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Dáil Éireann díospóireacht -
Tuesday, 18 Oct 2016

Vol. 925 No. 1

Other Questions

Home Care Packages Funding

Catherine Connolly

Ceist:

20. Deputy Catherine Connolly asked the Minister for Health the funding made available for County Galway and south Mayo for home help packages in 2016; if his attention has been drawn to the fact that as a result of going over budget early in the year to relieve the pressure on the hospital, the service has now been severely curtailed with the result that there are both delayed discharges and delayed admissions to the hospital; the steps that have or will be taken to make sufficient funds available to rectify the situation; and if he will make a statement on the matter. [30393/16]

Has the Minister of State's attention been drawn to the crisis in home care packages in Galway and the fact that the budget was overspent? There is now a severe crisis with delayed discharges and admissions in the hospital. Will the Minister of State address whether her attention has been brought to that and, if so, what she will do about it?

I thank the Deputy for raising this issue. It has been brought to my attention. The original allocation for home care packages and home help hours in 2016 for counties Galway and Mayo is in the region of €27.3 million.

Home care services across the country are being stretched by demands from more people and for more hours in the evenings and at weekends, all of which cost more. Activity in the first quarter of 2016 was ahead of the same period in 2015 as efforts continue to alleviate pressure on the acute hospital system. Without additional funding, this could not have been sustained and the allocations for the rest of the year would have been reduced. The Government has been able to respond to this situation by providing an extra €40 million for home care in 2016, of which community health care organisation area 2, which includes Galway and Mayo received almost €5.5 million.

According to the HSE delayed discharges report, as of 27 September 2016 there were 30 delayed discharges in Galway University Hospital. Of these, five people had submitted applications for home care. On 11 October 2016, the HSE reported that this had reduced to 21 cases with two applications being processed for home care.

As part of the winter initiative €1.8 million funding has been made available to provide six new home care packages each week from October to February at Galway University Hospital. This will provide for 114 new home care packages over the winter period. The hospital is also being provided with an average of 16 transitional care bed approvals per week throughout the course of the year.

I am pleased to say that overall funding for services for older people has increased to €765 million in 2017, which is an increase of €82 million. In a situation where demand continues to grow, as the Deputy rightly pointed out, challenges remain in managing home care budgets. However, the increased resources provide additional flexibility to managers who are responsible for meeting these challenges in the different geographic areas within the resources available.

I did not catch whether the matter has been drawn to the attention of the Minister of State. Has she spoken with the hospital in Galway and with Galway Primary Care? That is a specific question.

As a result of the cutbacks in Galway city, there are patients in the hospital who cannot be discharged and, as a result, patients cannot get in. I refer to one particular case where the patient had to stay in bed and breakfast accommodation. Meetings are taking place on a weekly basis and the role of the public health nurse has been extended in order to reduce the number of home care packages and home help hours patients are getting. I have an urgent message on my phone about a patient in the hospital. I will not go into it because we are in the Dáil Chamber. The patient's recommended package is 21 hours, which gives an indication of the seriousness of the medical condition. The public health nurse's role is to reduce that number. They are now at eight hours and they are negotiating in a situation where 21 hours is recommended.

I thank the Deputy again. It is something that has been brought to my attention. I have not been at the hospital yet but I hope to be in Galway in the coming weeks. It is something I can address at that stage. I am aware there have been exceptionally high patient numbers recorded, particularly in Galway - 224 on 27 September and 233 on 10 October were recorded. Similarly there has been a high number of patients who have required acute admissions. There are about 40 emergency department admissions each day. Many of the patients are elderly and have a variety of conditions, some of which the Deputy has outlined.

I reiterate that €1.8 million has been allocated to Galway University Hospital in the winter initiative to provide the six new home care packages and 114 home care packages over the winter period. In last year's allocation, we spent approximately €330 million, including €20 million in time related savings which accounted for 15,450 home care packages and 10.4 million home help hours. I cannot tell how many hours and home help packages the additional funding for this year will result in. When the service plan is drawn up, each area, including the CHO we are discussing, will receive additional home care packages and home help.

It is difficult to digest the figures the Minister of State has given. Presumably I will get a copy of all those figures. I will bring those figures down to a personal level. I do not like bringing stories into the Dáil Chamber but I have to do it to illustrate. The Minister of State is talking in general figures and increases. Currently in Galway there is a patient who is not unique - I will not say whether the person is male or female - who cannot be discharged because the recommended number of hours cannot be given. How can the Minister of State stand over that, given the cost of keeping someone in hospital, at a conservative estimate, is €1,300 and in a nursing home is €800 to €1,200? Home care is the cheapest, most effective and best way on a human level. How can the Minister of State stand over a situation where somebody cannot be discharged and the public health nurse has been given the terrible role of reducing the number of hours? Is the Minister of State standing over that type of system?

This is a situation we have all found ourselves in throughout the year. The number of people seeking home help hours and care packages at the beginning of this year reached an unprecedented high and without the €40 million in additional funding this year we would possibly see even more cuts than we see across the board now. We will be spending €68.4 million more on home care packages and home help next year than we are this year. I do not like to put it into figures because we are talking about somebody's mother, grandmother, brother or sister. Without that additional funding, we will not be able to provide the additional support. I cannot give the Deputy the exact figures of how much will go to CHO area 2, which covers the hospital the Deputy has asked about. It will be decided in the coming weeks. I will provide the Deputy with the figures I have discussed here on the increases this year and next year.

Ambulance Service Provision

Eugene Murphy

Ceist:

21. Deputy Eugene Murphy asked the Minister for Health if he envisages significant improvements in ambulance service provision in 2017; and if he will make a statement on the matter. [30683/16]

I want to ask the Minister for Health if we will see significant improvements in ambulance service provision in 2017. I am particularly interested in my constituency of Roscommon-Galway. Rural Ireland has to be looked at in a different way in terms of ambulance cover. There is a problem with response times. It is not acceptable. The delivery of unrealistic timelines for ambulance response in rural areas has not been tackled and patients are being left waiting.

I thank the Deputy for raising this important issue. It is one he has raised with me before. The national ambulance service has undergone a programme of modernisation in recent years and a number of significant service innovations and developments have taken place. These include the establishment of the National Emergency Operations Centre, a state of the art facility, from where all call-taking and ambulance dispatch is now undertaken. The centre also houses the ambulance training college.

We have had substantial investment in new technology and fleet to help improve ambulance service provision. The intermediate care service has been introduced to provide inter-hospital transfers for some lower acuity patients, as we have already discussed, and this is freeing up more emergency ambulances for more urgent calls.

We have also established the emergency aeromedical support service to provide rapid access to appropriate treatment for very high acuity patients in remote rural areas where access by land ambulance may be difficult or take too long.

I am fully conscious of the need for a multi-annual programme of phased investment in ambulance manpower, vehicles and technology. In that regard, I assure Deputy Murphy that increased funding will be available to the national ambulance service for 2017. The detail of the improvements to be funded will be provided in the HSE's 2017 national service plan. Over the coming weeks my Department will work closely with its counterparts in the HSE and the national ambulance service to agree priorities for the 2017 allocation. I will reflect the Deputy's concerns in that regard.

The Minister addressed this with a deputation he met from Roscommon University Hospital. I thank him for that occasion because there was a great expression of views. The Lightfoot Solutions report, commissioned by the HSE and published in May, stated that the national ambulance service required 750 more staff and 250 more ambulances to ensure delivery of a safe and swift service. Only one in 15 ambulances are reaching patients in need of emergency care within the eight minute target in rural Ireland. That is not acceptable, considering that 60% of patients in rural Ireland live another 45 minutes or more from an accident and emergency department. That is the reality if one lives in central Roscommon and one is trying to get to Galway. The least we can do is ensure that emergencies are dealt with in a timely fashion by the ambulance. Our accident and emergency service has been cut and other accident and emergency services in rural areas have been closed. The one thing we must have, and which we were promised, is a proper ambulance service. That is what is required in the constituency of Roscommon-Galway.

I will make two points about the Lightfoot Solutions capacity report. I am familiar with the report as it was the first thing to land on my desk when I was appointed Minister for Health. First, it requires a multi-annual funding plan. Nobody in this House or working in the national ambulance service believes we can implement all of the recommendations in the Lightfoot Solutions report in one year, but what we can and must do is show progress year on year. Recently, I met the unions representing the ambulance personnel and I visited the national ambulance service co-ordination centre to discuss this. In 2017 more funding will be spent on the national ambulance service than in the current year, and this year we spent more on it than we did last year.

There is another point, and the Deputy mentioned it with regard to ambulance response times. The Lightfoot Solutions report is an external report by a UK firm, the first such report on our ambulance service. It stated that even if it were possible to put in place all of the required ambulance personnel and the extra ambulances, and they are not all available even if we had the funding, there would still be an issue in rural Ireland due to how our population is dispersed compared with the UK. According to Lightfoot Solutions, that involves examining the role of community first responders and the role of the air ambulance. We must be honest with each other on these issues. Even when we make the improvements to the ambulance service, these target times will require new ways of being examined.

I was surprised, but delighted, to hear the Minister say there will be increased funding for the national ambulance service. Why has a review of the role of advanced paramedics as part of the national ambulance service in the mid-west been announced? This has been confirmed by the ambulance service. There have also been meetings about it, including one in Tipperary. I presume that this review will mean there will be more advanced paramedics, given the closure by the Fianna Fáil and Green Party Government of the accident and emergency departments in Nenagh and Ennis. The advanced paramedics were in place to deal with the fact that there is a large geographical area which ambulances will not reach in time. I presume there will be more paramedics as a result of this review, rather than fewer. I know what I am talking about here. My parliamentary assistant would have died were it not for the fact that one of these advanced paramedics reached her in time.

I thank the Deputy for raising this. I will have to revert to him about the specifics relating to the mid-west, but I thank him for making me aware of the details about the advanced paramedics. I envisage an important role for advanced paramedics. I am providing more funding to the national ambulance service for the coming year than was provided for this year, and more funding was provided this year than was provided last year. However, I will revert directly to the Deputy on the issue.

Deputy Alan Kelly is a woeful man at getting in the back door, even when it is locked. I tabled the question and I should get my two minutes.

Deputy Murphy is as familiar as I am with the Standing Orders.

I accept that. I learned from being in the Chair that Deputy Alan Kelly is good at this.

I wish to make another point to the Minister. A great deal of money is wasted when a number of ambulances attend accidents on the roads where one ambulance would suffice. I know what happens. An accident occurs and all of the ambulances are sent in the same direction, whether a garda, doctor or nurse arrives at the scene. Twice recently I was the first person to arrive at the scene of an accident. One person was injured and thankfully nobody was killed. One ambulance and one fire service vehicle would have been sufficient. A great deal of time is wasted and many ambulances are taken out of service for a period of time when that happens. My suggestion is that a person in authority could ring the centre to let it know that only one ambulance is needed.

The issue the Deputy raises should no longer occur because we have a national emergency control centre. It is a single control centre over two sites, Tallaght and Ballyshannon. We have nine regional call centres which have been merged into the national centre, to ensure there is greater visibility and that the resources are deployed as effectively as possible. All emergency calls to the national ambulance service are now received and dispatched from the national emergency control centre. We also have the use of technology, such as digital radio, computer aided dispatch and mobile data terminals, to allow the NAS to use resources more effectively on a national basis, rather than in small geographical areas, using a single computer aided dispatch platform. I visited the centre recently to see how the service now has sight of all of the ambulances. If the Deputies are interested in seeing more of this or meeting with the NAS or visiting the centre, I will be happy to arrange it.

Hospital Waiting Lists

Bernard Durkan

Ceist:

22. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he and his Department have precisely identified the most common causes for long waiting lists in respect of various elective procedures; when he expects these issues to be resolved with the objective of bringing waiting times to the minimum; and if he will make a statement on the matter. [30613/16]

This is the old chestnut of trying to identify the long waiting lists for various elective procedures, the causes of them, the most common delays experienced and whether it might be possible to put in place remedial measures to deal with them.

I thank the Deputy for raising this timely and important question. A key challenge for our health system is to ensure that patients have timely access to health services, in light of significantly increased demand. The overall demand for hospital treatment is increasing year on year in line with a growing and ageing population and the expanded range of treatments thankfully made possible by new technology. The Central Statistics Office, CSO, estimated an increase of almost 1% in the total population between April 2015 and April 2016, with the number of people in older age groups increasing at a faster rate. For example, the number of people over 85 years of age is currently increasing by 3.3% per annum. Thank God for that, but it puts extra pressure on our health service.

Every year there are over 3 million outpatient attendances at our hospitals and in the first half of 2016 there was an increase of over 4% in the number of outpatient attendances compared with the same period last year.

My Department works closely with the HSE and the National Treatment Purchase Fund, NTPF, to implement measures to try to improve waiting times. At my request in August, the HSE developed an action plan to reduce, by year end, the number of patients currently waiting 18 months or more for an inpatient-day case procedure. I expect it to deliver on that plan.

In addition, within current resources, the NTPF is currently implementing an endoscopy initiative which aims to ensure that by year end no patient will be waiting 12 months or more for an endoscopy procedure. We all know the importance of driving down that waiting time, and it has reduced in the last two months in a row.

Furthermore, €7 million of the winter initiative funding is to be utilised to fund a targeted waiting list programme - the Deputy is correct that targeting particular areas is important - to provide treatment for patients waiting for orthopaedic, spinal and scoliosis procedures.

Finally, budget 2017 provides for the treatment of our longest waiting patients. A sum of €20 million is being allocated to the NTPF. It is the first ring-fenced allocation to drive down waiting lists for a number of years. That will increase to €55 million in 2018. That is a total of €75 million for 2017 and 2018 specifically to use all the resources across the health service, public and private, to drive down waiting lists. Planning of this initiative is at an advanced stage by the NTPF, my Department and the HSE. I expect to receive proposals on this shortly, but the target will be those waiting the longest and areas of acuity where there is particular difficulty.

To what extent have individual and precise areas been examined with a view to identifying what might be done in the short term to alleviate some of the delay problems? For example, delays in waiting to see a consultant is a common cause put forward by patients. Subsequently, the next delay occurs when waiting for the procedure. What are the contributory factors in that regard? Is it due to a shortage of bed space, a shortage of theatre space, a shortage of theatre staff or a combination of all of them? To what extent can they be addressed and dealt with in the short term? These issues have arisen repeatedly for years. Bearing in mind the increase in population, the increasingly ageing population and the increased demand, is it not time to take an initiative that will have a telling, lasting and beneficial effect from the point of view of patients?

It is probably all of the above; it is a range of factors. It also comes after a very difficult period for the health service. Thankfully, we are now seeing re-investment in health again. However, there are some interesting points. We have a do-not-attend rate for hospital appointments of approximately 15%, which is much higher than it should be. I am not blaming the patients for this. Perhaps patients are waiting too long and by the time the operation can be carried out it is not needed or circumstances have changed. We must ensure we are reminding patients to turn up for their hospital appointments as well. People are given a scheduled appointment and they might forget to attend, but that costs the health service a great deal. It also wastes a large number of hospital appointments. We must drive that down. A do-not-attend rate of 15% works out at approximately 60,000 missed attendances at our hospitals every year.

That is an awful lot of hospital appointments and wasted time for doctors. In the circumstances, I plan to introduce a reminder system involving SMS messaging very shortly. That system will be important. We also need clinical verification. We need to ensure that people on waiting lists still need to be there and that they have not been referred to more than one doctor for procedures. We also need to see more procedures being performed in the community, which is the big win. We need to see GPs obtaining access to diagnostics. Many GPs tell me that it is a bugbear for them to be obliged to refer someone to an outpatient appointment to access a test they know they could provide themselves. I will revert with a suggestion I have in a moment.

I will not shock the Minister because I have asked him about this matter on a number of occasions. We have proposed an integrated system of waiting lists. It is a very good system. In fact, the Minister is on record as saying that it has some merits. I have contacted the Minister's office several times and he has said publicly that he would like to meet us to discuss the matter. I am happy to meet him for that purpose. I have contacted his office a few times but, as yet, no arrangement has been made. We need an integrated waiting list system that will address a large number of the issues referred to in Deputy Durkan's question. Could we have some time allocated to address that and could we know in advance how much of the budget the Minister has allocated to an integrated waiting list system or a similar system? It works in Portugal and could work very well here.

To what extent have we made comparisons with other jurisdictions that have similar population age profiles with a view to identifying what the obvious causes were? To what extent have any comparisons been made in respect of the primary care centres and their impact on the kind of thing to which the Minister has just referred? This relates to whether primary care centres are intercepting patients requiring procedures that can be performed at such centres, having particular regard to the very sophisticated nature, scale and size of the centres that are now being provided.

I am always happy to talk to Deputy Louise O'Reilly. While we have not had a specific meeting on this, we did have a good exchange at the Joint Committee on Health and I believe there is merit in her suggestion. However, there is a missing piece, although it is not the Deputy's fault. It concerns knowing what is on the waiting list. The fact that we do not have a unique health identifier means we do not know how many times a person could appear on a waiting list. The key to unlocking the potential in the Deputy's suggestion is the unique health identifier. I have asked the e-health people in the HSE to look at the Deputy's suggestion in that context. The next step in any reform of waiting lists is putting in place the unique health identifier so we can establish exactly how many times people appear on waiting lists. At present, nobody knows if a patient is on a waiting list multiple times for multiple doctors because the health service lacks the ability to identify individual patients. The unique health identifier is due in 2017 and is a really important element. I will keep in touch with the Deputy about this matter.

In response to Deputy Durkan, the primary care centres are very important but not if we just consider success to be bricks and mortar. It is what happens within the primary care centre that matters, which is why we need a new GP contract. Access to diagnostics is a huge piece. I want to work with the Department of Finance to fulfil a commitment in the programme for Government to see how we deliver diagnostic equipment in the community.

Question No. 23 replied to with Written Answers.

Home Care Packages Funding

Billy Kelleher

Ceist:

24. Deputy Billy Kelleher asked the Minister for Health the extra provision that is being put in place for home-care packages and home helps in 2017; and if he will make a statement on the matter. [30643/16]

Could the Minister of State make a statement about the extra provision for home-care packages and home-help hours in 2017? In view of the supplementary budget earlier in the year and the additional €491 million allocated for health in budget 2017, we are back to where we were in terms of peak spending on health in 2007. It is important that a clear outline is given to ensure that the money provided to the HSE actually goes where it is supposed to go in terms of home-care packages and home-help hours, as identified by the executive itself in 2015.

I thank Deputy Kelleher for raising this question. To return to what Deputy Connolly said, we are not just talking about figures but people's parents, brothers and sisters. I am pleased to say that overall funding for services for older people has increased to €765 million in 2017, which is an increase of €82 million since the HSE's 2016 service plan. As Deputy Kelleher rightly pointed out, the 2016 service plan included €40 million in additional funding, €10 million of which is under the winter initiative and €30 million of which was allocated to home-help hours. This has focused on additional funding for home care in particular and is aimed at allowing people to continue to live in their own homes and at facilitating discharge of older people from acute hospitals.

Since the Government took office, it has significantly increased the funding available for home care. An additional €40 million, which included €10 million as part of the forthcoming winter initiative, already provided in 2016 represented an increase of over 13% in the total funding available and means that the number of home-care packages provided this year will increase from 15,450 to 15,800 and home-help hours from 10.4 million to 10.57 million.

The winter initiative will also provide another €1.4 million for home care this year, which will result in the provision of a further 650 packages by year's end. These will be targeted at ten specific hospitals to allow people to be discharged home quickly. During 2016, the number of home-care packages being provided will have increased by 1,000. As stated previously, we will not know the amount of home-care packages and home-help hours until we finalise the sign off of the service plan this year.

In 2017, €14.6 million of the winter initiative will be to fund home care. There will be another €3.8 million to maintain existing levels of service and €10 million for new developments. Details of the services to be provided with these funds will be set out in the coming weeks.

I thank the Minister of State for her reply. We talk about the winter initiative. The winter initiative should be over, above and beyond home-care packages and home-help hours. That should be systemic in terms of delivery of care. We already know that large numbers of people are presenting in the accident and emergency departments of our acute hospitals day in and day out, particularly during the winter period, because people do not have access to community services, out-of-hours GP services, proper home-care packages or sufficient home-help hours. With all of that, we consistently seem to be of the view that when there is a shortage in budgets, we fund the acute side and diminish the capacity of the primary care and community care services, which is why we continually have difficulties in our hospitals. I am concerned that we use the winter initiative to dolly up announcements towards the tail end of the year when there should be systemic investment in this area as part of planning for the future in terms of demographic changes, the changing population and associated challenges.

I agree with the Deputy. The winter initiative is only one part of this. If we look at the figures and the experts, the number of people over 65 will double in the next 30 years and the number of people in their 80s will quadruple. That does not just happen in winter and we need to be able to provide the resources throughout the year. This is the reason that we have increased and will increase funding by €68.4 million this year alone. It shows that we are committed to increasing on a year-on-year basis. In particular, the focus next year needs to be reducing the community waiting lists because we know that providing a limited or smaller amount of home help or home care for somebody before they fall or end up in hospital and need to be discharged with a more intensive home-care package will save us in the long run and will save that person the trauma of having gone to hospital. The focus next year must be on reducing the community waiting lists, which we have not really been able to tackle in the past few years.

I urge that a strong emphasis be put on that in the context of requesting the HSE service plan. It is stated in the budget in terms of the commitments that are to be made with regard to older people, home-care packages, home-help hours and all the ancillary supports that are required. It is important that when assessing the reply from the HSE in terms of the plan and the analysis carried out by the Department in advance of its publication, strong emphasis should be put on that to at least underpin and put us on a sound footing with regard to the delivery of community care and home care. As we all know, this is the preferred option for the vast majority of people. Otherwise, we are back in here calling for more money for the fair deal scheme and criticising the fact that we have prolonged waits on trolleys in our accident and emergency departments.

As Minister of State with responsibility for older people, my focus this year, particularly in this budget, has been on increasing the number of home-help hours and home-care packages with increased funding. Obviously, the nursing homes support scheme and maintaining that funding have been priorities but I am acutely aware that keeping people in their homes and maintaining people within the community requires an across-the-board approach. The national positive ageing strategy - of which my Department is in charge - will progress into the next stages, which I hope will involve support from all Departments, including the Departments of Finance, Housing, Planning, Community and Local Government and Transport, Tourism and Sport, in respect of a range of areas that will make every environment more suitable for older people to remain within their communities, not just within their homes. As home help comes under my Department, it needs to remain a priority and we must continue to increase investment in those areas. As I said, community will be our main priority.

National Treatment Purchase Fund

Dessie Ellis

Ceist:

25. Deputy Dessie Ellis asked the Minister for Health the funding allocated to the National Treatment Purchase Fund, NTPF, in each of the years since its inception; the way the money was spent; the number of surgeries and services that were purchased in each of the years since its inception; the way the funding allocated in budget 2017 to the NTPF will be administered; the surgeries to be prioritised under the NTPF; and if he will make a statement on the matter. [30510/16]

This question relates to the National Treatment Purchase Fund, NTPF. I seek a breakdown of the manner in which the money was spent, the specific services and procedures that were procured and how priorities will be decided for the future NTPF, particularly in light of the fact that we have just had a discussion on the manner in which waiting lists operate and the fact it is difficult to have sight of what is needed.

The NTPF was established on a statutory basis in 2004. Since its establishment, the NTPF has carried out a range of functions, including arranging the provision of hospital treatment, maintaining and validating waiting list data, and making arrangements in respect of the price for long-term residential care services under the nursing homes support scheme. The NTPF's annual funding allocation was at its highest between 2004 and 2012 when it was involved in arranging the direct provision of hospital treatment to patients.

Since 2012, the NTPF's role has focused on the maintenance, audit and quality assurance of waiting lists, pricing under the nursing homes support scheme, and supporting the HSE in the delivery of a number of waiting list initiatives, most commonly initiatives regarding endoscopy. During this time, the NTPF has also directly delivered a number of smaller waiting list initiatives such as the endoscopy initiative in 2016. Its annual budget allocation has been aligned with these functions.

I propose to circulate with the Official Report a tabular statement setting out details of the annual budget of the NTPF and the number of patients treated per annum.

The Deputy asked for information on the procedures. I do not have that in my file but I will get the Deputy a detailed note of what was done in each of the years.

The 2017 budget provides for the treatment of the longest waiting patients. The budget allocates €20 million to the NTPF for 2017, rising to €55 million in 2018, giving a total of approximately €77 million for dedicated waiting list initiatives between 2017 and 2018. Planning of this initiative is at an advanced stage by the NTPF, my Department and the HSE. I expect to receive proposals from them very shortly. I will focus on the longest waiters. While the NTPF was very effective in getting treatments done, it did not always focus on the longest waiters. There cannot be self-selection. We must focus on those waiting the longest. We must also focus on particular specialties where there are specific delays, such as orthopaedics and scoliosis which were identified in the winter initiative. We also have waiting problems in ear, nose and throat, ENT, and some general surgery. I have asked for the longest waiting, the areas of acuity and the areas in which we have particular difficulty and I will have plans for it very shortly.

Additional information not given on the floor of the House

Tabular statement setting out details of the annual budget of the NTPF

Year

Total Patient Numbers

NTPF Care Expenditure (€m)

Revenue Grant from Department of Health (€m)

2016 (Forecast)

3,000

2.0

5.1

2015

1,092

1.0

5.1

2014

1,002

0.5

5.1

2013

1,950

4.8

17.4

2012

2,012

41.9

40.6

2011

19,217

57

85.6

2010

33,639

84

90.1

2009

28,758

90

90.4

2008

36,269

94

104.6

2007

32,638

95

91.7

2006

24,411

75

78.6

2005

18,994

60

64.0

2004

13,627

42

44.0

The Minister outlined that the NTPF performs a range of functions. It might, but not one of those addresses in any meaningful or long-term way our hospital waiting lists. I would not ask the Minister to take my word for it. Dr. Sara Burke confirmed it to the Oireachtas Committee on the Future of Healthcare when she addressed us. It is counter-intuitive to suggest pumping money into the private sector will magically have an impact on the public sector in any long-term or meaningful way. The Minister said he would target the longest waits and specific procedures. I struggle to understand how it will be done, given the conversation we have just had on the number of unknown individuals on our waiting list and the fact that we do not necessarily have clear sight of who is waiting for what procedures. If the Minister could give us some details on it, I would appreciate it.

I tend to agree that if a waiting list initiative is a flash in the pan or a one year thing it does not have a major impact. It just drives down some waiting lists for some time, after which they pop back up. This is why, in my budget discussions with the Department of Public Expenditure and Reform, my Department and I were very eager to get continuity of funding for the NTPF. This is why we are announcing not only an allocation for this year but also for next year, which allows the NTPF to gear back up. It also provides a degree of certainty for people working in the system and, most important, for patients. While we can have this ideological debate about people waiting, people are waiting too long and there is some spare capacity in parts of the public hospitals and private hospitals which we must use to try to drive down waiting lists. The Deputy is correct that we do not know everything about waiting lists. There is much we do not know, and we need more data. However, through the HSE liaising with our acute hospitals, we know there are particular difficulties. As a public representative, the Deputy knows it through her clinics that there are difficulties in orthopaedics, scoliosis and ENT cases. We will go with what we know, but we could do with better data.

We do not know enough for the Minister to say with any confidence that the NTPF will have anything other than a very short-term effect of temporarily massaging the figures. I do not think it will have any real impact. I do not think the Minister does either. Regarding the follow-up that goes with the NTPF and the purchase of private health care, we are having an ideological debate here and I am not shy about saying it. The Minister is wedded to the notion of privatising our health service and I have been elected to try to stop it. When a person is treated in the private sector under the NTPF, the Department pays for the treatment, after which the patient is discharged and goes home. If the patient needs any follow-up care, such as physiotherapy - there is precious little of that and the patient may go onto another waiting list for it, God help them - how is it done? There is no joined-up thinking between the outsourcing and the public service. Will the Minister address it?

I have no doubt we are having an ideological debate. I am just saying patients would not thank us for having one, given that they just want to know when they will get their operations. I, too, despite the Deputy's best efforts to paint it otherwise, am a major supporter of the public health service. This is why I have just delivered the largest ever budget it has received in the history of the State. However, I am not shy about saying that when there is capacity in other areas to try to help patients who are waiting too long, we will use the capacity. Follow-up care is part of the discussions between the NTPF, the HSE and my Department. We are discussing exactly what happens after a patient has a procedure and whether it will be in the private hospital or in a public hospital and who does what. It is not all about outsourcing. Some of it is about insourcing. There is spare capacity in parts of our public hospitals. I have seen it as I have visited hospitals. This will be detailed when we publish the NTPF plan shortly.

I believe it will make a difference. However, it must make an appropriate difference and it cannot be used to cherry-pick people. It must be used for acuity and certain specialties where we have a shortage in the public health service, which we will address but cannot address overnight. It must also be used to target those waiting the longest time. There must be a fairness about it.

Hospital Waiting Lists

Bobby Aylward

Ceist:

26. Deputy Bobby Aylward asked the Minister for Health the reason that University Hospital Waterford has experienced an increase of 159% in inpatient and day case waiting lists since May 2013 when it became part of the South-South West Hospitals Group and that it now accounts for more than 40% of the group waiting list compared with 23% in 2013. [30687/16]

I want to ask the Minister the reason University Hospital Waterford has experienced a 159% increase in inpatient and day case waiting lists since May 2013, when it became part of the South-South West Hospitals Group, to the point where it now accounts for more than 40% of the group waiting list compared with 23% in 2013. This is of major concern. The figures are alarming. Why is it happening and what can be done about it?

I thank the Deputy for the question. As he probably knows, I am due to visit Waterford hospital shortly and I look forward to discussing the issues with health care professionals in the hospital.

A key challenge for our health system is to ensure patients have timely access to health services in light of increasing demand. This is why we have to put a sustained focus on improving waiting times, especially for those waiting the longest, as I just discussed with Deputy O'Reilly.

The key issue is how long they wait. People appear on waiting lists, but it is when they are on waiting lists for too long that we have a problem. According to the September waiting list data published by the NTPF, 85% of patients on the inpatient or day case waiting list for University Hospital Waterford are waiting less than 15 months. I am not saying it is good enough.

Over the period 2013 to 2015, inpatient activity increased by over 11%, from 20,042 to 22,315. This is a contributing factor. The July HSE management data report points to a 4% increase in inpatient discharges and a 10% increase in day cases compared with the same period in 2015.

My Department works closely with the HSE and the NTPF to implement measures to reduce waiting times. At my request, in August, the HSE developed an action plan to reduce, by year end, the number of patients currently waiting 18 months or more, and then we go on proceeding with the NTPF, trying to drive down waiting lists throughout 2017. The endoscopy waiting list initiative started this year, and the NTPF will work with public hospitals, including University Hospital Waterford, to ensure the hospitals validate their waiting lists, identify patients who will be continue to be treated by the public hospital, and identify those patients who will be offered outsourcing of their procedure to a private hospital.

I should also mention that €7 million of the winter initiative funding is to be utilised to fund a targeted waiting list programme for patients waiting for orthopaedic, spinal and scoliosis procedures.

As part of the winter initiative, an additional five home care packages per week will be funded to support timely discharge from University Hospital Waterford. The hospital will also provide 15 additional surge capacity beds, and two complex delayed discharge cases will be transferred from the hospital by the end of the winter initiative reporting period. I accept the issue and will have it examined by the HSE.

Additional information not given on the floor of the House

The 2017 budget provides for the treatment of our longest waiting patients and allocates €20 million to the NTPF, rising to €55 million in 2018. Planning of this initiative is at an advanced stage by the NTPF, my Department and the HSE.

Waterford joined the South-South West Hospitals Group in May 2013 and the waiting list for inpatient day cases since then makes for interesting reading. My statistics do not compare with the Minister's. I will cite mine. Overall, the group's list is up 48% since May 2013, well below the national average of 62%, but Waterford has increased by 159% whereas Cork University Hospital, CUH, has decreased by 27%. In May 2013, Waterford accounted for 23% of the group's waiting list. Now, it accounts for 41%. Waterford also accounts for 60% of those waiting 12 months plus when no one there was waiting for that long in May 2013. Some 4,123 people were waiting on the inpatient day lists in August, an increase of 2,542 or 160.8%, on the 1,581 who were waiting in May 2013. While 1,120 people have been waiting longer than a year for treatment, none was waiting for more than a year in May 2013, and 168 people have been waiting for longer than 18 months. These statistics contradict the Minister's.

I thank the Deputy for bringing those to my attention. I will have my officials examine them with the HSE. In light of more home care packages, surge capacity beds and the activation of the National Treatment Purchase Fund, NTPF, for the Waterford area with dedicated funding to try to drive down waiting lists, though, we should see improvements.

I have been informed by the hospital that there have been significant increases in respect of ophthalmology, gastroenterology and general surgery. As to ophthalmology, we have seen an increase in the age profile, including the frail elderly, who require additional levels of care. The hospital is working with the HSE and the NTPF to source additional capacity for those waiting the longest. The hospital has only one gastroenterologist and is awaiting the appointment of a second consultant in early 2017, which will assist in the management of the endoscopy waiting list. The Deputy will be glad to know that this post is funded and has been submitted to the consultant application advisory committee for approval. University Hospital Waterford, UHW, is working with the NTPF to refer patients to private facilities in an effort to reduce waiting times and the number waiting.

The general surgery waiting list is affected by available theatre and bed capacity due to an overall increase in emergency referrals. The hospital is working with the hospitals group to determine where to find other elective capacity within the group.

The Minister stated that he was due to visit the hospital shortly. Will he put these figures to its management? Will he ask management to explain such a hike in the numbers? There are 30,992 people awaiting outpatient consultations, an increase of 16% since last December. Why is that? It would be remiss of me not to ask the Minister whether he will meet the consultants in Waterford and the rest of the south east and whether he will take issue with the finding of the Herity report on the second catherization laboratory, a finding that is debated in our part of the country. Even the Minister of State is having problems with it. That catherization laboratory is needed, given the concerns about the provision of a 24-7 service with the current laboratory. This is my priority. Will the Minister undertake to meet these people? There were problems with the risk assessment. The Herity report cited a risk rating of 16 out of 25 whereas the consultants and clinicians referred to a score of 20. The south east's catchment area has a population of approximately 500,000 people, but the Herity report claimed that it was only 220,000. There are contradictions. Will the Minister meet the consultants about this issue when visiting the hospital?

It is not the first time that I have been asked that question.

It is the first time by me, though.

Yes. I stand by the Herity report in full. That is why I published it in full. The report was carried out by an eminent external consultant cardiologist who examined all of these issues and arrived at his conclusions. The Herity report does not suggest that everything is rosy. It certainly suggests that there are areas that need improvement at UHW. It refers to the need for increased resources, staffing and equipment levels. I want to get on with delivering on the three issues outlined in the report in terms of improving the service before examining the situation next year to see what impact those additional resources, staff and equipment have had on the volume of patients using the hospital. This is a sensible approach. I will stand by the clinical advice provided to me by the Herity report, but I am happy to have the matter examined next year.

When I visit hospitals, as I will in Waterford in the coming weeks, of course I talk to health care professionals. I look forward to that opportunity. The Deputy might even come with me on that occasion.

What about the 24-7 service?

I stand by the Herity report and will make the improvements that it suggests.

Occupational Therapy

Margaret Murphy O'Mahony

Ceist:

27. Deputy Margaret Murphy O'Mahony asked the Minister for Health the action that is being taken to improve waiting times for occupational therapy, especially for children; and if he will make a statement on the matter. [30649/16]

I am grateful for the opportunity to raise this issue. As those opposite know, the waiting list is getting larger rather than smaller.

I thank Deputy Murphy O'Mahony for raising this important matter. She has pushed this issue as well as that of speech therapy previously.

The programme for a partnership Government commits to a decisive shift within the health service towards primary care in order to deliver better care close to home in communities across the country. Community-based occupational therapy is a key component of a multidisciplinary primary care service and can play a considerable part in supporting people to remain in their own homes and communities.

Significant additional resources have been invested in primary care and disability services in recent years with a view to enhancing therapy service provision. In particular, additional funding of €20 million was provided in 2013 to strengthen primary care services and to support the recruitment of prioritised front-line posts. As part of this initiative, the HSE recruited more than 260 additional posts for primary care teams, which included 52 occupational therapists.

The HSE has established a national therapy service review group to address therapy waiting times, including those for occupational therapies. This joint primary care and social care project will include a detailed analysis of waiting times and resource deployment across the country. The group's objective is to complete its work by March 2017. It will seek to make the services more responsive to people's needs and to put in place a standardised approach to the delivery of occupational therapy services.

With respect, the Government could be doing more. Currently, 4,370 people have been waiting for more than a year for their first occupational therapy assessments. This time last year, it was 3,081. Last year's figures were awful, so the increase is worrying. Some 3,500 people aged under 18 years have been waiting for longer than a year. Cork and Kerry combined account for one quarter of the waiting list. Is there a specific reason for this and will the Minister comment on the issue?

Occupational therapy is fundamental in assisting people who have disabilities or had accidents and need help dealing with injuries and is important for their quality of life. Will the Minister of State please do more to reduce the waiting lists for such essential services?

I take the Deputy's points. As of May, there were 1,148 occupational therapist posts across mental health primary care and social care, representing an increase of 53 posts since May 2015 and 81 posts since May 2014. The recruitment of additional occupational therapist posts is ongoing. These figures do not cover section 38 bodies. Additional therapy supports, including speech and language therapy and occupational therapy, are being put in place this year. These will be further augmented by increased funding for the continued implementation of the progressing disability services programme for children and young people with disabilities.

I have prioritised this issue and am sitting down with the HSE to draw up a service plan. Occupational therapy and speech and language therapy are on the list.

I thank the Minister of State for his reply. As he draws up those plans with the HSE, I will be watching him. I hope that he sticks to his word.

The Minister of State will agree that so many young people waiting this long for an assessment is worrying.

Occupational therapy is vital for children with conditions such as cerebral palsy, dyspraxia, spina bifida, etc. We really are at a crisis point with these waiting lists so I ask the Minister of State to do his best to reduce them.

I reassure the Deputy on these issues. I accept that in the past, particularly in recent years, there has been a lack of investment in these services so we need to build and develop them to ensure that all children receive proper occupational therapy. It is a very important part of developing a forward-looking health service that includes everybody in society.

Speech and Language Therapy Provision

Margaret Murphy O'Mahony

Ceist:

28. Deputy Margaret Murphy O'Mahony asked the Minister for Health the action being taken to improve waiting times for speech and language therapy; and if he will make a statement on the matter. [30648/16]

This question also relates to waiting lists. It is not a coincidence that this second question is again about people who have been waiting for treatment for long periods. What action is being taken to improve waiting times for speech and language therapy and will the Minister of State make a statement on the matter?

He is a fast-moving Minister of State.

Quick Draw McGrath.

He is like a hare.

I am not finished yet. There are a few more coming down the line as well.

The Government recognises that waiting times for speech and language therapy have posed significant difficulties for families and their children.

In 2016, €4 million was provided under the HSE’s national service plan to focus specifically on speech and language therapy waiting lists in primary and social care for children up to 18 years of age. This investment represents a long-term increase in speech and language capacity that will be maintained into 2017.

The HSE has also introduced a number of initiatives specifically in the area of speech and language therapy services that are aimed at improving access to these services. I refer to therapists increasing clinic-based work and, whenever possible, providing family-centred interventions in a group.

The additional €4 million in 2016 is enabling the HSE to fill 83 new full-time and recurring posts in primary care to address waiting lists, prioritising the longest-waiting children. To ensure that best use is made of the available funding while recruitment is under way, the HSE is implementing interim measures in 2016 that include temporary appointments and use of agency staff.

The HSE has established a national therapy service review group to address therapy waiting lists, including the speech and language therapies raised by the Deputy. The group will agree a revised national model of speech and language therapy provision that will be standardised across all community health care organisations as regards referral criteria, assessment and treatment arrangements, models of care and standardisation of a prioritisation system for speech and language therapy. It is anticipated that the group will have completed its work by the end of March 2017.

I thank the Minister of State for outlining the future plans but, with respect, more could be done. The numbers waiting for first assessments have increased from 14,047 to 15,545. After the first assessment, people must wait for treatment to kick in. In that regard, we have gone from 8,326 to 8,974. Of the latter, 117 people have been waiting for over two years, which is really not acceptable. Does the Minister of State find it acceptable? Two years is an awful long time in the life of a child. We speak about early intervention, which deals with children between birth and six years, so two years from that is a big fraction of a child's life. Early intervention is very important.

The number of speech and language therapists appointed by the national recruitment service from 1 June 2016 to 5 August 2016 is 92. The appointments in 2016 to date have resulted in an increase of 86 whole-time speech and language therapists, based on the 2015 HSE employment census. Of the 92 whole-time equivalent speech and language therapists appointed this year, 43 were for social care, 33 were for primary care, seven were for acute services, eight were for mental health services and one was listed as being recruited for another service.

I take the Deputy's point on speech and language therapists and this is a very important issue. One must get in early with speech and language therapy and I accept the Deputy's argument, particularly with regard to young children. This will ensure that young children will develop right through into their teenage years. I am focusing much of my service plan on this but there are other issues relating to residential, day care and respite places. Within that top five, I tell people that speech and language is very important for me. During my Estimates meeting with the Minister, Deputy Harris, I received great support for this issue. I have also received support from the Minister for Public Expenditure and Reform, Deputy Donohoe. We accept the argument that we must do something radical and invest in speech and language therapists. That process has begun and I hope we will continue that work.

Written Answers are published on the Oireachtas website.
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