Written Answers Nos. 1-33
8. Deputy Cathal Crowe asked the Minister for Health if he will provide an overview of plans his Department has for Inis Ghile Centre in Parteen, County Clare; and if he will make a statement on the matter. [48823/23]
View answerInisgile has been identified as the base for two new Dual Diagnosis Team(s) in the Mid-West Region. In addition, it will also provide outreach accommodation for the CAMHS teams operating in the East Clare area.
The term “dual diagnosis” is used to describe a person who presents with a concurrent mental health disorder and a substance use disorder (SUD). The Model of Care for Dual Diagnosis was launched on 23 May 2023 by myself and my colleague Minister Hildegarde Naughton T.D.
The Dual Diagnosis Clinical Programme aims to develop high-quality, person-centred and integrated care pathway through a clinically-led approach to people who present with a mental health diagnosis and co-morbid addiction. The three main objectives of the programme are:
• Improved quality of care delivery to all those with a dual diagnosis
• Improved access to assessment and treatment
• Improved value for money and cost effectiveness.
Funding has also been secured for the establishment of a youth service in the mid west and space has been identified in Inisgile which will run alongside the Adult Dual Diagnosis.
This is a particularly welcome initiative as a number of young people attending CAMHS would often have addiction challenges and as they reach eighteen, will require onward referral to Adult Dual Diagnosis.
The HSE will provide outreach clinics for East Clare CAMHS in Inisgile Parteen, which will improve access to services for users from East Clare and will help to alleviate the pressure on space in Quinn Road.
13. Deputy David Cullinane asked the Minister for Health the level of additional core expenditure for new developments, excluding funding for carryover and otherwise maintaining existing levels of service, which has been allocated to the national sepsis programme for 2024; and if he will make a statement on the matter. [48901/23]
View answerPromoting awareness and early recognition of sepsis are key elements of the HSE’s National Sepsis Programme.
While the initial priority of the Programme was raising awareness among healthcare staff, the focus has since moved the community. To support this, the Programme developed several patient focused resources, along with educational and clinical management resources for healthcare staff. The Programme undertook a number of activities in 2023 including the organisation of the 7th National Sepsis Summit in September.
My Department continues to work with the HSE to increase sepsis awareness. This includes a ‘Patient and Staff Stories’ project to capture the experiences of those affected by sepsis, which I am pleased to say will commence in 2024. It is hoped that the findings will drive improvements in sepsis practices across health and social care settings.
Following the announcement of the budget allocation for my Department, I will shortly be issuing a Letter of Determination to the HSE outlining my priorities and funding levels for 2024. This will be the basis on which the HSE will draw up its National Service Plan for 2024. It is not until the conclusion of this process that a detailed breakdown of New Developments expenditure will be available.
However, there is an ongoing significant increase in funding for nursing and consultants in a wide range of disciplines, and it is possible for individual clinical areas and hospitals to reallocate according to priorities.
17. Deputy David Cullinane asked the Minister for Health the level of additional core expenditure for new developments, excluding funding for carryover and otherwise maintaining existing levels of service, which has been allocated to primary and community care reform programmes for 2024; and if he will make a statement on the matter. [48902/23]
View answerFollowing the announcement of the budget allocation for my Department, I will shortly be issuing a Letter of Determination to the HSE outlining my priorities and funding levels for 2024. This will be the basis on which the HSE will draw up its National Service Plan (NSP) for 2024. It is not until the conclusion of this process that a detailed breakdown of New Developments expenditure will be available.
18. Deputy Frankie Feighan asked the Minister for Health to outline the progress made to date in expanding community-based care by increasing opening times for unscheduled care, radiology, and diagnostic services. [48867/23]
View answerSince the July 2023 review of HSE Injury Units (July 2023), 12 units under acute governance operate on a 7 day per week basis, including Monaghan Hospital which expanded to a 7-day basis since July 2023. A new injury unit was opened in Mullingar in December 2022 and by this August there were approximately 600 presentations per month. Between January and August this year, over 110,000 patients have attended injury units, 15% above the numbers treated during the same period last year.There has been a doubling in the use of National Ambulance Service alternative pathways, with those pathways now accounting for over 5% of total emergency call compared to approximately 2% in September 2021. GP access to diagnostics has exceeded 285,000 tests by the end of October, 14% more than the number of tests conducted during all of 2022. Over the last ten weeks, 27% or over 14,000 more radiology diagnostic tests have been accessed by GPs compared to the same 10 weeks last year.GPs now have direct access to NTproBNP testing for their patients, which can indicate that the walls of the heart are stretched and that the heart is struggling to meet the body’s demands. From January to September this year, there were approximately 138,000 test reports, nearly 300% more than the same period in 2022.
Enhanced Community Care Programme (ECC)
· In line with Sláintecare, the Enhanced Community Care Programme (ECC) objective is delivering increased levels of health care in general practice, primary care, and community - based services.
· Significant progress is being made with 95 of the 96 Community Healthcare Networks (CHNs), 24 of the 30 Community Specialist Teams (CSTs) for Older People ICPOP and 24 of the 30 CSTs for Chronic Disease are now operational.
· Part of the ECC, a service which allows for direct referral pathways to diagnostic tests for GPs, has proven hugely successful with over 280,000 scans have already been provided this year.
· However, referral of GPs of patients who require immediate access to scans is not provided for through this initiative as it is intended for patients that can wait up to one month for an urgent scan and up to three months for a nonurgent or routine scan.
Supplementary Briefing Material
Enhanced Community Care Programme (ECC)
In line with Sláintecare, the Enhanced Community Care Programme (ECC) objective is delivering increased levels of health care with service delivery reoriented towards general practice, primary care, and community - based services, enabling a “home first” approach to the delivery of healthcare.
The focus is on implementing an end-to-end care pathway for people at home and over time, it is expected that it will prevent referrals and admissions to acute hospitals where it is safe and appropriate to do so and enable a “home first” approach.
Progress to date
Over 2,900 staff have been onboarded or are at an advanced stage of recruitment (78% of full recruitment target achieved).
· 95 of the 96 CHNs are now operational
· Community Specialist Teams (CSTs) for Older Persons – 24 of 30 are now established
· Community Specialist Teams for Chronic Disease Management – 24 of 30 are now established
· Community Intervention Teams –21 are operational, with national coverage secured.
GP Access to Diagnostics
· The nationwide GP Access to Diagnostics programme began accepting referrals in January 2021 and enables GPs to directly access diagnostic tests (X-Ray, CT, MRI, and DEXA scans) enables a greater level of care to be delivered in the community, supporting patient-centred care, early diagnosis, and early intervention. Limited access to diagnostics can result in patients being referred into hospital Emergency and Outpatient Departments for services.
· In the year to date 285,676 scans of various modalities have been completed as follows:
o 180,748 MRI scans (63%), 55,472 X-ray (20%), 22,255 CT scans (8%) and 27,201 DEXA scans (9%)
19. Deputy Pauline Tully asked the Minister for Health if he will consider providing a funded bandage scheme for those battling with epidermolysis bullosa; and if he will make a statement on the matter. [49084/23]
View answerEpidermolysis bullosa (EB) is a rare, life-long genetic condition which causes fragile, blistering skin.
I fully recognise and appreciate the difficulties experienced by patients suffering from this painful condition.
There are approximately 300 patients in Ireland with EB, with around 60 new patients annually.
Children with EB are cared for at the multidisciplinary clinic in Children’s Health Ireland, Crumlin.
Adult patients are treated at a multi-disciplinary clinic in St. James’s Hospital.
Care requires the involvement of many different clinical specialists to extend life span and improve quality of life.
There has been considerable work undertaken to enhance the availability of treatment for those suffering with EB.
For example, in recent weeks the HSE published a rare disease care pathway for the diagnosis and multidisciplinary care of Inherited EB.
I am aware that the Debra Report published in October found that people “with less severe forms of EB often do not have access to bandages”.
The HSE advises that it provides support to people in accessing them, including those with EB.
For medical card holders, bandages may be accessed:
1. through the Public Health Nurse at a local level (under a national tender arrangement), or
2. through their GP for ambulant patients who attend the surgery for wound management and dressing application,
Alternatively, where dressings are not obtainable by patients in the community via either of these avenues, an application can be made through Discretionary Hardship Arrangements.
This also provides for access to dressings not on the Reimbursement List. In some cases, this will require a hospital prescription, or a recommendation from a HSE Tissue Viability Nurse.
All dressings on the Reimbursement list are also available under the Drugs Payment Scheme.
20. Deputy Aindrias Moynihan asked the Minister for Health what measures are being taken to supply home supports to all people approved and waitlisted in the Cork-Kerry community healthcare area; to lift the recruitment freeze on securing additional home support workers; and if he will make a statement on the matter. [49046/23]
View answerImproving access to home support is a priority for the Government. Since Budget 2021 I have secured an additional €228 million in funding. In 2023 the overall home care budget is €723 million.
Across Cork and Kerry there are almost 7,500 people in receipt of a Home Support Service and at the end of August over 1.8 million home support hours had been provided year to date. At the end of October 2023, there were 1,648 clients assessed and awaiting a new or additional Home Support Service.
The current recruitment pause in place at the HSE was extended beyond clerical, administrative and management grades from 13 October and is expected to continue until the end of 2023. However, the HSE is still processing applications for a limited number of additional direct home support employments where the employment and deployment of the worker is directly connected to delayed transfers of care of clients from an acute setting.
Work continues to deliver on the recommendations of the Strategic Workforce Advisory Group which I established last year. A new and improved HSE Home Support Tender delivers on commitments for sectoral reform such as payment for travel time, paying carers the National Living Wage at a minimum, and bringing legacy rates in line with the new revised rates of funding.
21. Deputy David Cullinane asked the Minister for Health the level of additional core expenditure for new developments, excluding funding for carryover and otherwise maintaining existing levels of service, which has been allocated to the National Cancer Strategy for 2024; and if he will make a statement on the matter. [48898/23]
View answerCancer services are a top priority for this Government, and this is shown by the unprecedented funding allocated to the National Cancer Strategy in recent years. Over 2021 and 2022 I secured €40 million in funding for the Strategy, supporting the recruitment of approximately 360 staff to date in cancer services, and €30 million in funding for new cancer drugs.
What this means is that more patients are being seen and waiting times are down. For Rapid Access Clinics for breast, lung and prostate cancer, waiting times for patients are down by 14 to 57 weeks across the clinics, and over 40,000 patients have been seen so far this year, 2,000 more than the same period in 2019. There have been over 10,000 cancer surgeries performed so far this year, 700 more than the same period for 2019. Over 75,000 chemotherapy and other systemic anti-cancer therapies have been administered, 6,500 more than the 2019 figure.
In Budget 2024, I have allocated €3m in funding to the National Cancer Control Programme's Alliance of Community Cancer Support Centres. This funding will help these voluntary and charity organisation centres to deliver services directly to cancer patients and their families. The work of the centres emphasises the importance of quality of life during and after cancer treatment.
22. Deputy Matt Carthy asked the Minister for Health if funding will be provided to deliver a MRI scanner to Monaghan Hospital. [48992/23]
View answerMonaghan Hospital and Cavan General Hospital operate as a single entity, with an integrated managerial and clinical governance system, care pathways and support functions. Monaghan Hospital is focused on elective care and the streaming of appropriate patients to the Minor Injuries Unit.
The HSE advises that Cavan & Monaghan Hospital has two operating CT scanners and one MRI scanner. There are currently no proposals within my Department to increase the number of CT and/or MRI scanners in Cavan & Monaghan Hospital.
As Minister for Health, I am committed to the ongoing development of regional hospitals, including Monaghan Hospital, which has a role as part of Cavan & Monaghan Hospital in delivering a higher volume of less complex care closer to a patient’s home. It also ensures that patients who require emergency or complex planned care are managed safely in a larger hospital environment.
The budget for Monaghan Hospital has increased from €7.7m in 2019 to €9.9m in 2022, an increase of 28% in 3 years. Since July 2023, the Minor Injury Unit at Monaghan Hospital has been open 7 days a week, enabling patients to be seen and treated in their local area. The Government will continue to ensure that Cavan & Monaghan Hospital is supported to provide services to a high standard for patients in the region.
23. Deputy Frankie Feighan asked the Minister for Health if he will provide details on his Department's latest work in tackling overcrowding in hospitals. [48866/23]
View answer26. Deputy Alan Farrell asked the Minister for Health to outline his Department’s efforts to reduce the number of patients on hospital trollies this Winter; and if he will make a statement on the matter. [49045/23]
View answerI propose to take Questions Nos. 23 and 26 together.
Urgent and Emergency Care pressures are no longer just experienced during winter periods and prolonged levels of high daily presentations and congestion are now being experienced 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 UEC planning in 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 currently being prepared for government.
The plans will identify and prioritise operational challenges and initiatives to be adopted across the system based on level of expected impact and value.
Key Performance Indicators
The UEC Operational Plan 2023 will focus on improving four key performance indicators and has set the following targets:
• No patient aged 75 years or over to wait more than 24 hours in an ED;
• The number of patients with Delayed Transfers of Care to be at, or below, 440 by the end of 2023;
• The average trolley count at 8am not to exceed 320 each month; and
• The average inpatient length of stay for those over 14 days not to exceed 28 days.
24. Deputy Paul McAuliffe asked the Minister for Health for an update on the delivery of the primary health care centre in Finglas. [49072/23]
View answerA central objective of the Programme for Government is to deliver increased levels of integrated health care, with service delivery reoriented towards general practice, primary care and community-based services to enable a “home first” approach.
Primary Care Centres play an essential role in the delivery of that objective and significant progress has been made in the delivery of these centres nationally.
Finglas has long been identified as a high priority location for the development of a Primary Care Centre due to the population level, care requirements for the community.
The Finglas Primary Care Centre is to be located on land between Cappagh Road, Cardiffsbridge Road, Wellmount Avenue and Fergal’s Lane.
Fruitful engagement between Dublin City Council, Dublin Archdiocese, the HSE and City of Dublin Education & Training Board has led to agreements on the preferred option for all parties in relation to access and land ownership.
The legal process to transfer the land is progressing and the HSE are engaging with all parties to complete the necessary property transactions.
The transfer of lands from Dublin Archdiocese to Dublin City Council completed in June. Dublin City Council are now in a position to issue the contract for sale to HSE for sale of Fergal’s Field.
Based on the latest available information, planning application is expected to be submitted in Q4 2023.
25. Deputy Pádraig O'Sullivan asked the Minister for Health his plans to expand the virtual home hospital services within the HSE for early supported discharge in order to reduce strain on the hospital service during the winter surge; if he will provide an update on existing pilot programmes; and if he will make a statement on the matter. [48608/23]
View answerThe Virtual Ward is a flexible and integrated model of care provision, clinically led through a blend of medical and advanced nurse practice governance. The care is enabled by remote monitoring technology, clear patient care pathways and robust escalation protocols.
Following successful proof of concept tests in Beaumont Hospital and CHO Dublin North City and County, and more recently in Letterkenny, the virtual ward is expanding in a number of sites. The test sites demonstrated the capability of a virtual ward in supporting the delivery of Sláintecare and effective utilisation of the Advanced Practice and Enhanced Nurse roles.
The current status on virtual ward service include:
• Letterkenny Community Virtual Ward is currently in operation with 26 virtual beds targeted specifically on reducing/eliminating admissions for a cohort of patients with significant history of high admission rates.
• Furthermore, an operational model has been identified for expansion of the virtual ward model in the Acute Hospital Group. The virtual wards support hospital avoidance and early discharge delivering care in the patient’ home or residential care setting.
The National Steering Group overseeing implementation has been established. The procurement process in underway for the technology platform to support the virtual ward and ensure clinical data safety and governance. Two 25 bedded virtual wards will commence by end of year 2023 and a further Hospital Group will commence in early 2024. The decisions on the other 2 Hospital Groups will be made very shortly.
I am confident that these virtual wards will deliver more hospital care at home and thereby make a significant contribution towards reducing strain on the hospital services during the winter period and beyond.
27. Deputy Pauline Tully asked the Minister for Health if he will review the health services that are covered by the medical card, with a view to including such costs as signed letters from a GP or nurse and blood tests; and if he will make a statement on the matter. [49085/23]
View answerUnder the GMS scheme, GP services are provided without charge to GMS patients, people who hold a medical card or GP visit card. The terms of the GMS contract set out that GPs are required to provide eligible patients with ''all proper and necessary treatment" that is usually undertaken by a GP and which does not require specialist skill or experience that the GP cannot reasonably be expected to possess.
The contract stipulates that fees for medical and GP visit card holders are not paid to GPs under the contract in respect of certain medical certificates which may be required, for example, "under the Social Welfare Acts or for the purposes of insurance or assurance policies or for the issue of driving licences". Services provided outside the terms of the contract are a matter of private contract between the GP and their patients.
The issue of GPs charging GMS patients for phlebotomy services (blood tests) is complex given the numerous reasons and circumstances under which blood tests are taken. Determinations as to whether a blood test should be taken to assist in the diagnosis or treatment of an illness are made by the GP concerned. There is no provision under the GMS contract for GMS patients to be charged for such blood tests. Blood tests undertaken in the context of services provided under the GP Chronic Disease Management Programme are covered by the fees paid to GPs for this care.
This issue has been raised previously with the relevant GP representative body, however, it was not possible to achieve agreement that no charges for blood tests would be applied in any circumstances. Where a GMS patient believes they have been incorrectly charged for phlebotomy services by their GP, then that patient should report the matter to their HSE Local Health Office. Local management upon being notified will contact the GP concerned and carry out an investigation into the complaint and, where appropriate, will arrange for a refund of the charges incorrectly applied by the GP.
28. Deputy Jennifer Murnane O'Connor asked the Minister for Health if he will provide an update on the provision of a primary care centre in Tullow, County Carlow; and if he will make a statement on the matter. [48988/23]
View answerI wish to thank the Deputy for allowing me the opportunity to discuss the progress being made on expanding our primary care infrastructure nationally and, indeed in County Carlow.
A central objective of the Programme for Government is to deliver increased levels of integrated health care with service delivery reoriented towards general practice, primary care and community-based services to enable a “home first” approach. Integral to this, is the development of Primary Care Centres in our local communities, 172 of which have opened to date, with a further nine in construction.
Regarding the provision of a Primary Care Centre in Tullow, County Carlow, this development is currently at the early planning stage and will be delivered via the developer-led Operational Lease model. I am happy to inform the Deputy that the HSE has confirmed that a Letter of Intent was issued to the successful developer and this matter has now proceeded to the next stage, which is the Agreement for Lease (AFL).
As the Deputy will understand, at this very early stage of the process, it is not possible to provide specific timelines for the completion of this project. However, once the Agreement for Lease process has been completed, an outline of the construction programme and target dates will be confirmed. It is currently anticipated that the planning application will be submitted by year end 2023.
The Primary Care Centre in Tullow will join the Carlow Town Primary Care Centre serving the population of North Carlow. The Deputy might also wish to note that a further Primary Care Centre, also at the early planning stage, will be located in Graiguenamanagh and will serve parts of the South Carlow catchment area.
29. Deputy Patricia Ryan asked the Minister for Health the level of additional core expenditure for new developments, excluding funding for carryover and otherwise maintaining existing levels of service, which has been allocated to CHO7 for 2024; and if he will make a statement on the matter. [48994/23]
View answerFollowing the announcement of the budget allocation for my Department, I will shortly be issuing a Letter of Determination to the HSE outlining my priorities and funding levels for 2024. This will be the basis on which the HSE will draw up its National Service Plan (NSP) for 2024. It is not until the conclusion of this process that a detailed breakdown of New Developments expenditure will be available.
30. Deputy Brian Stanley asked the Minister for Health what preparations have been carried out to provide for the health care needs of the 950 people to be accommodated in Stradbally under the temporary international protection scheme and the existing local population. [47528/23]
View answerThe Department of Health is providing access to healthcare services for Ukrainian refugees under the temporary protection directive. To-date, over 98,000 individual health identifiers has been allocated, along with over 60,000 medical cards, to beneficiaries of temporary protection.
The HSE has developed and implemented a primary care service delivery model (Migrant Health Model) to address unmet health needs among Ukrainian refugees which takes into account capacity issues in the health system. The model provides for a range of services including health needs assessments, migrant health teams, GP sessional clinics, psycho-social supports and catch-up immunisation.
The Government has allocated an additional €50m in non-core funding to meet the health needs of Ukrainian refugees in 2024. This funding continues the investment in healthcare services provided in 2023.
The PQ has been referred to the HSE to provide additional information on healthcare services for refugees in the location mentioned.
31. Deputy Pádraig O'Sullivan asked the Minister for Health if he will provide an update on his plans to end hospital overcrowding, especially in Cork hospitals which experienced record overcrowding this year; and if he will make a statement on the matter. [48607/23]
View answerUrgent and Emergency Care pressures are no longer just experienced during winter periods and prolonged levels of high daily presentations and congestion are now being experienced throughout the year. In this regard Cork University Hospital has experienced a 9.4% increase in ED attendances to the end of the September, compared to the same period in 2019.
While significant investment has been driven through Winter Planning and National Service Plans over the past three years, a new approach to UEC planning in 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 currently being prepared for government.
The plans will identify and prioritise operational challenges and initiatives to be adopted across the system based on level of expected impact and value.
Key Performance Indicators
The UEC Operational Plan 2023 focuses on improving four key performance indicators and has set the following targets:
• No patient aged 75 years or over to wait more than 24 hours in an ED;
• The number of patients with Delayed Transfers of Care to be at, or below, 440 by the end of 2023;
• The average trolley count at 8am not to exceed 320 each month; and
• The average inpatient length of stay for those over 14 days not to exceed 28 days.
32. Deputy Rose Conway-Walsh asked the Minister for Health if he will provide an update on the inquiry into the historical licensing and prescribing of sodium valproate; and if he will make a statement on the matter. [48477/23]
View answerWhen I met with the patient groups involved with this issue, I supported their call for an inquiry into sodium valproate and I committed to making that happen. I was delighted to secure Government approval for the establishment of an inquiry which will examine the licensing and use of sodium valproate in women of child-bearing potential in the State.
I am very pleased to be able to progress this. This inquiry will be designed to give a voice to patients and their families while looking at the use of sodium valproate in Ireland since it was first licensed.
There is more work to be done to establish the inquiry It is important that enough time and resources are invested in completing this work. There are many factors to consider, and I want to ensure that the inquiry established delivers and allows those impacted to tell their story and my officials are working to ensure that this will be facilitated. The Chair is an essential role that needs careful consideration. Work is actively ongoing in my Department in this regard and I will provide an update on this matter once this work is finalised.
33. Deputy Brendan Smith asked the Minister for Health when he expects the Commission on Care for Older People to convene; the impact that the additional funding secured in Budget 2024 will have on expediting this process; and if he will make a statement on the matter. [48616/23]
View answerAcknowledging the disproportionately negative impact of the pandemic on older persons, the Programme for Government (2020) commits to the establishment of a ‘commission to examine care and supports for older people’. On 3 October 2023 the Government approved the proposal for a Commission on Care for Older Persons, which was put forward by myself and the Minister for Health. In Budget 2024 €1.243 million was secured to support the work of the Commission.
The Commission will examine the provision of health and social care services and supports for older persons and make recommendations to the Government for their strategic development. In addition, a cross-departmental group will be established under the auspices of the Commission to consider whether the supports for positive ageing across the life course are fit-for-purpose and to develop a costed implementation plan for options to optimise these supports. The Commission will be comprised of independent experts and will be supported by a secretariat from the Department of Health.
The funding secured in Budget 2024 will provide for the recruitment of staff to the Commission’s secretariat; the procurement of research and other support services for the Commission as required; and the remuneration of the chairperson and members of the Commission as appropriate.
The work of the Commission will formally commence in early 2024.
