Caoimhghín Ó Caoláin
Ceist:6. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the position regarding the review of ambulance services; and if he will make a statement on the matter. [27041/14]
Other Questions
Ambulance Service Provision
I seek to establish if the review of the ambulance service currently under way will be comprehensive, including address of the capacity of the service to fulfil its obligations to the public properly.
As the Deputy is aware, three reviews of the national ambulance service are currently under way.
The national ambulance service has commissioned a national capacity review to determine the level and use of resourcing required for a safe and effective service. This independent review is being undertaken by the UK Association of Ambulance Chief Executives, an organisation with considerable international experience in operational and strategic reviews of this kind.
In the context of the development of the single national control and dispatch system, a review of the Dublin Fire Brigade emergency ambulance service is also under way. This review was commissioned by the Dublin city manager and the HSE’s chief operating officer, and is considering all aspects of Dublin Fire Brigade ambulance operations, including the capacity and capability of current ambulance services. The review will inform consideration of the best model for provision of emergency medical services in the greater Dublin area.
HIQA is undertaking a scheduled review of the national ambulance service, examining the governance arrangements for pre-hospital emergency care services, to ensure the timely assessment, diagnosis, initial management and transport of acutely ill patients to appropriate health-care facilities.
The three reviews are being conducted in parallel, in a concerted effort to examine our pre-hospital emergency care services throughout the country, with a view to identifying the best way to enable them to meet the challenges of the future. I am confident the recommendations will guide us in the provision of a modern, forward-looking service, capable of delivering the best possible outcomes for the public.
I note from the Minister's reply that one of the reviews under way is addressing the capacity of the current service. Without questioning the industry of the people entrusted to deliver the review, I must ask whether they are looking honestly at the capacity of the ambulance service to deliver on a day-to-day basis. Does the Minister agree with the National Ambulance Service Representative Association's statement that targets are not being met because of a shortage of personnel, infrastructure, including an ambulance fleet, and funding? Has he, independent of the reviews, brought to an end the scandal of the misuse of rapid response vehicles as personal cars for managers, an issue that was highlighted some time past? Has he undertaken a comparison between the provision for the ambulance service in the State and the experience north of the Border and in Scotland, statistics for which I have cited to him on the floor of the House? Will he seek to establish a truly national ambulance service that would initially encompass cross-Border co-operation and ultimately provide for integration under an all-island ambulance authority?
The use of response cars by ambulance service officers is making a real difference in improving response times for patients. Between 1 January and 1 April this year, officer vehicles responded to more than 630 incidents, over 250 outside working hours. On average, the cars responded to seven incidents a day, almost three of which occurred outside working hours. The vehicles can be tracked by control centres. For example, an officer working in Wexford but with a vehicle in Limerick after hours is available to respond to incidents in Limerick for that period. The response cars are a valuable additional response resource and the officers provide an emergency service in their communities outside normal working hours. They are not paid an on-call allowance and respond to these calls pro bono. Officers using the cars also attend and manage complex incident scenes such as multiple-casualty road accidents during and after hours. Examples include the recent chemical incident in Maynooth and the national ambulance service's response to the Altnagelvin hospital fire.
The Minister chose to focus on only one of the points I raised. I again ask for his view on the case made by the National Ambulance Service Representative Association, the members of which are front-line service providers, on the shortage of personnel, infrastructure and funding. In my own region which comprises counties Cavan, Monaghan, Louth and Meath ambulance service staff are expected to deliver the service with only 12 ambulances functioning and available at any one time. I know from direct personal experience both in December last year and January this year, which I have shared with the Minister, that the current provision is absolutely inadequate. I have appealed to him before and do so again to recognise that my experience is not unique to the region from which I come but is replicated across the State. How can this be acceptable? Will he undertake to deliver a truly State-wide audit of ambulance services with a view to increasing the number of front-line personnel and the level of infrastructure, including the ambulance fleet, in order to bring the service across the country up to a safe and efficient level? When will the reviews under way be concluded and when does the Minister expect to take possession of the relevant reports? In each of the cases he cited, will the report be published?
On the last point, it is, of course, my intention that the reports will be published. The HIQA review of the national ambulance service will be a very comprehensive analysis of how to make the best use of the resources available to us. Response time requirements have been in place since 2011 - no such criteria applied before then - and everybody will agree that the people providing the service are very committed to it. However, there is no service so good that it cannot be improved. The Deputy referred to the position in Scotland which has a similar dispersed population. We will learn from our neighbours in any way we can. The objective of the three reviews to which I referred is to improve the service to the patient. The most important point, as the Deputy reminded me when he spoke about his own experience, is that the patient should receive the right treatment as quickly as possible. The ambulance that takes a patient to hospital is very important, but having rapid access to a skilled advanced paramedic who can administer care is the critical consideration.
Hospital Waiting Lists
Bernard Durkan
Ceist:7. Deputy Bernard J. Durkan asked the Minister for Health the extent to which patients presenting for what are deemed to be non-emergency or non-urgent procedures are put on waiting lists for prolonged periods, often in very severe pain which results in great distress for them and their families; the effort being made to examine such cases with a view to ensuring the alleviation of pain becomes an issue in the determination of priority; and if he will make a statement on the matter. [27007/14]
This question relates to the number of incidents brought to my attention, whereby patients in need of particular procedures such as prostate operations, hip replacements and so on are being placed on waiting lists of considerable length. They are left, in the meantime, to suffer extreme pain which is highly distressing for themselves and their families.
Management of all patients on waiting lists takes place in line with an agreed national policy on waiting list management that issued in 2013. This policy was developed to ensure all administrative, managerial and clinical staff would follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. The policy describes the process for assigning priority to patients and all patients, with every person added to the waiting list assigned a priority category of either "routine" or "urgent". Several factors determine prioritisation of the clinical urgency of a patient and his or her subsequent scheduling, including pain levels. The decision on prioritisation is a clinical one, taken by a doctor, as is proper.
In addition to the national waiting list management policy, a toolkit to support the successful implementation of the new policy has been developed. The performance improvement toolkit for scheduled care focuses on the organisational, procedural and operational changes necessary to improve patient experience of scheduled care. It provides an organisational assessment tool to enable hospitals to understand their current capabilities and performance. It also identifies areas for hospitals to focus on improvements based on the organisational assessment.
With the assistance and support of the special delivery unit, SDU, and the National Treatment Purchase Fund, NTPF, 90% of adult patients were waiting less than eight months at the end of April, with 10% waiting for longer than the eight month target. That 10% comprises 4,462 patients, which compares favourably with the 5,302 adult patients who had been waiting for longer than eight months in April 2013. Even more significant improvements are evident in outpatient waiting lists, which indicate that 93% of outpatients had been seen within 52 weeks by the end of April, whereas only 73% of outpatients had been seen within 52 weeks in April 2013.
Should any patient consider that his or her clinical condition and-or pain levels are disimproving, it is recommended that he or she bring this to the attention of a GP who can bring it to the attention of the consultant, with a request that the level of priority of the patient be reconsidered.
I thank the Minister for his comprehensive reply and acknowledge that considerable progress has been made on waiting lists in general. Moreover, I fully accept clinicians' right and duty to make the clinical decision in the first instance. However, my question relates to the pain suffered by persons waiting for treatment. When one tables a parliamentary question about such cases, the standard reply is that patients whose condition has deteriorated should contact their GP. However, if the patient had not been concerned in the first place, he or she would not have contacted a public representative. Would it be possible to review the status of those patients who seem to be on a circular list and whose only means of accessing treatment quickly is to go through hospital emergency departments, with the consequent disruption of that service? I am not satisfied that every case is treated with the urgency it should be given, given the severity of pain suffered by patients.
I can certainly consider the Deputy's suggestion on exploring how we might develop a separate route for patients who feel they are deteriorating, without requiring them to resort to attending an accident and emergency department. As a doctor, I am aware that if people are left to wait for a prolonged period, elective surgery can turn into emergency surgery. That is not something anybody would wish to see. It is only right and proper, however, that the clinicians make these decisions. It would not be proper for management to do so.
Major improvements have been made to waiting times but I acknowledge that they are still too long. We seek to continue to improve them through further reform of the health services and monitoring of waiting lists. Some hospitals have not been co-operating with the policy of seeing those who have waited longest first, once urgent and cancer cases have been dealt with. That is a problem.
I thank the Minister for his reply. I hope he will be able to carry out a review of this issue. A case was recently brought to my attention involving an elderly lady who was awaiting a hip replacement. Although she was in extreme pain, her case was not deemed urgent or a priority. She had been waiting between one year and 18 months in that condition. In another case, a prostate patient was deemed as non-urgent. This unfortunate individual's family became extremely distressed at the extent to which he was in discomfort, screaming with pain on a daily basis. It was poor consolation to them when I forwarded them a reply suggesting that he should go to his GP. He would not have complained to me in the first instance if the situation had been the way it should have been.
If I may make a general point, nobody should be in pain. Adequate pain relief mechanisms are available and a GP would be in a position to provide such relief. I accept, however, it is not ideal that people would take painkillers for prolonged periods when a procedure could resolve the problem in a more comprehensive fashion. As we all know, some painkillers have side effects which can be serious in their own way. I take note of what the Deputy had to say. We are striving to improve the system. It has evolved in a chaotic fashion over many years and through various Governments, and we are trying to put order on it to benefit patients by ensuring that those who are waiting the longest are seen first and that people are seen in chronological order as they are referred rather than permitting people who have only been waiting three months to be seen prior to those who have been waiting six months, nine months or a year. That has been happening in our hospitals.
Medical Card Reviews
John Browne
Ceist:8. Deputy John Browne asked the Minister for Health when he expects the thousands of discretionary medical cards withdrawn since 2011 to be restored; and if he will make a statement on the matter. [27064/14]
The current eligibility system for health services, which has been in place since 1970, is based primarily on financial criteria. The Government has decided to develop a policy framework for eligibility for health services to take account of medical conditions, including new legislation as appropriate, and a HSE clinical expert group is to examine the range of conditions that should be considered as part of this process. The group has been asked to prepare an early report for the Minister for Health in the autumn.
The Government was very concerned about the potential impact on the health of persons with serious illnesses whose discretionary medical cards and GP visit cards had been refused renewal since the centralisation of medical card assessment in 2011. Therefore, in the context of the development of an eligibility policy, the Government decided that medical cards and GP visit cards were to be issued to persons with a serious medical condition or disability who had the renewal of their discretionary card refused by the HSE, having completed an eligibility review during the period from 1 July 2011 to 31 May 2014.
This arrangement applies in the following circumstances: during the period the person held a medical card or GP visit card issued on a discretionary basis but the HSE made a decision to refuse its renewal on foot of a completed eligibility review; the person completed the review process during that period - that is, provided the information and documentation required to assess eligibility; or the person has a serious medical condition which required that his or her case to be referred to a medical officer as part of the review process. It is anticipated that approximately 15,300 cards will be issued to people with serious medical conditions as part of this process. It is estimated that 5,288 people will be issued with a discretionary medical card, 2,899 people will be issued with a discretionary GP visit card and 7,118 people will be moved from a GP visit card to a discretionary medical card.
It is also recognised that a small number of individuals may not have been able to complete their review during the defined period due to circumstances relating to their medical conditions, such as hospitalisation or a change of residence during treatment. Therefore, the director general of the HSE may act on his own initiative, to take account of an ad misericordiam appeal on a case-by-case basis to issue a discretionary card to such a person where he or she has a serious medical condition.
People do not need to make an application to receive a card because the HSE is working through its database as quickly as possible to contact the people concerned over the next few weeks to inform them that their card is being issued. If people do not hear from the HSE by mid-July, they should contact it on its Lo-Call contact number.
Has this question been assigned to a particular grouping?
There is no grouping because it is grossly unfair to Deputies who are waiting for their questions that 30 questions might be taken in conjunction. The system is intended to apply fairly to everybody. When a question is reached, it is taken.
I thank the Minister of State for his reply. Over the past week the Taoiseach cited figures of more than 15,000 discretionary medical cards and 5,000 mercy cards. However, when I contacted the medical card section yesterday it had no information on the criteria or method for acquiring a mercy card. Many people with severe disabilities lost their discretionary cards, including people with spina bifida, Down's syndrome and cancer, resulting in severe financial hardship for the families concerned. How soon will cards be issued to such people, will they be given priority and will the cards be reissued automatically? Will the money spent over the last year by families who have lost medical cards be refunded?
In the first instance, it is not proposed to issue refunds in these circumstances. This problem will ultimately be resolved only through a change in the legislative basis for awarding medical cards. The Government has now set in train a process to achieve that intended outcome. With regard to the speed at which this will happen, the HSE is working as quickly as possible to contact those concerned. We estimate it will take a number of weeks to resolve the issue. It is not necessary for individuals to the contact the HSE because they can rest assured that their cases will be dealt with in accordance with the criteria published last week. However, if people remain concerned and they do not hear from the HSE by mid-July, they are free to contact it on the Lo-Call contact number.
I am disappointed that a refund is not being considered. I am aware of a large number of families in my constituency who are paying their chemists for drugs on a weekly basis because they were unable to pay the full amount up front. The Minister of State should reconsider the possibility of refunding such patients.
I understand the Deputy's point, but the cards were removed for proper legal reasons. I am not saying that did not affect the individuals concerned. In terms of the actual position of the time, the HSE applied the law correctly. As legislators, we are trying to change the law. People often ask us why we cannot change the law if it is against us on a particular issue. We are setting out to do that, and that is why the expert panel has been established. We look forward to receiving support from the Opposition in dealing with the issue.
However, for the moment, what the HSE has done - it has been fortified by the Government announcement in respect of a change of policy - is to move to a position, as it were, in which all further reviews are suspended. The circumstances relating to the return of cards were announced last week.
Can I ask a supplementary question?
Sorry; the time has expired. Six minutes are allowed.
Medical Card Reviews
Michael Moynihan
Ceist:9. Deputy Michael Moynihan asked the Minister for Health to detail the number of discretionary medical cards he will restore; and if he will make a statement on the matter. [27060/14]
Will the Minister for Health detail the number of discretionary medical cards he will restore and make a statement on the matter?
The current eligibility system for health services, which has been in place since 1970, is based primarily on financial criteria. The Government has decided to develop a policy framework for providing eligibility for health services to take account of medical conditions. This will include new legislation, as appropriate, and a HSE clinical expert group to examine the range of conditions that should be considered as part of the process. The group has been asked to make an early report to the Minister for Health in the autumn.
The Government was concerned about the potential impacts on the health of persons with serious illnesses whose discretionary medical cards and general practitioner visit cards were refused renewal since the centralisation of medical card assessment in 2011. Therefore, in the context of the development of an eligibility policy, the Government decided that medical cards and GP visit cards are to be issued to persons with a serious medical condition or disability who had the renewal of their discretionary card refused by the HSE having completed an eligibility review during the period 1 July 2011 to 31 May 2014.
The arrangement applies in the following circumstances: during the period in question the person held a medical or GP visit card issued on a discretionary basis but the HSE made a decision to refuse its renewal on foot of a completed eligibility review; the person completed the review process during that period - that is, provided the information and documentation required to assess eligibility; and the person has a serious medical condition, one which required the case to be referred to a medical officer as a part of the review process.
It is anticipated that approximately 15,300 cards will be issued to people with serious medical conditions as part of this process. It is estimated that 5,288 people will be issued with a discretionary medical card, 2,899 people will be issued with a discretionary GP visit card and 7,118 people will be moved from a GP visit card to a discretionary medical card.
Despite the replies to previous questions, major difficulties remain with what are perceived as the criteria for discretionary medical cards. This is the case even for applications that have gone in over recent weeks and in respect of which people have been diagnosed with serious illnesses and have submitted their documentation. There is a major issue with the process. Reviews are still ongoing. We have people coming into our office who have a major difficulty with the process.
The Minister of State gave us figures and he alluded to changes in legislation. This matter is a priority and legislation should be before the House as soon as possible. The Minister gave us figures and stated there would be a report in the autumn, but that is far too late for the families concerned. These people have major medical difficulties and in some cases a terminal diagnosis. They are still waiting for medical cards and there is toing and froing with the HSE seeking clarification on pieces of paper and so on. It needs to be treated with more urgency than is the case at present.
The determination of the basis for the awarding of medical cards on medical grounds, as opposed to means grounds, which has been the case since 1970, will be dealt with absolutely comprehensively through the expert panel. If we are to determine a basis for awarding a medical card where a person has a medical condition or an illness then there must be some basis for determining what that will be and what the grounds will be. The Government has correctly commenced its consideration of the matter by putting together an expert panel of medical professionals. These are people who work in medicine - clinicians who are in a position to list conditions and make an assessment of conditions and illnesses appropriate for access to services under the scheme. That is the job this panel will have to undertake.
I agree with Deputy Moynihan that this should be resolved as quickly as possible. However, there is no use in saying the legislation should be before the House as soon as possible unless the Deputy can suggest to me or unless someone has a view on what the legislation should contain. We want to get the legislation correct and we must decide the criteria for the awarding of what one might term medical medical cards.
The Government and the Minister have constantly referred to changing the legislation and so on, but the practice in the HSE, which dates back to the health boards, has been to grant medical cards on a discretionary basis. I am unsure why the Minister of State is saying there no basis for it in law.
I have no wish to mention the exact details because the families would know that I am quoting their files on the floor of the Dáil, but some people who have been diagnosed with serious illnesses have approached me in the past week or two. The medical card section of the HSE is looking for pieces of paper with minute clarifications on this and that and clarifications in respect of income details. The people concerned may be on social welfare. This practice is continuing. As late as yesterday we had a major difficulty with a family of a person with an illness. The HSE was looking for scraps of paper, for want of a better term, and it is intolerable.
Deputy, please. You are over time.
The human situation that the Deputy describes is extremely frustrating. I understand what the Deputy is saying - I imagine all Members understand. The Government is now dealing with the issue of access to services. I am referring to necessary access that people with medical conditions and illnesses must have, even if they are over the means test limit. All Governments have been sticking to the 1970 Act, dating back almost 45 or 50 years, and held that unless a person satisfies the mean test, he does not get access to services. That is what we are trying to change and that is what we will change. That is what we are going to do properly and comprehensively through this review. The Government has indicated that it will come back to the Oireachtas in early course. We hope we will be able to do so, and we intend doing so in the autumn.
Primary Care Centre Provision
Seán Kyne
Ceist:10. Deputy Seán Kyne asked the Minister for Health to set out the progress in establishing new health centres at two locations in County Galway (details supplied) in recognition of the critical nature of the health facilities for the communities; whether the provision of the health facility is a matter for his Department and the Health Service Executive rather than any other Department; and if he will make a statement on the matter. [27009/14]
The question relates to the plans for replacement of a health centre on Inisbofin Island and the plans for Corrandulla health centre.
The development of primary care is central to the Government's objective of delivering a high-quality, integrated and cost-effective health system. Primary care infrastructure is being delivered through three mechanisms: direct build, a leasing initiative and a public private partnership initiative announced in the July 2012 infrastructure stimulus package. The development of primary care centres through a combination of public and private investment will facilitate the delivery of multidisciplinary primary care and represents a tangible refocusing of the health service to deliver care in the most appropriate and lowest cost setting.
Considerable progress has already been made in the delivery of primary care centres. Since this Government came into office in March 2011, a total 37 primary care centres have been opened and infrastructure development is under way or at an advanced planning stage at a further 43 locations, where delivery is expected during the period between 2014 and 2016 or early 2017.
As with all capital projects, the primary care infrastructure programme must be considered within the overall capital envelope available to the health service. There will always be more projects than can be funded by the Exchequer. There is limited funding available for new projects over the period 2014-18 given the level of commitments and the costs of completion. The HSE is concentrating on applying the limited funding available for capital works in the most effective way possible to meet needs now and in the future.
I thank the Minister of State for his reply. I commend the Government on the ongoing work and on the number of primary care centres that have opened, including those recently opened in Athenry and Loughrea in Galway. There is no update on the two projects that I mentioned. I spoke to the Minister of State before regarding Inisbofin. There was back-and-forth between the Department of Health and the Department of Arts, Heritage and the Gaeltacht over which had responsibility for the project. There had been an issue previously that the Department with responsibility for the Gaeltacht and the islands had responsibility for island communities. Anyway, I understand that has been cleared up. Perhaps the Minister of State could come back to me with details of the progress on that health centre as well as the centre in Corrandulla, which is currently closed, but which, I understand, is listed for refurbishment. This issue arose often during the recent canvas.
Locals in the area must attend the primary care centre in Turloughmore. Their concern was that the Corrandulla centre may not re-open.
The Deputy is correct. He has raised this issue previously. I will revert to him on it today or tomorrow at the latest, as I know the issue. I welcome his general support for primary care centres.
In recent weeks, the Minister, Deputy Reilly, and I have had the honour of opening additional primary care centres in different parts of the country. One could see the value their communities placed in them and the incredible services they provided. I opened one in Schull in County Cork, another in Blanchardstown recently and one in Summerhill, County Meath. One has been opened per month since the Government came to office. We receive a great deal of criticism. Some is justified, but much is not. I draw the House's attention to the amazing work that is being done in the primary care sector, particularly in the provision of new buildings. The housing of services under one roof obviates the need for people to travel long distances, as was the case in Schull, for services that should be available in their own communities. This kind of change is taking place in our health services and is valuable to communities across the country.
Maternity Services
Denis Naughten
Ceist:11. Deputy Denis Naughten asked the Minister for Health the current status of his review of maternity services; and if he will make a statement on the matter. [26885/14]
I tabled this question to find out the Minister's timeline and terms of reference for the national review of maternity services. It also reiterates Deputy Ó Caoláin's question on the status of the tainted review of the west-north west hospital group.
My Department, in conjunction with the HSE, is preparing a new national maternity strategy, which will provide the strategic direction for the optimal development of safe and high quality maternity services. The commitment to develop a maternity strategy arises from my acceptance of the recommendations of the Health Information and Quality Authority, HIQA, report into the death of Savita Halappanavar. That report recommended that a strategy be developed to implement standard and consistent models for the delivery of a national maternity service that reflected best available evidence to ensure that all pregnant women had appropriate and informed choices and access to the right level of care and support. The strategy will incorporate a review and evaluation of our current maternity services. This will give us the opportunity to take stock of the services that are provided to women and their babies in our 19 maternity hospitals and identify how we can further improve the quality and safety of the care we provide. It is intended to finalise the new strategy by the end of this year.
I asked this question, which the Minister has not answered twice this morning, because five of the six options contained in the west-north west hospital group's report suggested the closure of Portiuncula Hospital's obstetrician-led maternity services. The sixth option - to do nothing - was dismissed. Of the hospitals in the group, Portiuncula is the safest, one of the most efficient and the second largest. This week, the group's management team issued a statement to the effect that the current review would be subsumed by the national review of maternity services. I am concerned by this, as it will not lead to the best possible patient outcome or the provision of the safest possible services.
Sadly, the Deputy is prejudging the situation. The national maternity review being conducted by my Department is nowhere near finalised. I have made it clear on the floor of the House that, while the report commissioned by the west-north west group may be used to help inform the national review, it has no status in and of itself. My Department is conducting the review to ensure safe and comprehensive services while observing the underlying principle of our health policy, namely, that patients should be treated as near to home as possible in a safe, timely and effective manner. I ask the Deputy not to prejudge the national review's outcome. It may suit purposes locally to upset people and undermine their confidence in the hospital-----
The Minister spent a fair bit of time doing that himself.
-----and the staff's confidence in their security of tenure, but it is not necessary. There is no intention of closing Portiuncula Hospital or its maternity services.
I thank the Minister for his clarification, but that was not my suggestion. I do not want to prejudge the outcome of the review that the Minister is spearheading, as a review of maternity services is necessary, given the death of Savita Halappanavar and events in Portlaoise. We all want a quality and safe maternity service. However, a report specifically focused its attention on Portiuncula Hospital. I want the Minister's assurance that the report in question, which is tainted in its content, never mind its origins, will make no input into the national review. There is an agenda in the west-north west hospital group to undermine services at Portiuncula Hospital, which is not in the best interests of women anywhere in the country.
I am happy to assure the people of Ballinasloe and surrounding areas that they have in Portiuncula a good and safe maternity service with a bright future. Without prejudging the outcome of the review, we have no notion of downgrading or removing that service. I do not know where the patients would go.
Exactly.
However, I must point out that, were I to tell the House that the report compiled by the west-north west group at a cost of €20,000 was to be utterly ignored, I would be castigated from a height for wasting public resources. Of course it will help to inform the national review, but the fact that some of its options - I remember there being four, not five - suggested closing Ballinasloe hospital's maternity services has no status in my view. I see no rationale for doing that.
I thank the Minister for his clarification.
Written Answers follow Adjournment.