, the global pandemic, the invasion of Ukraine and its impact on supply chains, global supply chain difficulties more generally, including shortages of construction raw materials, and the current inflationary pressures on energy and material costs.
Government has been previously advised that the project and programme will take longer and therefore cost more.
In 2018, the previous Government approved a capital budget of €1.433bn for the NCH project. This included the capital costs for the main hospital at St. James’s Hospital campus, the two satellite centres, equipment for the three sites, and the construction of the carpark and retail spaces. €1.3bn has been drawn down to date against this budget.
A number of items were not included in this investment figure, as there was no price certainty for them and nor can there be, for some, for the duration of the project. These include construction inflation, the impact of unforeseen events (e.g. Covid-19), statutory changes, the contractor’s right to claim for additional true costs in line with public works contract provisions, and implementation of the 2019 PwC report recommendations.
Additional costs in relation to the integration and transfer of services of the three hospitals to the new sites brings the total programme cost to €1.73bn. This includes investment in ICT, a new Electronic Health Record system, and the Children's Hospital Integration Programme, (the merging of three paediatric hospitals), including commissioning. Detailed planning around the commissioning, staff training and transfer of services to the new hospital is well advanced.
Definitive updates or outturn forecasts costs cannot be provided, as there is a live, commercially sensitive contract in place. Discussion of any costs outside of the approved budget, hypothetical or otherwise, could adversely affect the NPHDB’s commercial engagements, contractual relationships and consequently the project itself.
Whilst there is a focus on the capital project and its delivery, we must not lose sight of the fact that the NCH project will deliver world class facilities that will improve and prioritise medical outcomes for the nation’s sickest children, while bringing about transformational change to the delivery of healthcare for the children of Ireland for generations to come.
320. Deputy David Cullinane asked the Minister for Health to outline all meetings attended by him in 2022 and 2023 relating to the NCH, listing each meeting, the location and the date; and if he will make a statement on the matter. [30335/23]
View answerThe New Children’s Hospital (NCH) Project, comprising of the main hospital at St. James’s campus in Dublin, and two paediatric outpatient and urgent care centres at Connolly and Tallaght hospitals, is a Government priority.
We now have two wonderful satellite centres operational, and I am fully committed to ensuring the main hospital at St. James’s is completed as quickly as possible on behalf of children and their families.
In conjunction with the parliamentary attendances and internal Departmental updates, I visited the New Children’s hospital site on 10th June and 17th November 2022. I was delighted with the demonstrable progress between both of those visits.
Throughout 2022 and 2023 I have attended various Oireachtas committees and debates where NCH was discussed, details of which are available on the Dáil record. Officials within my Department are in constant communication with key stakeholders involved in the project, including the National Paediatric Hospital Development Board, (who have statutory responsibility for planning, designing, building and equipping NCH), Children’s Health Ireland, (the entity who will occupy the hospital upon its completion), and the HSE. Updates are regularly provided to me regarding the project and its delivery.
321. Deputy David Cullinane asked the Minister for Health to outline all meetings attended by the assistant secretary responsible for health infrastructure in his Department in 2022 and 2023 relating to the NCH, listing each meeting, the location and the date; and if he will make a statement on the matter. [30336/23]
View answerThe Assistant Secretary of the Health Infrastructure Division within my Department, engages with the New Children’s Hospital project’s key stakeholders, including the National Paediatric Hospital Development Board (NPHDB) and the HSE, on a consistent and continuing basis.
The outcome of these ongoing engagements is that everything possible is being done by key stakeholders to ensure the timely completion of the project.
Substantial completion of the hospital build is informed by the main contractor, BAM’s, construction programme. The NPHDB has advised that the contractor’s programme is under constant review and evaluation. To date BAM has been behind the schedule outlined in its own programme. The contractor’s most recent construction programme was received in September 2022. It outlined that substantial completion could be achieved by March 2024. This programme was subsequently deemed non-compliant by the Employer’s Representative.
BAM’s most recent monthly report for February 2023, issued in April 2023, included a programme update with a substantial completion date for the new children’s hospital of May 2024.
The NPHDB continues to engage with the contractor to secure a compliant programme, as required under the contract, and to get certainty on this substantial completion date.
322. Deputy David Cullinane asked the Minister for Health the number of design changes made to the national children's hospital since the original design; and if he will make a statement on the matter. [30337/23]
View answerThe National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for planning, designing, building, and equipping the new children's hospital. I have therefore referred your question to the NPHDB for direct reply.
323. Deputy David Cullinane asked the Minister for Health if he will confirm if talks on settling claims arising from the NCH between the contractor and a company (details supplied) ended without agreement; and if he will make a statement on the matter. [30338/23]
View answerThe National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for planning, designing, building, and equipping the new children's hospital. I have therefore referred your question to the NPHDB for direct reply.
324. Deputy David Cullinane asked the Minister for Health to outline the nature of works carried out by a company (details supplied) for the NPHDB; the cost of such works; and if he will make a statement on the matter. [30339/23]
View answerThe National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for planning, designing, building, and equipping the new children's hospital. I have therefore referred your question to the NPHDB for direct reply.
325. Deputy David Cullinane asked the Minister for Health to outline the nature of works carried out by a company (details supplied) for CHI on the NCH; the cost of such works; and if he will make a statement on the matter. [30340/23]
View answerAs this is an operational matter I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
326. Deputy David Cullinane asked the Minister for Health to outline the nature of the works carried out by a company (details supplied) regarding the NCH; and if he will make a statement on the matter. [30341/23]
View answerThe National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for planning, designing, building, and equipping the new children's hospital. I have therefore referred your question to the NPHDB for direct reply.
327. Deputy David Cullinane asked the Minister for Health to outline the number of change orders given to a company (details supplied) regarding the NCH; to outline the nature of the change order, where the instruction came from and the date; and if he will make a statement on the matter. [30342/23]
View answerThe National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for planning, designing, building, and equipping the new children's hospital. I have therefore referred your question to the NPHDB for direct reply.
328. Deputy David Cullinane asked the Minister for Health if any element of the NCH was found not to be in compliance with HTM standards; if so, the nature of the failure in standards; and if he will make a statement on the matter. [30343/23]
View answerThe National Paediatric Hospital Development Board (NPHDB) has statutory responsibility for planning, designing, building, and equipping the new children's hospital. I have therefore referred your question to the NPHDB for direct reply.
