Written Answers Nos. 1- 30
14. Deputy Cathal Crowe asked the Minister for Health if he will provide an update on efforts his Department and the Health Service Executive are undertaking to improve University Hospital Limerick; and if he will make a statement on the matter. [1990/24]
View answerThe Government is committed to developing and improving services in University Hospital Limerick and overall Health services in this region.
This is evidenced by the substantial and sustained investment in infrastructure and staff in recent years.
There has been major capital investment in this hospital.
• In 2021, a new 60-bed modular ward block opened.
• Two separate rapid-build projects provided 38 additional inpatient beds.
• Work began on a new 96-bed ward block in October 2022 for completion mid 2025. This is an investment estimated in excess of €90 million.
• Enabling works have begun on a second 96-bed block.
There was a 45% increase in budget allocation in 2023 compared to 2019. In November 2023, there were 3,854 whole time equivalent staff employed. This represents a 38% increase in staffing since December 2019. More consultants, doctors, nurses, health professionals and support staff.
Outpatient waiting lists have decreased by 29% in 2023.
The Emergency Department continues to manage high volumes of patients attending. To respond to pressures experienced during winters and beyond, the HSE has introduced significant reforms. A new, three-year plan to improve Urgent and Emergency Care deployed. Additional staff have been rostered across bank holidays and weekends. This supports the timely treatment and discharge of patients.
All of these actions and investment are targeted to improve services in University Hospital Limerick.
15. Deputy Richard Bruton asked the Minister for Health if he will provide an update on the Hospital Winter Plan to cope with the seasonal pressure. [2081/24]
View answerThe Government is extremely conscious of the distress overcrowded Emergency Departments cause and the very challenging working conditions in hospitals throughout the country.
This winter is the first winter we are using an all-year approach to urgent and emergency care, since the switch last year from annual winter plans recognising that the required investment, changes and supports go beyond winter.
I am delighted to report important progress on behalf of all patients, and this is due to the huge efforts of healthcare workers across the country that deserve our appreciation and thanks.
Overall, there was an 8% reduction in the 8am trolley numbers last year compared to 2022, and due to the laser sharp focus on UEC from July to December, those six months returned over 20% less trolleys than 2022. To put that into context, it equates to 15,000 less patients waiting on trolleys in the second half of the year. There has also been a concerted focus placed on reducing the number of elderly patients, aged 75 and over, waiting on a trolley for over 24 hours and the second half of 2023 delivered a 40% reduction in that number (4,600 patients).
The plan for 2024 is a simplified follow-on, bringing continuity and sustainability to the improvements achieved so far. This does not mean that the system is fixed, but we are moving in the right direction. There is a wide variance in the UEC performance across different hospitals, with only seven sites accounting for half of all trolleys last year. We need to continue supporting those sites under pressure and insisting upon consistent implementation of the reforms and changes that we know work.
[<a ref="https://data.oireachtas.ie/ie/oireachtas/debates/questions/supportingDocumentation/2024-01-18_pq15-18-01-24_en.docx">Summary</a>]
16. Deputy Johnny Guirke asked the Minister for Health to provide an update on transformation plans at Our Lady's Hospital Navan; if he will reverse the stated policy that commits to closing the accident and emergency department at Navan Hospital; and if he will make a statement on the matter. [2086/24]
View answerAs the Deputy will be aware, the HSE has proposed a process of planned service changes at Our Lady's Hospital Navan and has advised that these changes are necessary to support safe service delivery on a sustained basis and are driven first and foremost by patient safety considerations.
I want to assure the Deputy that no decision regarding the HSE’s proposal for the transition of the Emergency Department at Navan has been agreed by me or by Government.
While recognising the very real clinical concerns identified, the Government has been clear that several important issues, including additional capacity in other hospitals impacted and the continued ability of people in the Navan area to access emergency and urgent care, would need to be fully addressed before any transition by the HSE.
I recognise that proposed changes to hospital services can cause much concern among the communities who use those services. It is important to note that the purpose of the reconfiguration changes that the HSE has put forward are about enabling Navan Hospital to provide more care, not less.
Patient safety and patient outcomes must of course be the absolute priority when considering service provision at Navan Hospital and I would like to reassure the people of Navan that I am fully committed to ensuring the future of Our Lady’s Hospital Navan.
The budget of the hospital has increased 29% from 2019 to 2023, and staffing levels have increased by 26% in the same time period. The Government is committed to Sláintecare goals, bringing care closer to communities. Under the HSE’s proposal, Navan Hospital would become a greater asset to the community by increasing services including orthopaedics, rehabilitation, diagnostics and elective surgery.
17. Deputy Gino Kenny asked the Minister for Health if he is aware that an organisation (details supplied) has stated that 122,879 patients, including 3,494 children, were admitted to hospital without a bed in 2023, that hospitals are in a near constant state of overcrowding coupled with short staffing; and if he will make a statement on the matter. [1648/24]
View answerThe Government is extremely conscious of the distress overcrowded Emergency Departments cause and the very challenging working conditions in hospitals throughout the country.
This winter is the first winter we are using an all-year approach to urgent and emergency care, since the switch last year from annual winter plans recognising that the required investment, changes and supports go beyond winter.
I am delighted to report important progress on behalf of all patients, and this is due to the huge efforts of healthcare workers across the country that deserve our appreciation and thanks.
Last year in total there was an 8% reduction in the 8am trolley numbers compared to 2022, and due to the laser sharp focus on UEC from July to December, the last six months returned over 20% less trolleys than 2022. To put that reduction into context, it equates to 15,000 less patients waiting on trolleys from July to December last year. There has also been a concerted focus placed on reducing our elderly patients, aged 75 and over, waiting on a trolley for over 24 hours and the second half of 2023 delivered a 40% reduction in that number (4,600 patients).
There have been significant levels of recruitment in recent years. The number of staff employed across the health service has risen by over 20% or 25,000 (net), in just over three years.
The plan for 2024 is a simplified approach, bringing continuity and sustainability to the improvements achieved so far. This does not mean that the system is fixed, but we are moving in the right direction. There is a wide variance in the UEC performance across different hospitals, with only seven sites accounting half of all trolleys. We need to continue supporting those sites under pressure and insisting consistent implementation of the reforms and changes we know work.
[<a ref="https://data.oireachtas.ie/ie/oireachtas/debates/questions/supportingDocumentation/2024-01-18_pq15-18-01-24_en.docx">Summary</a>]
18. Deputy Thomas Gould asked the Minister for Health the current deficit in addiction rehabilitation, detox and step-down beds. [2024/24]
View answerThe number of residential beds available for drug treatment services in 2023 was 1,036.
According to 2022 National Drug Treatment Reporting System data the total number of cases treated for problem drug use was 12,009. This is the highest annual number recorded to- date. 1,458 cases received inpatient (overnight) treatment. Separately, there were 7,421 cases treated for alcohol as the main problem. Of these, 2,440 received inpatient (overnight) treatment. In total, there were almost 4,000 cases of inpatient treatment for drugs or alcohol in 2022.
Almost €150 million is allocated annually to the HSE for the provision of addiction services, including community-based services. In 2023, €1.8 million of additional funding was made available for Tier 4 residential addiction treatment services for the purchase of additional treatment episodes across the country. This will benefit individuals requiring residential treatment.
Treatment services for substance use are structured within a 4 Tier Model. The majority of cases requiring intervention, or treatment, are managed within Tier 2 or Tier 3 services within the community. Treatment within Tier 4 will not be necessary or appropriate for all cases. Service users are offered the least intensive intervention appropriate to their need when they present for treatment initially, and where this does not succeed, more intensive interventions are then offered.
In 2024, a new national monitoring system will be piloted with the support of CHO 4 in order to track HSE referrals to Tier 4 residential services. This will standardise information collected across CHO areas and identify patterns to facilitate informed long-term service planning.
I am committed to enhancing access to, and the delivery, of drug services in the community.
19. Deputy Colm Burke asked the Minister for Health the current status of progress toward a new elective hospital for Cork; and if he will make a statement on the matter. [1927/24]
View answerThe National Elective Ambulatory Care Strategy was agreed by Government in 2021. Significant additional capacity to better enable the separation of scheduled and unscheduled care will be provided through a national network of dedicated, standalone Elective Hospitals. The Preliminary Business Case, approved by Government in December 2022, identified St Stephen’s Hospital as the preferred site for a new Elective Hospital in Cork.
Since that approval, the HSE has been progressing its plans, defining the shape and scale of the new hospitals as well as progressing procurement, ICT and workforce planning.
The HSE is also progressing the procurement of an integrated Design Team to provide the full scope of design services for the Elective Hospitals. The preliminary qualification stage for the Architect-Led Design Team closed on 15 January, and will close for the complementary Project Control team on 22 January – with a very positive market response thus far. Following conclusion of the procurement process, the HSE should appoint the successful teams by the Spring.
The HSE is also addressing waiting lists in the shorter term by expediting the development of ‘Surgical Hubs’ at locations across the country – including in Cork. The Cork Surgical Hub will be based at Cork University Hospital and the planning application for this has already been submitted. Enabling works have commenced in parallel to the planning and procurement processes in order to expedite delivery timelines as far as possible.
20. Deputy David Cullinane asked the Minister for Health the number of posts available to the health service in 2024; the number of posts required for full implementation of the safe staffing framework; and if he will make a statement on the matter. [2058/24]
View answerI am pleased to inform the Deputy that, as part of Budget 2024, I secured funding for an additional 2,268 posts in the HSE. This brings the agreed whole time equivalent (WTE) total for HSE for 2024 to 146,600 posts. The safe staffing framework implementation will be included in the HSE National Service Plan for 2024 using an agency posts conversion approach, resulting in an additional 400 WTE, approximately.
As the Deputy may be aware, the Framework for Safe Nurse Staffing and Skill Mix is an evidence-based approach to determine safe staffing and skill mix for nursing. It encompasses safety by determining staffing and skill mix requirements by patient need and demonstrates impact through the measurement of a range of outcomes. It is currently being implemented in acute medical and surgical care areas (Phase 1) and emergency departments (Phase 2). It is fully supported by Government and is being implemented by the HSE. To date, €56m has been invested to do this.
The Framework methodology uses new posts along with conversion of agency to permanent posts to achieve the required workforce stability. Nursing posts are a combination of registered nurses and health care assistants, and this combination refers to the skill-mix.
Implementation of the Framework to date this has delivered over 1,200 additional WTE registered nurses and health care assistants. The HSE has reported some delays with implementation, including those arising due to the recruitment freeze in the latter part of 2023. I have asked the HSE to ensure that those posts not filled in 2023 will be included as part of the HSE’s 2024 implementation plan for safe staffing. The Framework provides for ongoing evaluation on an annual basis to ensure staffing remains in line with patient need.
21. Deputy David Cullinane asked the Minister for Health his plans to respond to ESRI reports which have identified significant deficits and imbalances in critical healthcare infrastructure; and if he will make a statement on the matter. [2059/24]
View answerI thank Deputy Cullinane for his question on the ESRI Report ‘The National Development Plan in 2023: Priorities and Capacity’.
I welcome its publication.
My Department has only just received the report. My officials and I will be giving careful consideration to its findings in preparation for engaging with the Department of Public Expenditure, NDP Delivery and Reform in the updating of NDP ceilings out to 2026.
I am pleased to note that many of the Report’s findings are based on my Department’s in-house published analysis and spending reviews, which are heavily cited throughout the document. This includes:
• The recent increase and ageing of our population means that the projected demand for healthcare in the coming years will increase significantly.
• This recent increase in demand for healthcare will need to be matched by increases in capacity across the sector.
• The importance of addressing regional investment in a balanced manner, taking into consideration strategic priorities.
I welcome that the Report underscores and reiterates the position of my Department, validates the analysis undertaken and that has shaped wok to develop a Strategic Health Investment Framework under development by my officials.
The Report also notes that Irish healthcare expenditure lagged behind other European countries for a number of years, which is a point I have acted and continue to seek to address as Minster for Health with Government colleagues for the capital planning and delivery.
I, and my officials, have worked closely with the HSE to develop a well-thought-out capital plan for the coming years with significant ambitions in terms of health infrastructural investment.
I will also be engaging with my Cabinet colleagues around setting future policy priorities including health and funding needs.
22. Deputy Thomas Gould asked the Minister for Health for a timeline for the delivery of primary care centres in Blarney, Mayfield and Glanmire. [2025/24]
View answerI wish to thank Deputy for raising the issue of Primary Care Centre developments across Cork.
Regarding Blarney Primary Care Centre, the HSE advised that it had been engaging with a developer for this proposed PCC and that Cork County Council had granted planning permission for same. However, that planning decision was appealed to An Bord Pleanála, who upheld the planning decision. This decision was then appealed to the High Court. An Bord Pleanála has decided not to issue a defence at the High Court with the result that the planning permission will be void.
At present, the HSE is conducting a review of the options available for this proposed PCC. On completion of this review, the HSE will issue further communication to the proposed PCC developer regarding the advancement of this development.
In relation to, Cork City Primary Care Centre, covering the Mayfield, Montenotte and Dillon’s Cross areas, a preferred bidder was selected, and the property transaction was approved at the September 2023 meeting of the HSE Board. A Letter of Intent issued in late 2023 and discussions regarding the Agreement for Lease are now progressing.
Similarly, a preferred bidder was selected for Glanmire Primary Care Centre and the property transaction was approved at the March 2023 meeting of the HSE Board. The Letter of Intent has been issued, with discussions regarding layouts and the Agreement for Lease now progressing.
There are now 21 Primary Care Centres operational throughout Cork. In fact, just this week the Tánaiste visited Ballincollig PCC to officially open that centre. I’m sure the Deputy will agree that it is welcome news that further progress is being made on the developments of additional Primary Care Centres across Cork.
23. Deputy Alan Dillon asked the Minister for Health when construction will recommence on Ballyhaunis Primary Care Centre; and if he will make a statement on the matter. [2013/24]
View answerI wish to thank the Deputy for allowing me to update the house on this matter, as I know that the Deputy has raised this matter a number of times with my Department in the past.
Ballyhaunis Primary Care Centre (PCC) is to be developed through the Operational Lease mechanism, whereby the HSE enters into agreement with a developer to build a PCC and the HSE then leases the building for a fixed period.
Unfortunately, in the case of the PCC development in Ballyhaunis, the project has been impacted by delays due to several factors. The developer has confirmed to the HSE that the original rates in the lease agreement are now not economically viable due to increased construction costs from materials and trades. The HSE has assured the Department that there has been regular contact with the developer to understand all of the issues surrounding the paused construction and to request updates on programme for recommencement and completion dates.
The HSE has advised the Department that this issue is being assessed on a national basis and all options are being explored including rate uplifts, withdrawing the current agreement, and re-advertising of the development. Re-advertising may permit the developer to resubmit a tender at higher rates. Once that assessment is concluded and agreed, it is hoped that a programme for recommencement to completion will be confirmed.
I recognise that construction has been stalled for a considerable amount of time, and the frustration that this has caused the people of Ballyhaunis. However, I wish to reiterate that both my Department and the HSE remain committed to the completion of Ballyhaunis PCC. The Department will continue to engage with the HSE and support the efforts being made to bring this Primary Care Centre to completion.
24. Deputy Gino Kenny asked the Minister for Health if he will consider expanding the Medicinal Cannabis Access Programme to include other conditions outside of the current terms of reference of the programme; and if he will make a statement on the matter. [1651/24]
View answerIn it’s 2017 publication “Cannabis for Medical Use – A Scientific Review” the Health Products Regulatory Authority found that at that time
• There was an absence of scientific data demonstrating the effectiveness (efficacy) of cannabis products. The safety of cannabis as a medical treatment is not well characterised.
• There was insufficient information on its safety during long term use for the treatment of chronic medical conditions, such as those for which there is a public interest.
• Most cannabis products available under international access schemes did not meet pharmaceutical quality requirements and were not capable of being authorised as medicinal products (medicines).
• There was a significant gap between the public perception of effectiveness and safety, and the regulatory requirement for scientific data which is mandatory to determine the role of cannabis as a medicine.
• Any proposal to circumvent the medicines regulatory system, established by law, would require careful consideration, so as to avoid unintended consequences, and lower standards of patient protection.
• The HPRA advised that if the policy decision was to make cannabis available for medical purposes, that it should recognise patient need, but be evidence based.
• It was advised that treatment with cannabis be only permitted under a controlled access programme for the treatment of patients with;
• Spasticity associated with multiple sclerosis resistant to all standard therapies and interventions whilst under expert medical supervision;
• Intractable nausea and vomiting associated with chemotherapy, despite the use of standard anti-emetic regimes whilst under expert medical supervision;
• Severe, refractory (treatment-resistant) epilepsy that has failed to respond to standard anticonvulsant medications whilst under expert medical supervision.
It was also recommended that the MCAP be a 5 year pilot project subject to review.
After the necessary legislation was put in place and products sources for the programme the MCAP commenced in 2021. Given the time elapsed since the initial publication the decision was taken to commence an evidence review before the 5 years pilot period had been completed.
The current review consists of an evidence gathering, evidence synthesis and finally a clinical review to determine if evidence exists to expand the scope of the programme. In the circumstances it is appropriate to wait for the findings of the clinical review group before any decisions are taken whether or not to expand the conditions covered by the programme.
25. Deputy Gino Kenny asked the Minister for Health if he is aware that in December 2023 an organisation (details supplied) stated that the latest National Treatment Purchase Fund figures confirm that the three main health care waiting lists are at a virtual standstill; and if he will make a statement on the matter. [1647/24]
View answerI recognise that waiting lists have been historically high, a situation that worsened considerably with the Covid-19 pandemic. That's why I sought and secured significant funding for a multi-annual approach to reducing waiting lists and more importantly waiting times.
The core target of achieving a 10% reduction in the number of patients breaching the Sláintecare waiting times was exceeded, with an 11% reduction achieved, and the target of removing approximately 1.66 million patients from waiting lists in 2023 was exceeded by 5%. This covers inpatients, day case, outpatients and GI scopes.
Since the pandemic peaks there has been a 27% reduction in the number of people waiting longer than the Sláintecare targets, which equates to nearly 170,000 people.
However, when compared to both 2022 and the pre-pandemic period of 2019, the level of additions to our waiting lists also increased significantly last year. Despite this, 2023 was the second year in row that our total waiting lists fell, with over 177,000 more patients removed from the lists than 2022. They also fell in 2022, which was the first annual decrease in national hospital waiting lists since 2015.
In 2024 I've secured a further €407 million in funding to be allocated across acute hospital and community services. This includes €332 million for the 2024 WLAP, which is currently being developed by my Department and the HSE.
26. Deputy Duncan Smith asked the Minister for Health for a breakdown of the €20 million committed for new medicine funding in 2024; and if he will make a statement on the matter. [1974/24]
View answerIn 2023, a new record of almost €3 billion was spent on medicines by the State. This represents nearly €1 in every €8 of public funding being spent on health. This unprecedented level of investment in our health services supports access for patients to the latest range of medicines.
Over the last 3 years the State has invested €98 million in new medicines to provide 148 new medicines or extended uses for medicines.
In 2024, I have tasked the HSE, my department, and all relevant agencies and stakeholders to place a priority focus on achieving the most efficient and effective use of available resources. This will require opportunities for savings to be identified and implemented.
€20 million of dedicated funding has been allocated for new medicines in 2024. I have also asked the HSE to ensure it realises at least €10 million in new additional efficiency gains. This money will be re-invested in new drugs and will ensure that the substantial investment in medicines is maximised to treat even more patients with new therapeutic innovations in the years to come.
This funding is in addition to substantial investment in resources to enhance the HSE’s medicines pricing and reimbursement process. These enhancements were a recommendation of the working group, which I established following the publication of the Mazars Report in February 2023.
27. Deputy James O'Connor asked the Minister for Health to provide an update in relation to the HSE Capital Plan to provide a primary care centre in a location (details supplied); and if he will make a statement on the matter. [2072/24]
View answerI am very happy to report to the Deputy that there has been recent progress regarding the development of the Primary Care Centre (PCC) in Youghal.
Originally, consideration was given to development of a PCC through the re-configuration of existing facilities on the site of St Raphael’s Hospital at Old Golf Links Road, Youghal. However, following the completion of a feasibility study, it has been decided to pursue the development of a Primary Care Centre via the developer-led the Operational Lease Model.
In a previous update the Deputy received in June, the development of Youghal Primary Care Centre had progressed to Stage 2 of the Operational Lease process. Following this update, I am happy to confirm that Youghal Primary Care Centre has progressed further with the Stage 3 submissions currently under consideration. The proposed PCC will then progress through lease agreement and planning stages and then, subject to successful negotiations and planning permission, to the construction and equipping phase. It is important to note that it is not possible to estimate a completion date until construction commences.
It is envisaged that a wide range of Primary Care Services, alongside GP services will be delivered from the centre. This will allow existing services to relocate from outdated and dispersed facilities in Youghal into the one location - increasing ease of access for patients and helping to deliver our vision of truly integrated care in the community.
There are now 21 Primary Care Centres operational throughout Cork and it is welcome news that progress is being made on the development of a Primary Care Centre for the people of Youghal.
28. Deputy Marian Harkin asked the Minister for Health for an update on progress on the new 42-bed medical block at Sligo University Hospital, which was due to start construction before the end of 2023; and if he will make a statement on the matter. [1599/24]
View answerI would like to thank Deputy Harkin for her question and allowing me the opportunity provide an update on the progress being made in Sligo University Hospital.
The delivery of health capital projects is a dynamic process, subject to the successful completion of the various project approval stages, for example in line with the newly published Infrastructure Guidelines and also market response noting recent and current labour market and wider macro economy dynamics.
The proposals for additional beds for Sligo University Hospital are noted against recent progress where 1,126 acute beds have been opened since 2020. This represents more acute hospital beds delivered than in any comparable period since the HSE was established.
A service need for additional bed capacity was identified in Sligo University Hospital and an additional 42 bed project is underway. The project will deliver 2 x 21 bed wards, single en-suite rooms with ancillary accommodation. Planning permission and fire certifications have been received for the project.
Essential enabling works to facilitate the provision of a new Ward Block including a car park are under construction and nearing completion.
The 42 bed project is out for tender. Tenders for the project are expected back by end Q1 2024.
A review of the tender options will take place following their submission, and the preferred tender offered the contract in line with established procedures.
Following awarding of the contract, it is anticipated construction will commence in Q3 2024 with an estimated construction timeline of 30 months.
29. Deputy Alan Farrell asked the Minister for Health his views on the positive figures that showed a 20% drop in trolly numbers in the last six months of 2023; and if he will make a statement on the matter. [1441/24]
View answerThe reduction in trolley numbers witnessed in the last six months of 2023 compared to 2022 is testament to the efforts of healthcare workers. This winter is the first winter we are using an all-year approach to urgent and emergency care, instead of using a winter plan each year. The Urgent and Emergency Care Operational Plan is based on four pillars: ED Avoidance, ED Operations, In-hospital Operations and Discharge Operations. The focus is particularly on patient flow and discharge options, as well as supporting those hospitals under the most pressure.
Delivering additional and extended hours for senior decision makers and staff integral to patient flow significantly improves the weekend discharge rates, which is good measure for the delivery of a seven-day service on behalf of patients.
To put the 20% reduction of trolley numbers into context, it equates to 15,000 less people waiting on trolleys from July to December last year. There has also been a concerted focus placed on reducing the number of men and women, aged 75 and over, waiting on a trolley for over 24 hours. This has delivered nearly a 40% reduction in that number.
This does not mean that the system is fixed, but we are moving in the right direction. Maintaining this momentum in reducing trolley numbers is a priority for my department and the Government.
30. Deputy Ruairí Ó Murchú asked the Minister for Health if he will provide an update on the progress being made on the new protocols for hospital discharges to stepdown facilities; and if he will make a statement on the matter. [2017/24]
View answerAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
