Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Thursday, 2 Jun 2016

Vol. 911 No. 3

Other Questions

Hospital Waiting Lists

Seán Haughey


6. Deputy Seán Haughey asked the Minister for Health when the upward trend in waiting list and waiting times will be reversed; and if he will make a statement on the matter. [13802/16]

I look forward to working with Deputy Kelleher in his role as his party's spokesperson on health, a role he has carried out for a number of years.

Improving access for patients is a key objective for our public health service. The 2016 HSE service plan undertakes to maintain 2015 levels of service in respect of scheduled care and to continue to address waiting times as part of the regular performance and accountability process. The HSE seeks to ensure that those whose clinical needs are most urgent are prioritised accordingly, while managing the needs of those who have been waiting longest for routine treatment in chronological order. Currently, 94% of patients wait less than the maximum waiting time of 15 months for inpatient, day case or outpatient procedures, with over 60% of patients waiting less than six months for their required care.

A scheduled care governance group has been established within the HSE to co-ordinate key initiatives to reduce waiting times and the number of patients awaiting treatment. Actions overseen by this group include driving greater adherence to chronological scheduling, relocation of low complexity surgical procedures to smaller hospitals and administrative and clinical validation procedures to ensure that patients are available for treatment. All too often, I have heard stories of people who have passed away remaining on a waiting list and the difficulty this has caused for their family and for the accuracy of the list.

Each hospital group has been mandated to designate a key person to lead and support waiting list management improvements so as to advance towards compliance with maximum waiting times. The National Treatment Purchase Fund supports the management of inpatient, day case and outpatient waiting lists, by working with the HSE to assist hospitals in developing local demand and capacity planning and providing technical guidance materials to ensure the highest standard of data quality and practice.

My Department is currently engaging with the NTPF and the HSE on a focused plan for endoscopy waiting lists in 2016. The programme for Government and the supply and confidence arrangement with Fianna Fáil contain a commitment to reactivate the NTPF and to provide €15 million in 2017 to address waiting lists. My Department will engage with the NTPF and the HSE in this regard.

It is a sad indictment of the situation that over the past number of years we have seen an escalation in the number of people waiting for inpatient day case treatments, with 74,000 plus now awaiting treatment. The waiting list for outpatient appointments has risen to 407,000 people. Over the past number of years there has been a due diligence process in place for assessing waiting numbers, so the lists are reasonably accurate. The previous Minister for Health set a target of 15 months, a less ambitious one than the Minister prior to him. Therefore, it is backwards we are going in terms of the adjudication of our success or failure in terms of our ambition. This issue must be addressed.

I understand the Minister has had a meeting in regard to the winter readiness programme and I acknowledge that at least the Department is preparing in time. One of the solutions to winter readiness is the cancellation of elective surgeries and scheduled treatments, but I do not believe this can be seen as a long-term sustainable solution to overcrowding in our emergency departments. The NTPF is in place and I hope it is used wisely and efficiently. However, the issue of the 407,000 people on the waiting list is a sad indictment on everybody, because these people are unsure of what is wrong with them until they get a proper diagnosis.

The Deputy has made a fair point in regard to the 15 month target. As I said earlier, some 94% of patients are being seen within that 15 month target and 60% of patients are being seen within the six month period. However, we must continue to try to do better.

What we see here is a direct result of a period of difficult economic decisions, through the time Fine Gael was in government and during the time Fianna Fáil was in government before that. We are now in a different place, where we can now begin to reinvest in the health service, increase health budgets and increase the resources being made available to tackle the issues outlined. I am not afraid to admit it if I hear a good idea from somewhere else and I accept the NTPF was a model championed by the Deputy's party. I believe it has a role to play here and that it needs to be reactivated. We should all strive for investment in the public health service, but there is also a role for the NTPF in the effort to reduce waiting lists. I want to start a programme for endoscopy with the NTPF this year, to put at least €15 million into the NTPF for 2017 and to have discussion in this House about how best to target that in terms of the most difficult and acute types of treatment needed.

In regard to the winter initiative, the Deputy is correct that we must be very careful that the consequence of preparing for the emergency department situation does not distract from the waiting list situation. The best way to ensure that is to increase resources for the health service and increase recruitment and retention of front line staff.

As an aside, access to diagnostics is an important issue, particularly the issue of direct referrals by GPs into diagnostics. The reason we have such a build-up of people on waiting lists currently is due to the inability to access diagnostics. We do not seem to be sweating the assets of public diagnostic services, which work on a five day week.

We should be imaginative and creative to change the rostering programme in order to make radiography and other diagnostic services available seven days per week. We should utilise the huge capital investment that has gone into this in recent years to ensure we have greater capacity in diagnostics in the public health system. It is a key area.

The Deputy is correct. I recently met some of the representatives of radiographers and I am aware that the latter are willing to do more within the public health service. We are exploring with the HSE the additional tasks they want to take on, which will lessen the burden on other parts of our health service. Where health service professionals put their hands up and say they are willing to do more and play a role, it is very important that the HSE responds positively.

We must ensure that diagnostics are available within the community where it is possible to do so in order that we might keep people out of acute hospitals. Sometimes we clap ourselves on the back too much for building a primary care centre when the real question we must ask is what is in the primary care centre. It cannot just be a fancy GP centre that has diagnostic equipment. There is a commitment in the programme for Government to look at how we can incentivise health care professionals to provide diagnostic equipment within the community so that primary care centres can provide real primary care.

Hospital Consultant Recruitment

Eugene Murphy


7. Deputy Eugene Murphy asked the Minister for Health the number of consultants employed at Portiuncula Hospital, County Galway, and the number of vacant consultant positions. [13759/16]

There are 28 consultants employed at Portiuncula University Hospital, while three posts are vacant. This hospital, like many other smaller hospitals, has difficulty filling certain posts and relies on locums to fill posts pending permanent appointments. Of the 28 consultants in post, five are currently employed as locums.

The hospital is focused on filling posts on a permanent basis, reducing reliance on locums and recruiting additional consultants. Within medicine, three locum posts are due to be filled on a permanent basis this year, two in September and one in October. It is also intended to re-advertise one consultant in geriatric medicine post and one consultant in gastroenterology post.

In obstetrics, the consultant working as a locum at present is due to take up a permanent post on 7 July, strengthening the team to five permanent consultants.

Within radiology, two consultant radiologist posts are in clearance stage, one is to commence later this year and the second in 2017.

Reflecting the improvements in train, the hospital recently secured the permanent appointment of a consultant anaesthetist. This post-holder has key responsibility for the intensive care unit and is a joint appointment between Portiuncula and Galway University Hospital. There is also an additional consultant due to commence on the 23 January 2017.

The Saolta Hospital Group recognises the importance of Portiuncula to the delivery of care within the group and this is reflected in the recent and planned improvements in consultant recruitment at the hospital. I assure the Deputy that this process will continue.

I have congratulated most of the Minister's team on their appointments but I wish him well. Gan dabht, is jab an-deacair é d'aon duine bheith ina Aire Sláinte ag an am seo ach tá mé cinnte go mbeidh an tAire ina Aire Sláinte maith le linn an Rialtais seo. The very best of luck.

I welcome the reply to the question but I ask the Minister to ensure that all the appointments to which he referred will happen in the coming months. Portiuncula University Hospital is a very important part of the health system in the Roscommon-Galway constituency. Not only does it look after patients from Roscommon-Galway, it takes them from Clare, Offaly and other adjoining counties. Ever since the closure of the accident and emergency department at Roscommon University Hospital, it is even more important that all the services available at Portiuncula are retained and upgraded. I ask the Minister to make every effort to ensure that the appointments to which he referred will be made in the coming months because they are essential for the future of the hospital.

I thank the Deputy and I do assure him of that. The process of increasing both the number of consultants working in the hospital and the number working on a permanent basis, rather than on a locum basis, is the intention of the HSE and the Saolta hospital group. Three locum posts will convert to permanent posts later this year, two in September and one in October. In addition, we will advertise the consultant post in geriatric medicine and I invite the Deputy to keep in touch with me and the HSE on the matter. It is my intention that this continues to develop and that the number of consultants required, not just in this instance but throughout the country, are installed.

Since my election as a Dáil Deputy for the Roscommon-Galway constituency, I have met the community in Ballinasloe on three occasions, including business people and community people in the town and staff in the hospital. They are very proud of the hospital at Portiuncula and want to talk it up. They want to see new developments. It is really important for Roscommon University Hospital that they happen there as well. There is talk of a 50-bed unit at Portiuncula University Hospital going to planning and that is extremely important for the future of the hospital.

I welcome the Minister's statement and I hope the reinvestment that is taking place in the health service will continue because it is essential for the health care of the people in that region.

Hospital Services

Seán Crowe


8. Deputy Seán Crowe asked the Minister for Health why, as of 29 April 2016, only 234 of 301 new hospital beds were added to support the acute hospital system; the progress being made to date to increase capacity; the funding allocated and used to date for this purpose; and if he will make a statement on the matter. [13697/16]

I am very conscious of the impact that long wait times in emergency departments can have on patients and their families, as well as on front-line staff. Last Monday I attended my first meeting of the emergency department, ED, task force implementation group, which is co-chaired by the director general of the HSE and Mr. Liam Doran of the INMO and which is providing focus and momentum in dealing with the challenges presented by emergency department overcrowding. As Minister for Health, I intend to personally attend the monthly meetings in order to keep momentum going.

In June 2015, additional funding of €18 million was made available to the HSE under the winter additional capacity initiative. The initiative identified 301 additional winter capacity beds that could be opened. In some hospitals, beds have proved more challenging to open than envisaged, owing to difficulties in staff recruitment. However, to date, 236 of these 301 new beds have opened. In addition, 116 closed beds have re-opened and a further 14 beds have been opened in Sligo. In total, 366 new or reopened beds have been made available.

This extra capacity has enabled similar emergency department performance to the equivalent period in 2015, despite an average increase of nearly 6% in attendances so far this year.

Furthermore, figures for May show total numbers of patients on trolleys are approximately 18% lower than in May 2015, with numbers waiting over nine hours approximately 24% lower than in May 2015. I do not say this is acceptable but I want to put it into context.

The demand for acute hospital services continues to increase in line with a growing and ageing population. The overall population growth year on year is in the order of 1%, whereas growth in the over-65 age group is of the order of 3% to 4% per year. In addition, in 2014 adults aged 65 years and over accounted for nearly 13% of our population but used 53% of total hospital inpatient care, which demonstrates the demographic pressures on our health service.

Reviews of bed capacity and medical assessment unit hours of service are needed and are key commitments in the programme for a partnership Government, as well as for me, as Minister for Health, so that I can look at ways to address pressures on our emergency departments. I am planning a winter initiative, not just for this year but next year too and this is under way.

Some €18 million was spent last year on the winter initiative. Can the Minister advise if the same amount is being set aside for this year, or will it be more? We are 65 beds short of the target of 301 which was promised. Where did those 65 beds go?

The Minister said it is the intention to undertake a bed capacity review and that is very welcome. When will that start and finish and who will conduct it? Does the Minister have any plans or money set aside to act on the recommendations that will be made? We do not need too much time to know that there are not enough beds in the system. The bed capacity review should be a fairly quick exercise and it would be interesting to know whether the Minister has identified somebody who can carry it out.

I am not in a position to reveal the figure for the winter initiative today but I will be shortly. The Taoiseach and the Minister for Public Expenditure and Reform have made clear in this House that we will present our health Estimate, as well as all other Estimates for departmental Votes, in the next fortnight.

I hope I will be able to provide clarity to Deputy O'Reilly in this regard at that stage. I hope the decision to commence the winter initiative now, at the end of May or start of June, is seen as a signal of my intention and that of the HSE to try to prepare for this in advance and to look at next year as well. As this is a crisis that happens year on year, we need to plan ahead for it.

The Deputy spoke about the closed beds figure and asked where the 65 beds went. As I outlined in my initial response, there have been staff recruitment difficulties in some hospitals and some areas. One cannot open beds without staff. However, some 366 new or reopened beds that were not available in the system are now available in the system. The bed capacity review has to be different this time. I have no interest in carrying out a bed capacity review for acute hospitals only. We cannot keep seeing the acute hospital as the beginning and the end of every conversation. We must look at capacity in the community as well. I refer to nursing homes, long-term stay beds and community hospitals. The bed capacity review must look at the whole continuum of care and beds. I will come back to the Deputy with details of the timeframe. I would like it to take place as quickly as possible, particularly because I am conscious of the review of capital plans that is due to take place next year. I need to know the data so I can deliver in that regard. On the question of how I will have funding to deliver all of these things, the Estimates will be in the House in the next fortnight, as I have said.

We need to know who will conduct the review. I welcome the Minister's statement that it will encompass all beds because there is a serious need for that to be examined. The Minister may already be aware that according to the OECD, the number of beds we have per 1,000 people is below the EU average. We already have a deficit. I am disappointed that the figure for the winter initiative, which the Minister is right to start early, is not being shared with us. As the winter approaches, the pressure on our accident and emergency departments will increase. It used to get particularly bad when there were spikes, but now a level of difficulty is being maintained. I am familiar with this from my previous job. When one talks to the staff one is told that there used to be quieter times, but there are no lulls anymore. The sooner the bed capacity review is undertaken the better, because I believe this will result in all the beds that have been identified being opened. According to our figures, we are still 65 beds short, notwithstanding the other beds.

This is my first outing here, so I do not want to disappoint the Deputy at this early stage of our exchanges. The Deputy will know the figure within the next fortnight. In fact, she will know when I know. Obviously, we have to look at what did and did not work last year and what we did not look at last year that we should look at this year. That is the message I delivered to the emergency department task force on Monday of this week. The important message for the HSE is that the solution to this problem is not one that solely rests in the acute hospitals. It has to involve the primary care divisions of the HSE, social care and the home care packages that were discussed by the Minister of State, Deputy McEntee, with Deputy Kelleher earlier. We will have clarity on this matter for Deputy O'Reilly in the next fortnight or so. I largely agree with what she has said about bed capacity. I stress that we need to identify exactly where the beds are needed. We intend to work with everybody on this. As I have said, we also need to look at delayed discharges because the infrastructure in the community is sometimes inadequate.

Hospital Services

Seán Fleming


9. Deputy Sean Fleming asked the Minister for Health his plans to recast the Midland Regional Hospital in Portlaoise, County Laois, as a model 2 hospital; and if he will make a statement on the matter. [13755/16]

I thank Deputy Fleming for this question. I am committed to securing and further developing the role of the Midland Regional Hospital in Portlaoise as a constituent hospital within the Dublin midlands hospital group. Patient safety and outcomes must come first. As Deputy Fleming knows, a number of reports on the hospital in Portlaoise have been published in recent years. These reports pointed to the need for reconfiguration of some services to ensure patients are treated in the most appropriate setting by specialist staff who can safely meet their needs. Since 2014, the focus has been on supporting the hospital to develop and enhance management capability, on implementing the changes needed to address clinical service deficiencies and on incorporating the hospital into the governance structures of the Dublin midlands hospital group. Governance and management arrangements in Portlaoise have been strengthened, additional clinical staff have been appointed and staff training, hospital culture and communications have improved.

The Dublin Midlands Hospital Group recently produced a draft plan for clinical service delivery at the Midland Regional Hospital in Portlaoise. I want to stress that the draft plan, which has been discussed with officials in the Department of Health, is currently the subject of further work and consideration by the HSE. Any change to services at the hospital, including any plans for service reconfiguration, will be undertaken in a planned and orderly manner and will take account of current use of services, demands in other hospitals and the need to develop particular services at Portlaoise in the context of overall service reconfiguration in the Dublin midlands hospital group. It is important to note that this work is being done to strengthen services in Portlaoise from a patient safety and quality perspective and to ensure the services currently provided by the hospital that are not viable are discontinued and the services that are viable are safe, adequately resourced and developed on the basis of health needs. I am confident that any changes will improve services for patients at the Midland Regional Hospital in Portlaoise. I have to emphasise at this stage that no decisions have been made. There is quite a body of work to be done in this regard.

I welcome the Minister and congratulate him on his new position as Minister for Health. I wish him every success in the interests of the people of this country, who depend on our health service. Essentially, I am calling today on the Minister to reverse the plans for the downgrading of the Midland Regional Hospital in Portlaoise that are being considered by the HSE regional manager. She has produced a plan to reduce the services provided at Portlaoise to the level associated with a model 2 or category 2 hospital. Such an approach, as set out in the draft plan referred to by the Minister, would mean that a full accident and emergency service would not be available at Portlaoise into the future. If that were to happen, we would not have a proper paediatric or maternity unit in the hospital because such units require the presence of a full-time accident and emergency department. As the Minister knows, the hospital in Portlaoise has one of the busiest accident and emergency departments outside the major cities of this country. Up to 35,000 people attend it every year. People who need urgent treatment might not be able to make the journey to Dublin, Naas or Tullamore. This will put lives at risk. Patient safety must come first. Everybody knows that the accident and emergency unit in Portlaoise is overcrowded and that additional staff are required to deal with this situation. The HSE's approach, which involves trying to curtail services rather than upgrading them, is a dangerous one.

I thank Deputy Fleming for his good wishes. I emphasise that no decision has been made on Portlaoise or on the services mentioned by the Deputy. Officials in the Department of Health have been liaising with the HSE on the significant body of work that needs to be done in relation to the draft report that has been drawn up by the HSE. This work will answer some of the significant questions that have been asked here by Deputy Fleming. I want to make it crystal clear that nothing will be done to compromise patient safety and everything will be done to address patient concern. I cannot be clearer than that. Any decisions taken will have to be based on clinical evidence. Decisions about the provision of health services should be made by clinicians and not by Ministers for Health. There is a body of work to be done in that regard. I have read the media commentary. I know there has been some commentary in local newspapers and in national media outlets. I say respectfully to everybody that there is a body of work ongoing here. No decision has been made. Any decision that is made will be based on an assessment of the issues that have been outlined by Deputy Fleming and the other Deputies from the Laois constituency. I refer to issues like service provision and the capability of other hospitals. Consideration will be given to what should be provided in Portlaoise and what could be provided elsewhere. As I have said, there is quite a way to go in this regard. I will certainly keep the Deputy informed.

I am pleased that the Minister has an open mind on this matter. A great deal of further discussion will be required. I will set out the essential problem that has arisen in Portlaoise. As the Minister has mentioned, a number of reports have previously been published. The maternity unit has had a troubled history. It was under-staffed for several years. Twenty additional staff have been provided in Portlaoise over the past year or so. As a result, a first-class maternity service is now available in the region under the direct supervision and management of the Coombe hospital. The accident and emergency department at the hospital needs a similar staff upgrade. A lazy approach should not be taken just because there is a difficulty. I understand that HIQA officials are in the hospital this week. They are carrying out a number of inspections as we speak. These reports should be used to improve services. They should not be employed as a lazy excuse to downgrade services. This issue has arisen since the new regional manager arrived. She announced last autumn that she wanted to curtail the accident and emergency department by providing a daytime-service only, but she was told she could not do that. She was sent away to draft a report to back her original preconceptions. That report is now in front of the Minister. I am saying to the Minister that we need to keep the accident and emergency department in Portlaoise. As we all know, the triage service at the hospital currently sends some patients to the stroke unit in Naas. If there is a major car crash, injured people are sent to the trauma unit in Tullamore. That is fine but the facility in Portlaoise, which is used by 30,000 people every year, needs to be maintained in the interests of patient safety.

The Deputy is right to acknowledge the additional staffing that has been provided at the hospital in recent years. According to the information that is available to me, an additional 65 posts have been filled at Portlaoise Hospital since 2014, comprising 17 medical posts, ten nursing posts, five allied health professionals, 24 patient and client care staff and nine administrative staff. I have a more detailed list here, but I probably do not have time to go through it.

There has been significant investment. As I acknowledged at the outset, a lot of effort has been put into this hospital in terms of addressing a number of issues over the past number of years. I have no intention of stating anything other than the factual position. There is still a substantial body of work to be done. There are still conversations that need to be had at a clinical level in terms of what services can be provided and in what hospital within the hospital group. That work is ongoing. What I can assure the Deputy and the people of Portlaoise today is that all of this will happen in an orderly and planned manner and that people will be kept informed of any developments.

Will the Minister send me a copy of what he did not get an opportunity to read on the record?

It is a breakdown of the 65 posts. I will send that to the Deputy.

Mental Health Policy

Brian Stanley


10. Deputy Brian Stanley asked the Minister for Health his role in formulating the mental health policy to be implemented in schools; and how he has co-operated with other relevant Departments in this regard to ensure the provision of best practice and adequate funding; and if he will make a statement on the matter. [13716/16]

I thank Deputy Stanley for putting forward this question with regard to mental health promotion and policy and how it will be implemented in schools. I presume Deputy Louise O'Reilly will respond in his stead.

Back in 2013, the Department of Education and Skills, the HSE, and the Department of Health jointly developed Well-Being in Post Primary Schools Guidelines for Mental Health Promotion and Suicide Prevention. This was followed in 2015 by the publication of guidelines setting out a framework for mental health promotion in primary schools. Supporting schools to implement the guidelines involves a great number of agencies of the Department of Education and Skills and health promotion officers within the HSE. In addition, the Department of Education and Skills recently revised the Responding to Critical Incidents Guidelines and Resource Material.

In 2015, the Government launched Connecting for Life, Ireland's national strategy to reduce suicide. The aim is to reduce suicide and self-harm. We are looking at the figures from 2015 to 2020. The strategy clearly sets out a vision where fewer lives are lost through suicide and, most importantly, in which communities and individuals are empowered and given the ability to improve their own mental health and mental well-being. It provides a community-based organisation with guidelines, protocols and training on effective suicide prevention. It is so important that we equip ourselves with the ability to deal with everyday stresses and everyday life. Most importantly, education is key. It is important that we have a constant and direct link between the Department of Education and Skills, the Department of Children and Youth Affairs and my own Department of Health.

One of the main goals in Connecting for Life is to target approaches to reduce suicidal behaviour and improve mental health among priority groups, most specifically among young people. The best way to reach our young people is through education and within our schools. There are several key actions which have been identified to further this goal. I will not go through them all but they are there. They are part of the overall policy objectives of the Department of Education and Skills. They are supported by my Department and the HSE through the inter-agency implementation arrangements provided for in Connecting for Life and are overseen by the Cabinet committee on social policy and public service reform.

It is in the programme for Government that a wellness class will be added to the junior certificate cycle. That is to be welcomed. I share the Minister of State's views on the need to address issues of mental health and, more importantly, mental health well-being at the earliest possible stage. Has this been agreed with the people who will be delivering it, namely, teachers at the front line? If it has been agreed, when are we going to see the first wellness class as part of the junior certificate cycle take place? Has the Minister of State given any thought to the programme run by Pieta House? I think it is called "school resilience". I believe it to be a very good model, particularly with regard to young people. Specifically, we want to know when the first wellness class for a junior cycle student will take place.

Unfortunately, I cannot give the Deputy a set timeline for that. I spoke to the Minister for Education and Skills only yesterday on this issue. Essentially, what it means is that over a three year period up to the junior certificate, students will have to partake in 400 hours of wellness classes across a variety of different sections.

With regard to school resilience and Pieta House, at the moment Connecting for Life has a strong youth element to it. There is a pathfinder project set out to implement the youth aspect of it. What I will be introducing in the next 100 days on top of that is a youth mental health task force that will build on the pathfinder project and specifically focus on education at an early stage. The problem that we face is that many mental health problems manifest themselves much earlier than we feel comfortable talking about. We need to implement some sort of educational programme at a primary school level. There will also be a second dimension to that task force which will involve non-political, non-departmental individuals who are currently working and have a keen interest in advancing our services. Programmes, such as the school resilience programme, will be taking from what is best practice, what is out there and how we can best implement it together.

It does not sound like much of a priority if the Minister of State cannot even give us a date. It should be a priority and one that is accompanied by identifiable targets, dates, times, etc. We welcome the task force on youth mental health. Will the Minister of State give us some insight into the individuals who will be involved? The plan is that it will be established within 100 days. That is very much to be welcomed. We would like to know who is going to be on the task force.

To go back to my earlier question on the junior certificate cycle, is there agreement? We all know that there are issues around the junior certificate cycle with the people who are delivering it. Has this been agreed with teachers directly?

Unfortunately, as this is specifically within the Department of Education and Skills, I cannot give that information to the Deputy. However, I will give her a commitment that I will speak to the Minister of Education and Skills. As far as I am concerned, it is at an advanced stage. We should see it being implemented soon.

With regard to the specific individuals on the task force outside of the Department and the political sphere, I cannot give the Deputy the names because I do not have all of the names. They do not know themselves. That is a work in progress. The specific Departments that are going to be working with the taskforce will be the Department of Education and Skills, the Department of Children and Youth Affairs and our own Department. I have spoken to both Ministers in that regard and both of them are very much on board and their staff are willing to work with us on a continuous basis in order that it is a priority. This is something that will be worked on every week with all three Departments.

Health Services Funding

Dessie Ellis


11. Deputy Dessie Ellis asked the Minister for Health his progress, in conjunction with the Health Service Executive, in securing funding to complete episodes of scheduled care commenced in 2015; the amount of funding required to complete these episodes; how many episodes of care are outstanding for 2015; and if he will make a statement on the matter. [13695/16]

In January 2015, my predecessor introduced maximum permissible waiting times for inpatient and day case treatment and outpatient appointments of 18 months by 30 June and 15 months by year end. As the House will know, additional funding of €51 million was approved in 2015 to maximise capacity across public and voluntary hospitals as well as outsourcing activity where capacity was not available to meet patient needs. HSE figures for the end of December 2015 show 95% achievement for inpatient and day case waiting lists and 93% achievement for outpatient waiting lists against the 15 month maximum wait time.

The HSE has advised that €28 million of the funding provided was utilised in 2015. Expenditure on this initiative has continued into 2016 in respect of those patients who had been referred for appointments in the latter part of 2015, as well as those who had commenced treatment which could not be completed before year end.

In addition to the almost 40,500 patients who have already been treated under the 2015 initiative, there are currently 700 patients who are in the process of completing their episodes of care. The HSE has provided assurances that all episodes of care are to be completed by 20 June and that all treatment providers have been apprised of this deadline. Final expenditure on this initiative will be available after the end of this month, once all episodes of care have been delivered.

The outcomes of this initiative will inform the implementation of the programme for partnership Government commitment to provide €50 million per year to reduce waiting lists, including a sum of €15 million for the National Treatment Purchase Fund. I will be considering in the context of budget 2017 how best to utilise that €50 million, inclusive of the €15 million, to tackle waiting lists. I will await the end of this period of care at the end of the month in terms of how to best evaluate that.

The National Treatment Purchase Fund is simply code for privatising a problem. We do not support that. We support investment in our public health service. There is €50 million of continued investment - that is it how it is termed - per year and yet the ministerial brief given to the Minister advises that there was only €28 million of funding spent in 2015. There is clearly a deficit in those figures. Was this primary funding or additional funding?

In terms of what the money is spent on, exactly how many episodes of care did this cover for the year?

I also fully support the public health service and want to see investment in it, and I want to see the committee we set up yesterday devise a vision, a plan and funding costs for how to get the service to the place we all want it to be over the next decade.

Not privatisation.

I also recognise the NTPF as a useful vehicle at a time when there are people at home who could be watching our questions session today and who are in need of an operation, where perhaps the capacity does not currently exist within the public health service.

There needs to be investment in front-line services.

While we will disagree on the extent of that, it is very much my position and that of the Government.

With regard to the €50 million, €51 million was provided in 2015 and the Deputy is correct in regard to the ministerial briefing. Some of that funding has spilled over into 2016 in terms of pay. The €50 million referred to in the programme for Government is not something that would have been available in my ministerial briefing. It is a political commitment by me and in the programme for Government to allocate €50 million in the budget.

That is the question I was asking.

I expect that €50 million of the health budget next year will be allocated to waiting list initiatives. As I said, I will be looking at how best to outline that. I will provide the Deputy with some of the figures later.

Mental Health Services Report

Brian Stanley


12. Deputy Brian Stanley asked the Minister for Health the status of the review of A Vision for Change being undertaken, including the terms of reference, the membership of the panel, the progress to date and when it will completed; and if he will make a statement on the matter. [13717/16]

I thank the Deputy for his question, which relates to the review of A Vision for Change which is currently being undertaken. In January 2006, the Government adopted the report of the expert group on mental health policy, A Vision for Change, as the basis for the future development of mental health services in Ireland. It advocated, first, a holistic view of mental illness and an integrated multidisciplinary approach to addressing the biological, psychological and social factors that contribute to mental health problems; second, a move away from traditional institutional-based care to a patient-centred, flexible and community based mental health service; third, a person-centred treatment approach which addresses each of these elements through an integrated care plan, reflecting best practice, evolved and agreed with both service users and their carers; and fourth, the aiming of interventions at maximising recovery from mental illness, building on the resources within service users and within their immediate social networks, to allow them to achieve meaningful integration and participation in community life. This is something all of us want, namely, to be part of our community and be able to contribute to our community. Fifth, it advocated the organisation nationally of mental health services in catchment areas for populations of between 250,000 and 400,000, with specialist expertise provided by community mental health teams, which are expanded multidisciplinary teams of clinicians who work together to service the needs of service users.

A Vision for Change has guided national mental health policy for the past ten years and, as we all know, that term has come to an end. While that vision has not changed, the Department is currently finalising a request for tender for a review and analysis of international evidence and best practice in the development of mental health services, including a review of current delivery of services in Ireland. This review will provide evidence to determine the policy direction for a revision of A Vision for Change. The review will also have regard to both human rights and health and well-being objectives. At that stage, the exact timeframe for completion of the revised policy direction will be determined by the planned analysis outlined above.

The vision of A Vision for Change was never realised, although it was Government policy for five years under Fianna Fáil and further five years under Fine Gael. If the Minister of State talks to any person working in our mental health services, they will tell her the goals that were set out within A Vision for Change were not only not reached, they were not even nearly reached. All that happened is that the big psychiatric hospitals were closed but the community services that were promised were never put in place. I represented people working in the mental health services for years and we watched closure after closure and repeated failures by successive Governments, which did not put in the community care that is so essential.

We do not need another report, we need to have concrete action in terms of how mental health services are going to be protected into the future. In particular, we need to refer to the fact staffing levels are at 23% below what is needed. The Minister of State will be aware targets were set in A Vision for Change but none of those targets were reached in any discernible way. With regard to the review and everything else that will take place, will there be ring-fenced funding and if so, will that be raided like the Government raided it the last time? Can we have confidence that we will see a priority and focus on mental health?

To agree with the Deputy, when this document was published in 2006 we possibly did not foresee the financial circumstances in which we would find ourselves in the following years. However, in the last number of years the implementation of A Vision for Change has been given greater priority, with the Government providing an additional €160 million in ring-fenced funding for mental health in the period 2012-16. In view of that additional funding, we have had 1,550 additional posts in that field. However, I am very much aware there is a difficulty in obtaining and maintaining staff. Only this week, the HSE is reintroducing a one-year post-registration programme in psychiatric nursing for nurses who are already in the general field, in intellectual disability or in the children division. While I understand it is not enough, 30 posts are being made available from August onwards. A lot of work needs to be done in that regard.

As the Deputy said, there is no point conducting a review and having it sitting on a shelf, doing nothing. There needs to be a continuous assessment and continuous review, given times have changed since A Vision for Change was published in 2006. We know that the manner in which we implement our policies and our framework must change dramatically. While it will eventually be published, this review will be continuously reviewed and the implementation will be reviewed.

Is it intended that mental health service users, their advocates, workers in the service and people with a material interest in the findings of this will have an opportunity to have an input into it? Does A Vision for Change, and the priorities set out therein, remain a priority for the Government? If so, will the Minister of State confirm that the workings of the task force will not hinder or impede the implementation of A Vision for Change any further?

It would be my intention that the report will be brought before the committee so it could be discussed not just by ourselves and by Deputies but also, as Deputy O'Reilly said, by those who have an interest in it, such as the service users, the providers and the professionals themselves.

Perhaps the Minister of State misunderstood my question. I asked if these people would have an opportunity to have an input into it, not simply to read the report when it is completed.

The review of A Vision for Change will allow the different individuals to have an input to this. We will need to look at best practice and at international norms, which will include asking those who are in the field and within the service. The Deputy asked if this is a priority, and it most certainly is. The fact is we have committed to increase spending on mental health year upon year, although I cannot give the Deputy a figure for that increase. We have committed to implement the review and implement A Vision for Change, and also to implement Connecting for Life and the priorities set out in that.

Written Answers are published on the Oireachtas website.