Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Tuesday, 5 Feb 2019

Vol. 978 No. 8

Ceisteanna Eile - Other Questions

Dietician Service Provision

Dara Calleary


47. Deputy Dara Calleary asked the Minister for Health the action being taken to reduce waiting times for dietician consultations in County Mayo; and if he will make a statement on the matter. [5401/19]

At the end of October, we received information from the Minister that 635 people were on waiting lists for dietician services in County Mayo and that 226 of them had been waiting for more than a year. This affects every cohort of the population, including teenagers and older people, with conditions linked to obesity and diabetes. What plans does the Minister have in place to address these waiting lists? What is the current state of the dietician service in County Mayo?

I thank Deputy Calleary for the question. In line with the all-party vision set out under Sláintecare, the Government is prioritising investment in the expansion of primary care services, including dietetics. Overall funding for primary care increased by more than €50 million, or 6.1%, in the HSE's national service plan for 2019. Among other things, this will enable the recruitment of additional nurses, therapists and other health professionals such as dieticians. I acknowledge the role of Deputy Calleary's party on this during the budgetary process.

I understand that the dietician service in Mayo has been under particular pressure as some staff are on extended leave, while the number of referrals rose significantly during 2018 to 830 compared with 425 in 2017. Nonetheless, despite these pressures, the number of individuals waiting for treatment fell from 700 at the end of 2017 to 523 at the end of 2018, a reduction of 25%. I recognise a large number of people are still waiting, and although such progress is to be welcomed, the numbers waiting to access this important service are still too high. I am very aware of the stress this can cause to families.

With regard to measures now being taken specifically to improve access times further in County Mayo, I can inform the Deputy that community healthcare area west recently completed panel interviews for senior dietician posts, which will fill two dietetics vacancies in Mayo, and dieticians are adapting their working methods by using web texts and opt-in letters to enable them to plan clinics more effectively. Although it is too early to determine the impact of these measures, it is anticipated that they will help to improve access times throughout the county during 2019.

I have asked the HSE to outline specifically the impact of these measures on waiting times for those seeking the service in County Mayo in 2019, and it has said it will revert to the Deputy directly.

I welcome the news of the appointment of two new dieticians. Will the Minister confirm the timeline for these appointments? When will they take up their positions? Will they be assigned to cover the entire county? How many of the 523 people on waiting lists in 2018 had been on it for more than one year and how many were under the age of 18? I ask that particular emphasis be placed on the cohort aged under 18 so their treatment is prioritised. This is causing concern to a number of my constituents, including parents of children with particular difficulties. Given the focus we have as a nation on obesity, early intervention through this service is crucial to preventing conditions such as diabetes taking hold down the line.

Some of my statistics are not exactly in the order the Deputy has asked for, but I will get the information for him from the HSE. The number of clients waiting for treatment at the end of 2018 was down to 523 from 700 in 2017. Of these, the number waiting for more than 26 weeks was 216. I will try to get the Deputy more information. I do not have information in my briefing on those under the age of 18 but I will get it for the Deputy.

At present, four dieticians work in County Mayo, with three other staff on extended leave, which has led to significant pressures. We now have two additional appointments, which will bring the number back to six. I am told the appointments are to be made shortly and I will get a specific timeframe for the Deputy. I will ask the HSE to revert to him on this and ask that it pays particular attention to the cohort aged under 18.

With regard to the other innovative developments that local staff have introduced in Mayo, which are to be welcomed, the opt-in letters are issued to those who have been waiting a long time to check whether they are still in need of the dietetic service in primary care. This makes better use of the dieticians' time. Web texts now issue approximately one to three days before an appointment reminding clients of the date, time and location of their clinic to help avoid issues of non-attendance. I pay tribute to the local HSE Mayo staff for these innovations.

Hospitals Capital Programme

Marc MacSharry


48. Deputy Marc MacSharry asked the Minister for Health when a permanent cath lab will be located at Sligo University Hospital; and if he will make a statement on the matter. [5400/19]

Against the backdrop of the overruns in the cost of the children's hospital, there is considerable concern about the provision of a cardiac catheterisation laboratory facility at Sligo University Hospital. A review has been going on for more than a year. There is concern about the provision of the laboratory and the provision of other capital projects in the region as a result of the children's hospital cost overrun. Will the Minister outline a timeline for when it will be provided, particularly against the superior influence, it seems, that the Minister of State, Deputy Halligan, has over Deputy McLoughlin from the Minister's party in terms of the provision of a second cath lab in Waterford while we still wait for one in Sligo.

Deputy McLoughlin has plenty of influence within the party structures and the Government structures. I thank Deputy MacSharry for the question. The Government is committed to ensuring that all citizens have access to safe, high-quality and evidence-based care, in line with international norms. Sligo University Hospital, which I had the pleasure of visiting recently, provides high-quality healthcare to the people of Sligo, Leitrim, south Donegal and west Cavan. At present there are two cath labs based in Galway that service acute cardiac cases for Sligo and the north west. For elective cases there is a mobile cath lab unit that operates two days per week in Sligo.

It is important to note that specialist cardiac catheterisation laboratory services are provided in a small number of hospitals to ensure that the services provided achieve the required standards of safety, quality and sustainability in the interests of patients. I want to check whether there is a fair distribution of these throughout the country because I have heard the concerns of Deputy MacSharry and others about how they are located. For this reason, I established the national review of specialist cardiac services. This is ongoing and it is expected that its work will be completed in June. The aim of the review is to identify where we should have the cath labs to achieve optimal patient outcomes at population level and an optimal configuration of a national adult cardiac service.

As set out in the national development plan, investment in such laboratories and other cardiac services nationally will be informed by the outcome of the national review. This was sought by Deputies on all sides of the House. It will provide us with the detailed information we need by June, and I will certainly act on it then.

I thank the Minister, but unfortunately the facts do not bear out what he has said. Is the review that was commissioned and begun in January 2018 being prepared in Aramaic, hieroglyphics or some other ancient text or form of writing? It does not take a year. I do not mean any personal disrespect to the Minister, but increasingly Ministers are becoming commentators, and very expensive commentators at €190,000 a year, telling us a review is taking place. A five year old child looking at the map could tell us about the gaping wound in the north west with no cath lab while there are two in Waterford. Before anyone from Waterford attacks me for saying Waterford is not entitled to them, I am not saying that. I am saying it is clear what type of review is required. Clearly, it is just a tactic to state it is under review. When did the last meeting of the review group take place? When is it reporting? How much does it cost? We must tell the truth to the people in the north west.

We do have to tell the truth but I would not have a five year old deciding where to locate our specialist cardiac services.

Perhaps we should when we look at some of the decisions that have been made.

Perhaps we should but I would like doctors to decide that. The national review of specialist cardiac services is independently chaired by the very eminent Professor Phillip Nolan who is president of Maynooth University. He is an independent chair. The aim of the national review is to achieve optimal patience outcomes at population levels. The scope of the national review is broad and was welcomed by many in the Deputy's party. It is badly needed. The report will examine services for adults that address elective, urgent and emergency need for hospital-based diagnosis and treatment of cardiac disease. That will include diagnostic and interventional cardiac procedures and associated interdependent services.

There are 15 members on the steering committee. The Deputy will be pleased to know they include healthcare professionals and, crucially, patients. Patient advocacy is important in this area. Officials from the HSE and my Department are also on the steering committee. The review will also consider responses gathered from public consultation. There has been an opportunity for people, including those from the north west, to have an input into review and I believe a number of people from the Deputy's part of the country gave their views. The steering committee will report in June. It will recommend the best service configuration for a national adult cardiac service. I understand how important and sensitive this matter is in the north west. That was made clear to me on my recent visit to Sligo.

The problem we have is the overrun in the national children's hospital and all of these capital projects we are told are now going to be put on hold. There is no specific information on which projects will be affected yet but we are all concerned. St. Patrick's Hospital in Carrick-on-Shannon and Shiel Hospital in Ballyshannon are both new hospitals and have been announced, expected and celebrated in press releases and photocalls by the Minister and his colleagues. Many capital developments are due to take place in Sligo University Hospital. There were also lots of photocalls, etc., but the Government should show us the money and the building. When are these projects going to happen?

We are worried about the level of autopilot and commentary from the Government. I do not mean that personally, but that is how this looks. We want leadership from the Minister and the Taoiseach. They should show us the money and tell us the facts. We certainly do not want the kind of autopilot that seems to be at play in the context of the national children's hospital. It appears that will have an adverse impact on the provision of a cath lab for the people of the north west. There is none there at the moment. Some 550 people a year, treated at the moment at a cost of €10.6 million to the Exchequer, are being shipped to Galway for treatment. The cost to rent the temporary truck that wheels in two days each week is €3.6 million, as the Minister mentioned. If that money was banked, it would make much more sense to finance a cath lab and put the staff in place as well.

That was a good effort but there is no linkage between the national children's hospital and the decision to provide a cath lab in Sligo.

There is one budget.

Let me explain why that is the case. We will make that decision on the cath lab in Sligo based on the clinical advice and the report that will be given to us by the national review group in June. I do not think that is being a commentator; that is asking medics and patients to come together under an independent chair and look at the best and fairest way to distribute specialist services across our country. While the national children's hospital will take up approximately 20% of my Department's capital budget - by the way 25% of our population comprises children - 80% of the budget will be spent on items that have nothing whatsoever to do with that hospital. There will be significant increases in capital expenditure in health. That is clear to see. The budget for the next ten years is almost €11 billion compared to just €4 billion for the past ten years. That will enable us to invest in furthering services in the north west, not just the cath lab but the additional bed block that is badly needed at Sligo University Hospital. I will keep the Deputy informed as this review comes to a conclusion this summer.

Mental Health Services Provision

James Browne


49. Deputy James Browne asked the Minister for Health if he will report on the construction of the National Forensic Mental Health Service complex at Portrane, County Dublin; and if he will make a statement on the matter. [5262/19]

Will the Minister report on the construction of the National Forensic Mental Health Service complex at Portrane, County Dublin?

I thank the Deputy for the opportunity to update the House on this project. My colleague, the Minister of State, Deputy Jim Daly, visited the project this afternoon. I am pleased to advise that construction is currently under way for the National Forensic Mental Health Service Hospital and is due to be completed at the end of the year. It is anticipated this new facility will open in 2020, following its equipping and commissioning. The new 170 single-bedroom National Forensic Mental Service Hospital is designed to facilitate segregated high and medium secure services. It will include a number of shared facilities, which will comprise the 130-bedroom National Forensic Hospital to replace the existing 94-bed Central Mental Hospital complex at Dundrum. It will also include a co-located ten-bedroom forensic child and adolescent mental health unit and a 30-bedroom intensive care rehabilitation unit, ICRU.

The new complex will position Ireland’s forensic mental health service as a world leader in best clinical practice. Developing mental health services remains a priority for the Government, as I know it is for the Deputy. Budget 2019 provided an additional €55 million for new developments in mental health, which brings overall HSE mental health funding to nearly €1 billion this year. This funding will help to make mental health services more person-centred, user-friendly, responsive to need, and recovery orientated. Separate from the project team responsible for the construction and commissioning phases of the new facility, the HSE recently established a high-level governance group for the transition of the forensic mental health service from the old Central Mental Hospital, Dundrum, to Portrane.

I hope the service provided within the new hospital in Portrane will be world class. The difficulty with this project is similar to much of our healthcare and concerns whether it will be possible to access the services provided. That provision will put us at approximately just two such beds per 100,000 people. The international norm is between five and nine per 100,000. We are significantly behind and this has led in the past to some significant criticisms from Professor Harry Kennedy. He has been critical of the difficulty of getting people in our prisons with serious mental health issues into the Central Mental Hospital due to a lack of places. Is this project is expected to finish on or under budget?

The short answer is "Yes". I was out there today and met with the team. We have continued to engage with them. I must also compliment the HSE which has been successful in this project. It began clearing the site in 2017 and the keys will be handed over by the builder in October 2019. The project is coming in within budget. No issues are arising in that respect. The completion date is ahead of schedule and it will be a state-of-the-art hospital. From a capacity point of view, and to address the issue that the Deputy raised and the fears expressed by Professor Kennedy and others, we are going from 92 beds in the Central Mental Hospital in Dundrum to 170 beds in the new facility in Portrane. That is almost a doubling of capacity when it comes to forensic mental health. As the Minister said, there will be a ten-bed CAMHS unit and a 30-bed ICRU. Capacity will be significantly improved as a result of this development. It is a testament to the ability of the HSE to deal with and manage this project very well, thus far. I acknowledge that.

Perhaps the Minister of State might examine why this project was able to come in on time and on budget in comparison to the national children's hospital. He has been economical with the numbers in respect of 170 beds. We are moving from 92 to 130 forensic beds. The other beds are welcome, but ten are for children and 30 are for intensive rehabilitation. They are additional beds, which are needed, but they are not replacement beds. We are comparing the current 92 beds to 130 beds that will be provided.

It was highlighted previously that about 28 people were waiting in prison last summer to get access to the Central Mental Hospital. Does the Minister know how many are currently waiting to access to that hospital? How many patients within the Prison Service are being serviced by inreach teams from the Central Mental Hospital?

I differ with the Deputy's view that this is not an increase in capacity. I accept that the ten CAMHS beds may not be an increase in capacity but the other 30 ICRU beds in that unit are intended to get people out of the system. We are not just building a prison; we are building a hospital that is transformative, where there is care and from where people will progress. That is why there will be an ICRU. That is a progressive step and it will be ideally suited to many of the patients currently in the Central Mental Hospital in Dundrum. That is, therefore, an increase in capacity. We have 160 beds, so we will be going from 92 to 160. I agree with the Deputy in respect of the prison population and the lack of opportunities for them. That is especially the case with rehabilitation to improve their well-being and move them on from the system. That is very much the focus. An ICRU is a first for Ireland. It is a progressive development and one to be acknowledged by all.

EU Directives

John Brassil


50. Deputy John Brassil asked the Minister for Health the action he is taking to address the concerns being expressed regarding the falsified medicine directive; and if he will make a statement on the matter. [5264/19]

Louise O'Reilly


67. Deputy Louise O'Reilly asked the Minister for Health if he is seeking a corporate transfer of responsibility in moving the responsibility for the provisions of the EU falsified medicines directive from the pharmacy owner or proprietor and onto pharmacists and employees; and if he will make a statement on the matter. [5315/19]

Tony McLoughlin


68. Deputy Tony McLoughlin asked the Minister for Health if his attention has been drawn to the concerns expressed by HSE hospital-based pharmacists with regard to the provision of the EU falsified medicines directive and the statutory instrument that will be used to make it law here; and if he will make a statement on the matter. [5274/19]

On 9 February, the EU falsified medicines directive will come into operation. Many concerns have been raised with the Minister, particularly by the cohort of hospital pharmacists. These issues include who is liable, the status of those pharmacists as HSE employees and not owners of the pharmacy, which is a major concern, staffing and IT requirements needed to implement this directive, technical problems that may occur which take precedent to the safety of the patient and a consultation regarding a statutory instrument. Has that now been finalised and will it be in place prior to 9 February?

I propose to take Questions Nos. 50, 67 and 68 together.

The safety features delegated regulation introduces new rules for the supply of medicines from 9 February 2019. As Deputy Brassil noted, the safety features include a form of an anti-tamper device and unique identifiers embedded in a two-dimensional barcode on the pack. The purpose of the regulation is to improve patient safety and maintain confidence in the safety of medicines supplied to patients.

A statutory instrument will provide that the Irish legislative system is consistent with the requirements of the regulation. Nothing in the new regulations seeks to alter the existing legal and regulatory responsibilities of persons authorised to place medicinal products on the market or supply them to the public. It will apply to manufacturers, wholesalers, pharmacy owners and pharmacists equally.

The regulation provided for a three-year transition period, starting in 2016, to facilitate preparation for its introduction. Details of the requirements of the delegated regulation have been communicated to all sectors during this period by the Irish Medicines Verification Organisation, the Health Products Regulatory Authority, the Pharmaceutical Society of Ireland and the Irish Pharmacy Union.

I recognise the sincere concerns raised by stakeholders and articulated by the Deputies regarding the practical implementation of the regulation. Above all, I want to ensure the normal supply of medicines to patients is maintained. I intend, therefore, to implement the system in a pragmatic manner and defer operating the offences provisions in the legislation for an initial period. This will allow everyone involved to develop familiarity with the new arrangements and overcome any teething issues before we proceed to the introduction of the provisions that deal with offences.

I considered the implementation issues and, on 25 January, decided that a pragmatic approach should be taken to the use of the system. This approach will ensure there is no break in the supply of medicines to patients, which is crucial, until the new system is bedded in, alleviate the concerns of pharmacists as to whether the offences and enforcement provisions would be commenced on 9 February and ensure that the offence's commencement and the proposed pragmatic implementation period will be subject to ongoing review. These three policy decisions, which I took at the end of January, were communicated by the implementation stakeholders to all parties concerned on Monday, 4 February in a co-ordinated manner, and have been well received by such stakeholders. We are trying to do what we need to do under the regulation and to achieve what we need to achieve, but in a pragmatic way that does not rush in offences until the new system is bedded in.

I welcome the Minister's response. Forgive me for not being up to date with the matter but 4 February was only yesterday. While many pharmacists who have contacted me, and Deputy O'Reilly and all the other Deputies will be delighted that a pragmatic approach is being taken, one or two issues arose. I was in contact with a number of pharmacists who were partaking in a pilot project to see how it would be implemented. On that pilot project, approximately 80% of the medicines put through the system were returned with a red flag, that is, if the medicine was operational at the time, the pharmacist would not have been able to dispense it even though he or she knew it was perfectly safe to do so.

There is much work required, therefore, to get the system working and operational. Particularly in the hospital setting, space, storage and IT systems are critical. I submitted a parliamentary question about robotic dispensing, which some hospital pharmacies have but most do not. There needs to be a levelling of the playing field in that area.

I welcome the deferral of the offences and the engagement that will happen, but will the Minister reconsider the manner in which the statutory instrument is being enacted? The directive places the responsibility on the corporate entity but the manner in which it will be implemented places much responsibility directly on the pharmacist but does not place enough emphasis on corporate responsibility. The employer has no obligation, for example, to provide the infrastructure or resources for a worker to carry out his or her duty. While it is all very well to defer the offences, if someone is guilty of an offence, regardless of when the offence might be introduced, there will be no allowance for the fact that it might not be his or her fault. There should be some obligation on the employer, therefore, to ensure the pharmacist has the best chance of not falling foul of the law.

I was not expecting the House to reach Question No. 68 but I heard the end of the Minister's statement and welcome it, although I hope he will send out a brief on the matter. Similarly to the other Deputies, I have been approached by HSE hospital-based pharmacists who had concerns about the matter. The Minister's comments are welcome and I hope we will continue to negotiate or, at least, that we will receive detailed updates from him.

A rare moment of harmony is to be welcomed. I thank Deputies Brassil, O'Reilly and McLoughlin, along with other Deputies, for their advocacy on this issue and for highlighting people's concerns. I will reflect on Deputy O'Reilly's comments and revert to her.

We will adopt a pragmatic approach. Once the new system becomes live on 9 February, it should be considered to be in a use-and-learn mode. Pharmacists will be able to continue for a defined period to dispense packs unless they have an overriding concern that a falsified medicine is involved. Within the defined period, which will possibly be between six months and a year, further intensive work can be carried out to devise and communicate a workable EU-wide process for the management of alerts and ensure that all parties affected by the regulation comply with its requirements and can join the new system. There will be a review by regulators after three months to assess the initial implementation period and whether the pragmatic approach needs to be continued for a further period. After 9 February, pharmacists will continue to carry out the professional product checks that they have carried out to date, which are important when dispensing any medicine to a patient.

Some other EU member states have voiced concerns about implementation at a technical group meeting in Brussels last week. While we cannot speak for them, it is likely that other member states, due to their size, will have similar implementation and alert problems and may well also operate a national pragmatic approach, such as that taken by Ireland.

I welcome the pragmatic approach. It is clear the Minister has read and listened to the concerns of the industry, but I reiterate the specific issue of hospital pharmacies. In a public hospital, the pharmacist does not have the authority to determine the human resources, space, logistics and equipment necessary to comply with the directive. All those factors must be taken into account to allow hospital pharmacists to carry out their duties without fear of being liable because they are not the hospital owner.

I look forward to working with the Minister and his Department on the implementation of the directive. Anything that improves safety of products is to be welcomed but must be done in the pragmatic manner we discussed.

We look forward to working with the Minister to implement the directive and I welcome that he will reflect on the points I made. They are practical points and are not made for any reason other than my belief that it is a little unfair to shift that level of responsibility onto an individual without placing the same level of responsibility on the employer to ensure compliance.

Another issue that was raised and must be considered is what will happen in the event of an IT malfunction. I welcome that the Minister will engage in some consultation and that there will be an opportunity to review. I ask that the concerns I have raised be taken on board.

Hospital pharmacists had concerns and I welcome the Minister's comments on them. He mentioned the date, 9 February, and I wish to be associated with his remarks on the matter.

It is fair to say that in recent weeks concerns were raised by hospital pharmacists and other pharmacists about who might be prosecuted for a breach of the statutory instrument, as noted in my initial reply. Pharmacists who are employees of a pharmacy owner or the HSE are concerned that if they were to dispense a medicine where the pharmacy was not connected to the new system through an omission of the employer or issue a medicine that failed in its alert, they could end up being prosecuted. The concerns that were raised were valid and helped to inform the decision that while certain elements of the statutory instrument will be commenced before 9 February, the offences provision will not be commenced for a period afterwards to let the final registrations of the new system take place, the system be bedded down and a definitive alert system be developed.

There are some challenges remaining, including the impossibility of predicting the volume of alerts and identifying the percentage which are true alerts. It would probably be a small percentage. There is also the matter of possible medicine shortages while alerts are investigated and medicine supply must be a key priority. We must also manage good communication between parties and queries from pharmacies about refunds for products with alerts. Ireland will proceed to implement the regulation, but it will do so in a common sense and pragmatic way. As I said, I do not expect that we will be alone in this with regard to the position of other EU member states.

Cancer Screening Programmes

Lisa Chambers


51. Deputy Lisa Chambers asked the Minister for Health the number of women who have received a notification asking them to take another smear test in view of the fact their original one was made unreliable as a result of being delayed; and if he will make a statement on the matter. [5255/19]

How many women have received a notification asking them to take another smear test in the light of the fact that an original test was made unreadable or unreliable as a result of a delay arising because of the CervicalCheck scandal? The Minister made a political promise last May to extend free smear testing and it resulted in 84,000 additional and unscheduled smear tests being added to a system that was already overloaded. He might have been aware at the time that this would put additional pressure on the system and the political promise he made was not resourced.

The Deputy's party leader raised this matter in the Dáil last Tuesday week and referred to me making this "political promise", as she calls it, against official advice. I hope the Deputy or Deputy Michéal Martin will clarify the official advice I was not following because I clarified for the House this afternoon that I followed the advice of my officials, including the Chief Medical Officer, in providing this important reassurance for women. It was welcomed by many members of the Deputy's party and across the House.

The Deputy made an important point about resources, but it is an issue of capacity. As I stated to Deputy Kelly, it was almost impossible to estimate how many would take up the offer of reassurance or how long the period of unease would be. Almost 350,000 screening tests were submitted to CervicalCheck laboratories during 2018, of which approximately 82,000 are still being processed. The increased workload has led to delays in the reporting of results. Results are being reported, as I stated, on average within 22 weeks of the test being taken. Owing to this processing backlog in the period April to December 2018, a proportion of cervical screening samples were not transferred to slides within the six-week timeframe. Repeat testing was required in 550 cases or 0.25% of total samples. This compares with a rate of 0.23% for the same period in 2017. CervicalCheck contacted the women concerned and their GPs to inform them of this issue and invite them to attend for a repeat smear test in three months, as repeat tests can only be carried out three months after the last test to allow time for cells to grow back.

I am conscious that there are two matters and I want to be clear on them. As I indicated, Quest Diagnostics has advised of an issue related to a number of human papillomavirus, HPV, tests carried out outside of the manufacturer's recommended timeframe of 30 days. The HSE advises that, subject to final confirmation, approximately 4,600 women will require a retest - the original estimate was 6,000 - and that the vast majority of letters to the women concerned have now issued. The clinical risk is deemed to be exceedingly low. I know that is a message all of us and patient advocates will want to get out. The two separate issues are the backlog, with 550 women recalled for repeat smear tests through their GP, and HPV testing, which has resulted in 4,600 women being recalled on a precautionary basis for a retest, despite the clinical risk being exceedingly low.

The Minister has said the Chief Medical Officer advised him to offer reassurance, but was he advised to offer repeat free smear tests to every woman in the country who wanted one? Was that the clinical advice given to the Minister? My information is that he was advised this would put additional stress on the system, that the capacity was not available and that he was repeatedly advised, month on month, to end the free smear tests because the backlog had started to build. There has been an attempt to muddy the waters with references to tests in 2015 that had expired. The focus is on the additional tests that took place from May to December last year, with 80,000 to 100,000 additional and unscheduled smear tests putting extra pressure on the system. We do not know the clinical impact of that decision and the delays. When will the backlog be cleared? When a woman presents for a smear test today - she may have high-grade or low-grade changes - her test will not be read for six months. If there is an interpretation of a smear slide that there are low-grade changes, the second part of the test - the HPV element - is necessary to decide if a colposcopy is required. The impact of a delay meant that women were not reassured, but rather there was additional panic and anxiety because of the lack of results. The six-month waiting time is an average and the wait is beyond six months for some women. As the Minister has said not all women have yet been notified, is he saying some of the 4,600 women in question are waiting for a letter? Another impact is delayed referral for a colposcopy and potentially delayed treatment. When will the backlog be cleared and has everyone in question been contacted?

The Deputy has said I was advised month on month to end the repeat smear tests by officials, I presume, or medical experts working for me or the HSE. I ask her or her party leader to clarify who advised me to do that. I have told her in this House that I worked hand in glove with the officials in my Department, including the Chief Medical Officer, at a very intense time. I could reference some of the calls made by the Deputy's party colleagues who sought free repeat smear tests to be provided, but I will not. They were making such calls for good reason, with members of my party and Members across the House. It was one of the primary queries coming to the helpline. I took the decision, but I did so with bipartisan support across the House. GPs spoke about the importance of being able to provide a repeat smear test without being worried about whether a woman could afford it if she sat in front of them looking for it.

As I indicated to Deputy Kelly in response to his similar question, the clinical advice given to me by the HSE is that the risk is very low, although I do not in any way suggest waiting does not cause worry and stress. On the specifics of HPV testing, there were 4,600 women who would require a retest on a precautionary basis, despite the clinical risk being exceedingly low. My briefing tells me that the vast majority of letters to the women concerned have been issued, but I will get the Deputy a very specific figure.

CervicalCheck became aware of this matter in November last year and we are now in February. Why have some women in the group of 4,600 not yet been notified three months on? When will the backlog be cleared? If a woman presents for a smear test today, when will she receive her results? My understanding is that, with current capacity, it will take in excess of one year to clear the backlog. Will the Minister update the House on how he is getting on in securing extra capacity and resources, as it is my understanding he is finding it difficult to source the extra capacity? Why are we still waiting to inform some of the women, as the Minister knew about this last November? When will the backlog be cleared? What is the update on increasing capacity and resources?

Accuracy is important. I did not know about this last November; I knew on 5 December that there was a potential issue highlighted by Quest Diagnostics that might or might not have required action, and that work was being done in that regard. I understand that only as recently as this week did my Department finally receive the report from the HSE as it was a major body of work to, first, ascertain the exact women who needed to be recalled and if there was a need for the precautionary retest to take place. I have been informed that there are 4,600 women who will need to be offered a retest as a precautionary measure arising from better quality assurance resulting from Dr. Scally's report. I will check how many are outstanding and revert to the Deputy directly as, truthfully, I do not know the number.

The Deputy is entirely correct that we are finding it extraordinarily challenging to find additional capacity because there is a cytology shortage globally. The Deputy will accept that it is not an issue of writing a cheque or providing more funding. The HSE - particularly Mr. Damien McCallion - is working extraordinarily hard and due to provide me with a capacity report in the coming weeks that I will be happy to share with the Oireachtas and relevant committees. The HSE is working extremely hard in trying to find additional capacity which is vital to clear the backlog.

When will it be cleared?

With some laboratories the backlog is beginning to decrease as levels begin to return to more normal levels, but it has not decreased in all laboratories. Currently, the average waiting time is 22 weeks, which is far too long for women, for whom I understand it is causing significant concern. I want to see it reduced. Extra capacity is key in that regard. I should point out that not all of the backlog is due to repeat smear tests as other women entered the screening programme for the first time who had never been involved with it. That is, of course, good.

Home Care Packages Provision

John Curran


52. Deputy John Curran asked the Minister for Health the provision he will make for home support services for the elderly in view of the significant increase in the number of persons waiting for home support services; and if he will make a statement on the matter. [5026/19]

The Minister will recall that in 2018 many people had significant difficulties in accessing home support services, particularly elderly people and those who had been discharged from hospital. What level of provision of home support services is the Minister making available in 2019 in recognition that last year there was a constant significant waiting list for services?

Home support is an important support that enables older people to remain in their homes and communities for as long as possible. It also facilitates timely discharge from acute hospitals. As a Government, we have made improved access to home support services a key priority. In the past four years we have seen sustained investment in these services, with a considerable increase of nearly €140 million in the budget, which has grown from €306 million in 2015 to almost €446 million this year.

The HSE's national service plan provides for a target of almost 18 million home support hours to be provided to 53,182 people. This represents an increase of 800,000 hours and home support for 2,682 more people over last year's target. In addition, 235 intensive home care packages will provide 360,000 home support hours for people with complex needs. Despite this significant level of service provision, demand continues to rise.

While the existing home support service is delivering crucial support to many people throughout the country, it needs to be improved to better meet the changing needs of people. That is why we propose to establish a statutory scheme for home support which will improve access to the service and put it on an affordable and sustainable basis, while also introducing a system of regulation that will ensure public confidence. This is a significant and complex undertaking, and the Sláintecare implementation strategy commits to the introduction of the statutory scheme in 2021.

I thank the Minister of State for his reply. I acknowledge the increase in figures he has outlined. It is fair to say that last year was problematic. It is an indication that we have an ageing population that is growing. Most public representatives would have had an increased number of people presenting at their offices looking for support.

The Minister of State has indicated that there will be home support services for 53,000 people. Last year the budget was for 50,500. Most times we asked questions, there were 52,000 to 52,500 people in receipt of service. At the same time, there were 6,000 to 7,000 on a waiting list. If the 52,500 is added to 6,500, there were 59,000 people looking for home support services at any given time. Making a service for 53,000 available does not seem sufficient to meet current need. Will the Minister of State look at that in the context of the constant demand last year, where hours were being recycled or diminished, and in the context of the problem for elderly people in hospital in particular where they are trying to come home and that demand is not being met by the number of hours being made available?

I would be the first to acknowledge that we will not meet the demand that will be there this year. We do not have an infinite budget and there are many competing demands that we discuss all day every day on the floor of this House such as more pay for the nurses, the drugs we want approved and so on. There are so many competing budgets, and this is just one more cog in that wheel, but €140 million over a four-year period is a very significant increase by any standard. It has allowed for an increase of 800,000 home help hours this year. I can categorically and regrettably state that we will not meet the demand for home help this year. There is no point in my pretending to dress that up in any way. I am sure the Deputy and I will have this conversation again during this year and that we will debate it many times during Leaders' Questions, but we have a finite budget and, as in all the other areas, the demands are increasing. That is why we have undertaken to do a statutory home care scheme where we can provide to everybody. That is our ambition for 2021 and significant work has been done, even by the Health Research Board, looking at Germany, Sweden, Scotland the Netherlands where they have similar schemes in operation. We are trying to build a scheme along those lines. That is complex challenge.

I recognise that the Minister of State does not have an infinite budget and has to work within constraints. In that regard we need to consider how things are done. For somebody who on a delayed discharge from hospital, there is an opportunity cost. When I asked a parliamentary question and got a response from the HSE, I was told that the number of direct employees of the HSE providing home services is reducing. The dependency on agencies to provide this type of service is increasing. Does the Minister of State believe that is the best value for money rather than having direct employees? Is there scope to examine that and increase capacity?

Something peculiar has been going on in my area, which falls under community healthcare organisation, CHO 7, that needs to be addressed. In March 2018, there were 724 people waiting for home support services, but by August that figure had gone up by over 50% to more than 1,100 people. That is out of kilter with all of the other figures. I do not expect the Minister of State to have the response here but I would like him to consider it directly. In terms of cost saving, will an analysis be done between using agency staff with a diminishing number of HSE direct employees, which had been the previous model? Would that be a way to provide additional hours?

We will try to get the best value for and best utilisation of the limited budget we have. While I have not focused on managing the existing system, neither have I directed many officials to spend time on that. I could start tinkering around the edges of the existing system, but there are problems with training and regulation, supply and the postcode lotteries, as they are referred to. There are myriad challenges in the existing system. I have taken the political decision to move away from that and develop, from the ground up, a new system that is fit for purpose and that will address many of these issues collectively.

I will certainly look into the disparity in the Deputy's area that he asked about. It seems unusual for it to jump by 50%, particularly in those months.

The Minister, Deputy Harris, has asked me to chair an implementation body on delayed discharges, so that is an area in which I have a particular interest. I absolutely accept the financial point the Deputy makes that we can be penny wise and pound foolish, but there is a cost basis to this and we will be considering that. I will focus keenly on that with a view to tackling the issue of delayed discharges in the acute hospital system, because I have responsibility for the home care service. I will come back to the Deputy about his local query.

Hospital Waiting Lists

Anne Rabbitte


53. Deputy Anne Rabbitte asked the Minister for Health the reason 3,135 persons have been waiting for an outpatient consultation in University Hospital Galway since before 1 January 2017; and if he will make a statement on the matter. [5258/19]

Why have 3,135 persons have been waiting for an outpatient consultation at University Hospital Galway since before January 2017? Will the Minister for Health make a statement on the matter?

I thank Deputy Rabbitte for raising this matter. It is quite timely because improving access to hospital appointments and procedures is a key commitment of Government and of hers. As a result of some of the work we have done together in recent budgets I hope to publish the joint Department of Health, HSE and National Treatment Purchase Fund, NTPF, scheduled care access plan 2019 shortly. This will set out commitments aimed at improving access for patients waiting for hospital operations or procedures. We have made a lot of progress on that side over recent months and years. It will also set out commitments for patients waiting this year for a first outpatient appointment, in keeping with the HSE national service plan and the increased funding totalling €75 million given to the NTPF this year.

Access to outpatient services remains a significant challenge although we have seen significant reductions in the number of people waiting for an operation or procedure, but outpatients remain the big challenge. That is what we need to focus on. In 2019, more than 3.3 million patients will attend HSE outpatient clinics while the NTPF will fund an additional 40,000 first outpatient appointments.

The outpatient waiting list figures for the end of December for University Hospital Galway show that there were more than 39,000 patients waiting for a first appointment, 71% of whom were waiting 12 months or less. These numbers are still far too high. There has been some stabilisation of the waiting list compared with December 2017.

Last year I met the CEOs of all hospital groups, including the Saolta hospital group, which has responsibility for Galway, and asked them to come up with outpatient initiatives, including the use of virtual clinics to address outpatient waiting lists so that we can fund new initiatives this year. Some progress has been made by the Saolta hospital group as a result of new initiatives, including an 11% reduction in the number of patients waiting in excess of nine months for an ear, nose and throat, ENT, appointment, a 30% reduction in those waiting over nine months for a rheumatology appointment, and a 42% reduction in the number of children waiting more than nine months for a paediatrics appointment. The Deputy's question is timely because we are finalising the outpatients plan, and in light of her raising this issue, I will specifically and personally consider the issues at University Hospital Galway and make sure that Saolta is bringing forward plans to benefit from the additional outpatient funding available in 2019.

The Minister's response is very welcome. There are long waiting lists of 12 months or more in many outpatient departments: urology, orthopaedics, paediatrics, plastic surgery, respiratory, dermatology and gynaecology. This comes up daily in my clinic as people try to get their first appointment. People are very frustrated. If the Minister could link with, and make a priority of, the Saolta group, we could put pressure on to ensure this is not put on the long finger but is delivered as quickly as possible. That would bring great comfort to many in the west. The hospital is a centre of excellence. It is a level four hospital and covers Donegal, Roscommon and Mayo as well as Galway. It is vital that the NTPF considers the outpatients department as quickly as possible.

I agree with what the Deputy said. I assure her that we will do that. I will take the opportunity to put some of the new measures to deal with outpatient waiting lists that are being tried in the University Hospital Galway on the record of the House. There is a urology pathway pilot scheme which should result in significant progress on wait times. The plastic surgery service in Galway has been running an innovative "see and treat" clinic. This involves patients attending outpatient appointments and, where a minor surgical intervention is required, receiving it on the same day. Approximately 220 patients were treated in this way last year. The National Treatment Purchase Fund, NTPF, agreed to fund this initiative from September 2018 onward, with an additional 143 patients accessing the service. Galway University Hospital has also put in place virtual clinics for ear, nose and throat, ENT, and vascular services. This is only appropriate for certain conditions, but should result in an improvement.

We have an issue with patients not attending and the hospital is working on this. Some 8,494 new patients and 28,689 review patients did not turn up for their appointments in Galway University Hospital in 2018. I am not blaming the patients but these figures show that there is a need to maximise attendance. The hospital is looking at a text reminder service and at overbooking clinics so that, if some people do not turn up, another patient will be waiting to be seen. Saolta is going to continue to work on that. I will certainly reflect on the Deputy's comments. We will make sure that Saolta and Galway benefit from the additional resources we have in place for outpatients and inpatients for 2019.

I would have liked the Minister to address the issue of paediatric diabetics in Galway University Hospital in his commentary. Perhaps he can come at it again. This is an ongoing issue. Patients have to go to Limerick or Dublin for some services. It is an ongoing outpatient issue. Perhaps it is due to hospital appointments or something like that - I do not know - but this issue, which affects children, is often raised in my office. I welcome the fact that progress is being made in the area of ENT services. Issues with the ears, nose and throat can affect everyone from the very young to older adults. Everything the Minister has said today is welcome, but action on delivery is what we are really looking for. The results will only be known when the figures come to hand.

I thank Deputy Rabbitte for raising the specific issue of paediatric diabetics. I will certainly look into it and either myself or the HSE will revert to her directly to see if we can make improvements in that regard. I thank the Deputy very much for highlighting the issue.

Written Answers are published on the Oireachtas website.