Written Answers Nos. 31-50
31. Deputy Bernard J. Durkan asked the Minister for Health what steps have been taken to address the patient waiting list in respect of scoliosis; the number of patients that have been facilitated to date in 2023; the number still awaiting treatment; when it is expected that their needs are likely to be met; and if he will make a statement on the matter. [40702/23]
View answerI sincerely regret that children can experience a long waiting time for scoliosis treatment, and I remain conscious of the burden that this places on them and their families.
Scoliosis and Spina Bifida have been identified as priority areas in both the 2022 and 2023 Waiting List Action Plans.
Last year some €19 million of current and capital funding was committed to tackle these waiting lists. In 2022, 509 scoliosis procedures were carried out, compared to 380 for the same period in 2019 (the most recent comparable year given the COVID-19 pandemic). This represents a 34% increase and an increase of 47% compared to 2021.
Despite undertaking a substantial number of spinal procedures in 2022, corresponding reductions in the waiting list were offset by significant increases in demand and referrals compared to previous years, with a 30% increase in additions to the spinal surgery list compared to 2021.
This Government continues to invest significant funding to help clinicians reduce the amount of time children are waiting for important hospital appointments and procedures, with scoliosis and spina bifida again included as a priority area for funding under the 2023 Waiting List Action Plan.
Recognising the significant increase in demand, I have requested that the HSE explore all options to increase capacity for this vital service, including outsourcing care both at home and abroad.
In 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.
32. Deputy Joan Collins asked the Minister for Health how he is making the Health (Termination of Pregnancy Services) (Safe Access Zones) Bill 2023 a priority, to have it in operation by Christmas 2023 (details supplied). [40652/23]
View answerSafe Access Zones legislation was prioritised for publication in the Government’s Summer legislative programme, and a Bill was published at the end of June. This Bill was initiated in the Houses in early July and is currently at Second Stage in Dail Eireann. Subject to the Parliamentary timetable it is my intention to progress this legislation through the Houses as expeditiously as possible and to have it enacted by the end of the year.
33. Deputy David Cullinane asked the Minister for Health if he will review dental practice regulations, in line with calls from the Dental Council; and if he will make a statement on the matter. [40787/23]
View answerThe practice of dentistry is underpinned by a range of legislation, of which the Dentists Act 1985 is only one. Currently 5 separate state and regulatory agencies (Health Information and Quality Authority, Health Service Executive, Health and Safety Authority, Environmental Protection Agency and Local Authorities) have a regulatory interest and oversight of dental practices, primarily for the protection of the public.
In the context of the wider need to update dental legislation, the Department of Health is committed to reviewing the Dentists Act 1985. The protection of the public and ensuring high oral healthcare standards will continue to be the central focus of this work. The review and updating of the legislation also, necessarily, is directly related to the wider implementation of the National Oral Health Policy, which envisages a fundamental reform of oral health services. As such, any new legislation will also be informed by this work.
Additional resources have been allocated to commence this work to further strengthen the regulation of dentists in Ireland. The Department is currently undertaking preparatory scoping and planning work to support the review. As part of this preparatory scoping work, the Department is considering all of the necessary inputs required to deliver a robust, evidence based modern regulatory framework with due consideration to the policy alignment referenced above.
34. Deputy Gino Kenny asked the Minister for Health if he is aware that an organisation (details supplied) has called for the emergency department taskforce to meet urgently to discuss how the HSE plans to tackle the persistent overcrowding problem in Irish hospitals; and if he will make a statement on the matter. [40713/23]
View answerThe Emergency Department Taskforce (EDTF) is an advisory body comprising representatives from the HSE, Department of Health, staff representative organisations, practitioners and patient representatives, and is co-chaired by the INMO and the HSE. The EDTF last met on the 18th of September 2023. The Minister was invited to, and attended, this meeting. The date of the next meeting of the EDTF will be set by the co-chairs.
35. Deputy Gino Kenny asked the Minister for Health if he is aware that an organisation (details supplied) recently published data showing that the mental health budget has declined as a percentage of the overall health budget from 13% in 1984 to 5.1% in 2023; if he is aware that the organisation has called for the mental health budget to be at least 10% of the overall health budget; and if he will make a statement on the matter. [40711/23]
View answerThe Government’s clear commitment to enhancing mental health services is shown by significant mental health funding increases in recent years. I would note that 2023 saw a record budget for mental health of €1.2bn. Budget 2023 delivered almost €58m in additional funding, and a further €10m in once-off funding for much needed minor capital works across the Mental Health system.
Funding allocated to mental health services in recent years has allowed for the continued investment in the mental health national clinical programmes and models of care, which has led to significant service improvements, including the full implementation of specialist perinatal mental health network provided for and the on-going expansion of specialist mental health teams for eating disorders, ADHD in adults, and dual diagnosis. In fact, since coming into Government I have secured almost 800 additional posts for Mental Health services in this country, and I am pleased to see that continued recruitment for these posts has remained a priority for the HSE.
Importantly, as budgets increase, we need to ensure that we have plans and strategies in place so that those resources are used effectively and efficiently to the benefit of people using our mental health services. All aspects of mental health services are being improved and developed, through Sharing the Vision in the short to longer term. Sharing the Vision aims to enhance the provision of mental health services and supports across a broad continuum, from mental health promotion, prevention, and early intervention to acute and specialist mental health service delivery, during the period 2020-2030.
It should be borne in mind that our health and personal social care services overall has changed and improved significantly on several fronts since 1984. This includes many new services that were prioritised and funded since that time to meet emerging needs in line with national and international best practice. This has to be taken into account for any comparison purposes, not only for Mental Health, but for health expenditure overall by the Exchequer.
The Department is currently engaging in dialogue with the Department of Public Expenditure, NDP Delivery and Reform and the HSE in relation to the 2024 Estimates. Until these discussions are concluded it would not be appropriate for me to comment on this matter. However, I am committed to ensuring the continued enhancement of mental health services through the allocation of additional funding for mental health in 2024. I am aware of the pre-Budget submission from the organisation referred to by the Deputy and I will bear this in mind in the context of the on-going Estimates 2024. process.
36. Deputy David Stanton asked the Minister for Health to outline the involvement, if any, of his Department in the provision of a new building for the Cork University Dental School and Hospital; the indicative timetable for the construction and completion of the new building; and if he will make a statement on the matter. [40411/23]
View answerIn June of this year, Minister Harris and I announced a number of options to expand third level places for healthcare. A report by the Higher Education Authority found, with investment, an additional 63 Dentists could potentially be trained annually.
This expansion is being considered in the context of the Budget/Estimates Processes and National Development Plan review.
37. Deputy Alan Dillon asked the Minister for Health for an update on his Department’s latest work in tackling overcrowding in hospitals; and if he will make a statement on the matter. [40744/23]
View answer38. Deputy Duncan Smith asked the Minister for Health his plans to tackle to ongoing trolley crisis in emergency departments throughout the country in advance of the oncoming winter season; and if he will make a statement on the matter. [40549/23]
View answer39. Deputy David Cullinane asked the Minister for Health the plans he has in place to prevent a serious hospital crisis in the coming winter; and if he will make a statement on the matter. [40791/23]
View answerI propose to take Questions Nos. 37, 38 and 39 together.
Urgent and Emergency Care pressures are no longer just experienced during winter periods. Prolonged levels of high presentations and congestion now occur throughout the year. While significant investment has been driven through Winter Planning and National Service Plans over the past three years, a new approach to Urgent and Emergency Care (UEC) planning is now required in response the changing demands.
This approach is twofold:
• The delivery of an Urgent and Emergency Care Operational Plan for 2023, which was signed off by Government at the end of July; and
• The delivery of a 3-year multi-annual UEC Strategy, which is expected to be submitted to Government in the Autumn.
The UEC Operational Plan 2023 focuses on improving four key performance indicators. There are specific targets to:
• reduce ED waiting times for older patients;
• reduce the number of patients with Delayed Transfers of Care;
• reduce the numbers of patients waiting on trolleys; and
• reduce average inpatient lengths of stay.
Surge periods of exceptionally high ED activity are anticipated for the remainder of 2023. The Plan contains surge measures, which were informed by the After-Action Review of the Winter Plan 2022/23.
The UEC Operational Plan 2023 will lead into year one of the multi-annual UEC Strategy and will align with the governance structure of the overarching multi-annual UEC Strategy.
40. Deputy Gino Kenny asked the Minister for Health when the new National Children's Hospital is expected to open; what the final cost of the project will be; and if he will make a statement on the matter. [40710/23]
View answerThe timely completion of the New Children’s Hospital (NCH) is a Government priority. Everything possible is being done to ensure the project is completed as soon as possible on behalf of children, young people and their families.
Works are progressing on the main site, with the construction and equipping phase now over 90% complete against contract value. The major focus of 2023 continues to be the internal fit out and commissioning of mechanical and electrical services. The installation of medical equipment has begun, and landscaping is underway in the 14 garden and outdoor spaces.
Substantial completion is informed by the main contractor, BAM’s, programme of works. Once substantial completion is achieved, the hospital will be handed over to Children’s Health Ireland (CHI) for a period of operational commissioning, (approximately 6 months), to support opening. This will ensure the hospital is ready for patients and staff.
The last programme update received from BAM suggested substantial completion could be achieved by May 2024. As construction progress has been significantly behind BAM’s own programme for timely completion of this critical project, this programme has now expired. The NPHDB and Employer’s Representative (ER - the independent body responsible for enforcing the contract) have been engaging with BAM for months, seeking a compliant programme, outlining how it will complete the final 10% of works.
An updated programme was received on 18th July 2023. This is currently under review by the ER, to determine compliance with the contract. The programme outlines how BAM propose to complete over 40,0000 separate activities at the hospital. Given this level of detail the review could take up to three months to complete.
NPHDB will not be commenting on the programme details until the ER has determined the programme’s compliance. In the meantime, NPHDB continues to engage with BAM to increase productivity on the project.
In 2018, the previous Government approved a capital budget of €1.433bn for the NCH project. This budget has not been depleted, €1.35bn has been drawn down to date. Additional costs in relation to the integration and transfer of the services of the three children’s hospitals to the new sites brings the total cost of the programme to €1.73 bn. As the project will take longer than expected, it will cost more as a result. There were costs not comprehended within the original 2018 budget that need to be addressed, including the impact of the once in a generation increases in construction inflation. Additional funding requests are subject to robust scrutiny and review and will be brought to Government for sanction in due course.
While much focus has been on costs and challenges faced by the project, it is important to note that once open the NCH will provide world class facilities to its patients. NCH is unprecedented in scale, facilities, and technological advancement. It will be transformational in how we treat and deliver care to children and their families. The hospital has been designed and constructed to be as enduring and adaptable as possible. It is a building for the next 75-100 years, rather than the 25-30 years of other hospitals internationally.
41. Deputy Catherine Connolly asked the Minister for Health for an update on the reopening of the day centre in Áras Mhic Dara in Carraroe; the reason the day centre did not reopen on 11 September 2023, as planned; if the promised bus service is in place to date; to clarify whether the promised nursing role has been filled to date; and if he will make a statement on the matter. [40728/23]
View answerAs this is an operational matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
42. Deputy Pádraig O'Sullivan asked the Minister for Health his views that the assessment processes for accessing new medicines are too stringent; and if he will make a statement on the matter. [40476/23]
View answerThe Health Service Executive (HSE) has statutory responsibility for decisions on pricing and reimbursement of medicines under the community drugs schemes, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013.
The HSE is committed to providing access to as many medicines as possible, in as timely a fashion as possible.
The HSE robustly assesses applications for pricing and reimbursement to make sure it can stretch available resources as far as possible and to deliver best value in relation to each medicine and ultimately more medicines to Irish citizens and patients.
HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds, on the advice of the National Centre for Pharmacoeconomics (NCPE). There are formal processes which govern applications for the pricing and reimbursement of medicines, and new uses of existing medicines, to be funded and/or reimbursed.
In February, I published the Mazars Review which examined the governance arrangements around the HSE’s Drug Pricing and Reimbursement Process. The Report found that the reimbursement process is operating in line with the legislation and that it is delivering results in line with international norms. I fully support the recommendations contained in the Mazars report around improving the process, increasing transparency, providing easier access, and supporting value for money.
An implementation group has been established between my Department and the HSE to consider and progress the various recommendations contained in the Report. The membership of the Group includes representatives of the Drugs Group, the HSE, the NCPE, and the Department of Health. The Working Group has met frequently since its establishment, to consider the involvement of patients, industry, and clinicians, in each stage of the reimbursement process.
Targeted stakeholder consultation commenced on the 31st of May and concluded on the 20th of June. The insights gained from stakeholders will be considered by the Group as it continues its work on progressing the various recommendations of the Review. A report on this will be submitted to me in the coming months.
43. Deputy Fergus O'Dowd asked the Minister for Health if he will provide an update on the progression of, and the timeline for, the establishment of a commission on care for older people and the establishment of a commissioner for ageing and older people; and if he will make a statement on the matter. [40604/23]
View answerAcknowledging the disproportionately negative impact of the pandemic on older persons, the Programme for Government (2020) commits to the establishment of a commission on care that will ‘assess how we care for older people and examine alternatives to meet the diverse needs of our older citizens’, learning the lessons from COVID 19.
While the scope of the commission has yet to be approved, it is envisaged that consideration of matters such as whether there is a need to establish a commissioner for ageing and older people will fall within the commission’s remit.
In 2022 preliminary research was undertaken within the Department of Health in preparation for the establishment of the commission, the scoping and planning for which are being further advanced as a priority in 2023. It is expected the proposal for the commission will be considered by the Government in the coming weeks and that, if approved, the commission will be formally established by January 2024.
44. Deputy Bernard J. Durkan asked the Minister for Health the extent to which ongoing measures are taking place to deal with the issue of waiting lists in all hospitals throughout the country in respect of all procedures; if steps have been taken to fill the various vacant posts which might facilitate this work; and if he will make a statement on the matter. [40701/23]
View answer278. Deputy Bernard J. Durkan asked the Minister for Health the degree to which ongoing emphasis is placed on the need to reduce hospital waiting lists throughout the country; and if he will make a statement on the matter. [40916/23]
View answer282. Deputy Bernard J. Durkan asked the Minister for Health the degree to which he and his Department continue to evaluate the needs of patients seeking various treatments such as cardiology, oncology, endoscopy, urology and neurology treatments; and if he will make a statement on the matter. [40920/23]
View answer283. Deputy Bernard J. Durkan asked the Minister for Health the efforts that continue to be made to review the most acute hospital waiting lists throughout the country on a regular basis, in order to target those areas particularly affected by long waiting lists/delays; and if he will make a statement on the matter. [40921/23]
View answerI propose to take Questions Nos. 44, 278, 282 and 283 together.
It is recognised that waiting times for many scheduled appointments and procedures were too long before and have been made worse by the Covid-19 pandemic.
The Department of Health continues to work with the HSE and the National Treatment Purchase Fund (NTPF) to identify ways to improve access to care.
On the 7th of March, the Minister for Health published the 2023 Waiting List Action Plan, which is the latest stage of a multi-annual approach to sustainably reduce and reform hospital waiting lists.
The 2023 plan builds on the foundational work done through the short-term Waiting List Action Plan between September and December 2021, and the Waiting List Action Plan for 2022, both of which reversed the annual trend of rising waiting lists.
The 2023 Plan sets out the priorities to continue to address waiting lists this year – in particular for the priority areas of Gynaecology, Paediatric Orthopaedics (Spina Bifida/Scoliosis) and Obesity/Bariatrics. The thirty actions in the Plan, which are governed by the Waiting List Task Force, focus on delivering capacity, reforming scheduled care and enabling scheduled care reform.
For 2023, funding totaling €443 million is being allocated to tackle Waiting Lists with €363 million of this being allocated to the 2023 Waiting List Action Plan, to implement longer term reforms and provide additional public and private activity to clear backlogs exacerbated during the pandemic.
The €363 million is targeted at reducing hospital waiting lists by 10% in 2023 as well as continuing to significantly reduce waiting times toward the Sláintecare recommended wait times, (10 weeks for new outpatient appointments and 12 weeks for procedures). The remaining €80 million of the €443 million is being targeted at various measures to alleviate community/primary care waiting lists.
In July (latest available figures) the total workforce stands at 141,723 WTE. There are 21,910 more WTE working in our health service than there were at the beginning of 2020. This includes 6,563 nurses and midwives; 3,141 health and social care professionals; and 2,189 doctors and dentists.
We are clearly making progress. At the end of August, the number of patients waiting over the Sláintecare targets have fallen by 21% since the pandemic peaks. We now have 497,963 people on the Active Waiting Lists (inpatient / day case, GI Scopes and outpatients) waiting longer than the Sláintecare maximum wait times, broken down as follows:
• 51,121 people are currently exceeding the 12-week inpatient / day case (IPDC) target.
• 10,697 people are exceeding the 12-week GI Scope target.
• 436,145 people are exceeding the 10-week outpatient (OPD) target.
• With this ambitious 2023 Waiting List Action Plan, the Department of Health, the HSE and the NTPF are taking the next steps in the multi-annual approach towards achieving the vision of a world-class public healthcare system in which everyone has timely and transparent access to high-quality scheduled care, where and when they need it, in line with Sláintecare reforms.
45. Deputy Gino Kenny asked the Minister for Health if he is aware that there are only 51 CAMHS inpatient beds operational across the country at any one time, falling well short of the 130 beds recommended in the Government's 'A Vision for Change' strategy; and if he will make a statement on the matter. [40714/23]
View answerThe Deputy will be aware that the previous Mental Health policy " A Vision for Change" has been replaced by the current widely agreed policy "Sharing the Vision 2020-2030. This aims to improve all aspects of CAMHS care, including CAMHS in-patient capacity nationally. "Sharing the Vision" promotes new service responses for CAMHS overall and greater flexibility for more person centered care at national and local levels. As this is an operational service matter, I have asked the Health Service Executive to respond to the Deputy directly as soon as possible.
46. Deputy Catherine Connolly asked the Minister for Health further to Parliamentary Question No. 1373 of 25 July 2023, to provide a status update on the Strategic Assessment Report/ Preliminary Business Case for the new emergency department, women and children's block at University Hospital Galway; the timeline for the completion of the SAR/PBC; and if he will make a statement on the matter. [40729/23]
View answerThe Strategic Assessment Report (SAR) review for the new Emergency Department, Women and Children's Block at University Hospital Galway has been completed. The output of the review has been shared with the HSE to ensure that the new SAR/Preliminary Business Case (PBC) document, as now required under the updates to the Public Spending Code (PSC) of March 2023, is as robust as possible.
The Project team has been working to finalise the new SAR/Preliminary Business Case, incorporating the outputs of the Department of Health’s SAR review and the PSC changes.
The Department understands that the new SAR/PBC has now been submitted by the Project Team to the HSE for approval. If approved by the HSE, the SAR/PBC will be subject to further review and Government consent before it can proceed to the pre-tender stage, as set out in the Public Spending Code. The timeline for this will be determined by when the SAR/PBC is received by the Department.
47. Deputy Colm Burke asked the Minister for Health the hospitals that currently have free Wi-Fi in public areas as of August 2023, in tabular form; and the estimated cost of ensuring that every public hospital in this country has Wi-Fi available for patients. [40619/23]
View answerDeputy, I have referred your question to the HSE as this is an operational matter and the HSE will be best placed to provide the latest information.
The department do understand the need for more ubiquitous access to WiFi, not just for patients in public areas but also for staff to access clinical systems, and our ongoing investment in technical infrastructure will go some considerable way towards addressing this, mindful of the need always to ensure cyber resilience when expanding this capability.
48. Deputy Brendan Smith asked the Minister for Health the progress to date in recruiting additional personnel for CAMHS teams in areas such as Cavan/Monaghan; and if he will make a statement on the matter. [40707/23]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly as soon as possible.
49. Deputy Aindrias Moynihan asked the Minister for Health if pharmacist services can be expanded to aid in alleviating some of the pressures currently experienced in GP services; and if he will make a statement on the matter. [40264/23]
View answerThe Department of Health recognises the value and importance of pharmacists and pharmacies in conserving, protecting and enhancing the health of our citizens.
Pharmacists are health care professionals who are expert in the use and management of medicines to treat and alleviate ill health and maintain good health. In their daily routine practice, they recognise and assess presentations of sub-optimum health and advise on its management, which may include the subsequent provision of medicines to patients as either preventative, treatment or maintenance options.
The practice of pharmacy and the provision of pharmaceutical care has the potential to be further evolved to deliver optimal patient outcomes - this potentially will provide a vehicle to alleviate the pressure on, and support, primary care practitioners.
There are legal and regulatory matters which will have to be considered as well as appropriate guidance and in some cases, further training for pharmacists, depending on the measures being implemented.
On the 24th July 2023 the Minister for Heath established an Expert Taskforce to support the expansion of the role of pharmacists in Ireland. The Taskforce has formally commenced and will work intensively in the coming months. The Minister has requested that the first of their recommendations be sent to him by the end of October this year, which the Taskforce has committed to. The Minister will consider the recommendations and direct officials accordingly.
In tandem, Department of Health officials are working to progress several projects to enhance scope of practice outside of the Pharmacy Taskforce. These include an expansion of the role of pharmacists in supporting existing public health and well-being programmes.
50. Deputy Aindrias Moynihan asked the Minister for Health what measures are being taken to ensure adequate GP services are in place for Cork north-west; if he is aware of the difficulties that people are experiencing in securing a GP in their area; and if he will make a statement on the matter. [40263/23]
View answerGPs are self-employed practitioners and therefore may establish practices at a place of their own choosing. There is no prescribed ratio of GPs to patients and the State does not regulate the number of GPs that can set up in a town or community.
Under the GMS scheme, the HSE contracts GPs to provide medical services without charge to medical card and GP visit card holders. Currently there are 2,544 GPs contracted to provide services under the GMS Scheme.
Where a vacancy arises in a practice with a GMS contract, the HSE becomes actively involved in the recruitment process to find a replacement GP. As of the start of August, there were no GMS vacancy in the area of Cork North-West.
The Government is aware of the workforce issues currently facing general practice, including the limited access to GP services in certain areas, and is working to ensure that general practice is sustainable in all areas into the future.
Under the 2019 GP Agreement additional annual expenditure provided for general practice has been increased now by €211.6m. This provides for significant increases in capitation fees for participating GMS GPs, and new fees and subsidies for additional services. Improvements to GP’s maternity and paternity leave arrangements and a support for GPs in disadvantaged urban areas, have also been provided for. In addition, the enhanced supports package for rural GP practices was increased by 10%.
The recent GP Agreement 2023 announced in July, which provides for the expansions of GP care without charges to those who earn up to the median household income and to children aged 6 & 7, includes additional capacity supports to enable the expansion and retention of staffing within general practice. It includes additional supports for GP Out of Hours services also.
These measures will make general practice in Ireland a more attractive career choice and will see an increase in the number of GPs working in the State, improving access to GP services for patients throughout the country.
The number of doctors entering GP training has been increased in recent years, with 287 new entrants for this year and 350 places for new entrants now planned for next year. Annual intake to the GP training scheme has been increased by over 80% since 2015. Furthermore, the joint HSE and ICGP programme underway to bring up to 100 non-EU GPs to Ireland in 2023 will help to quickly improve access to GP services, particularly in areas with limited access. It is planned to bring to Ireland up to 250 more non-EU GPs by the end of 2024.
Lastly, my Department and the HSE have commenced a Strategic Review of General Practice. The review, with input from key stakeholders, will examine the broad range of issues affecting general practice, including issues related to GP capacity, and will set out the measures necessary to deliver a more sustainable general practice into the future.
