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Tuesday, 18 Sep 2012

Written Answers Nos. 1567-1582

Proposed Legislation

Ceisteanna (1567, 1568, 1569)

Billy Kelleher

Ceist:

1567. Deputy Billy Kelleher asked the Minister for Health when he expects the health (amendment) Bill to be published; and if he will make a statement on the matter. [37107/12]

Amharc ar fhreagra

Billy Kelleher

Ceist:

1568. Deputy Billy Kelleher asked the Minister for Health the issues that will be rectified in the health (amendment) Bill; and if he will make a statement on the matter. [37108/12]

Amharc ar fhreagra

Billy Kelleher

Ceist:

1569. Deputy Billy Kelleher asked the Minister for Health the proposed rectifications for issues identified and to be addressed by the health (amendment) Bill; and if he will make a statement on the matter. [37109/12]

Amharc ar fhreagra

Freagraí scríofa

I propose to take Questions Nos. 1567, 1568 and 1569 together.

The Department has received advice from the Attorney General relating to a number of provisions in the Health Act 1970, which are currently being examined by the Department from a policy perspective.

Ambulance Service Provision

Ceisteanna (1570)

Billy Kelleher

Ceist:

1570. Deputy Billy Kelleher asked the Minister for Health if he will provide, in tabular form for each county or, if not available, each region, the average response times for ambulances in life threatening, potentially life threatening, and all other situations; and if he will make a statement on the matter. [37110/12]

Amharc ar fhreagra

Freagraí scríofa

HIQA requires the National Ambulance Service (NAS) to collate and publish response times data on a national basis only. NAS does have this information available (June 2012) by its three operational areas which are set out below:

NAS Area

ECHO First Response within 8 minutes (Target 75%)

DELTA First Response within 8 minutes (Target 75%)

ECHO Transporting Vehicle within 19 minutes (Target 80%)

DELTA Transporting Vehicle within 19 minutes (Target 80%)

North Leinster

64.62%

28.53%

71.54%

69.81%

South

38.64%

32.44%

84.09%

82.49%

West

36.00%

29.68%

58.00%

63.88%

Departmental Strategy Statements

Ceisteanna (1571)

Billy Kelleher

Ceist:

1571. Deputy Billy Kelleher asked the Minister for Health if he intends to publish the positive ageing strategy this year; and if he will make a statement on the matter. [37111/12]

Amharc ar fhreagra

Freagraí scríofa

The Programme for Government has committed to completing and implementing the National Positive Ageing Strategy so that older people are recognised, supported and enabled to live independent full lives. The Strategy will set the strategic direction for future policies, programmes and services for older people in Ireland. It will set out a common framework for the development of operational plans by a number of Government Departments which will clearly set out each Department’s objectives relating to older people. Mechanisms designed to monitor the implementation of measures contained in operational plans will also be included in the Strategy. However, I do not envisage that the Strategy will propose new service developments. Rather it will set the strategic direction for future policies, programmes and services for older people in Ireland. A considerable amount of preparatory work has already been completed. The drafting of the Strategy will proceed within the Department within the constraints of available staff and other priorities. At this stage I envisage that a draft of the Strategy will be brought to Government in Q4 2012.

Tobacco Control Measures

Ceisteanna (1572)

Billy Kelleher

Ceist:

1572. Deputy Billy Kelleher asked the Minister for Health the steps he will take to tackle smoking in society; the rate of smoking in 2003 for men and for women; the rates now; and if he will make a statement on the matter. [37112/12]

Amharc ar fhreagra

Freagraí scríofa

The last available Slán Survey data from 2007 indicates that 29% of people report being current smokers (31% men and 27% women). The Survey does state, however, that comparisons across the years are reported with caution because of the different survey methods utilised. Data from a survey undertaken in 2010 by the National Office of Tobacco Control in the HSE indicates a prevalence rate of 23.6% (25% men and 22.2% women). My Department is planning for the establishment of a new rolling health and wellbeing survey to provide data on the health status and other health related behaviours of the Irish population, including tobacco prevalence data. This is a priority initiative for my Department and a tender competition is underway in this regard. It is intended that the first of these surveys will commence in 2013.

As regards tackling smoking in Ireland, the Report of the Tobacco Policy Review Group will be published in the near future. This report will consider ways to denormalise smoking in society such as extending tobacco control legislation in particular for situations where children are present. It will also consider social marketing and educational programmes as well as smoking cessation services.

General Practitioner Services

Ceisteanna (1573)

Billy Kelleher

Ceist:

1573. Deputy Billy Kelleher asked the Minister for Health if he has consulted with the IMO regarding the provision of universal GP care; and if he will make a statement on the matter. [37113/12]

Amharc ar fhreagra

Freagraí scríofa

The Programme for Government provides for significant strengthening of primary care services to deliver Universal GP Care with the removal of cost as a barrier to access for patients. Universal GP Care will be achieved on a phased basis. Primary legislation is required to give effect to this commitment. Legislation to allow the Minister for Health to make regulations to extend access to GP services without fees to persons with prescribed illnesses is currently being drafted by the Attorney General's office and will be published shortly. Implementation dates and application details will be announced in due course. I have had preliminary discussions with the Irish Medical Organisation (IMO) and the Irish College of General Practitioners to outline policy in this regard. I expect to engage in further discussions with GPs/IMO as soon as the legislation is published.

Question No. 1574 answered with Question No. 1546.

Primary Care Centres Provision

Ceisteanna (1575)

Billy Kelleher

Ceist:

1575. Deputy Billy Kelleher asked the Minister for Health if he has initiated any discussions with the National Asset Management Agency regarding the use of its buildings for primary care centres, or the Minister for Justice and Equality regarding the use of unused Garda stations as primary care centres; the outcomes of those discussions; and if he will make a statement on the matter. [37115/12]

Amharc ar fhreagra

Freagraí scríofa

The development of primary care is central to this Government's objective to deliver a high quality, integrated and cost effective health system. The Programme for Government states that primary care will be an immediate priority area. The development of primary care centres, through a combination of public and private investment, will facilitate the delivery of multi-disciplinary primary care and represents a tangible re-focussing of the health service to deliver care in the most appropriate and lowest cost setting.

Within the context of its commercial remit, NAMA advises that it is at all times open to proposals which can contribute to the achievement of broader social and economic objectives and has committed to giving first option to public bodies on the purchase of property which may be suitable for their purposes.  The development of the primary care centre network is currently under review. Its delivery must be informed by needs analysis, with priority given to areas of urban and rural deprivation. Therefore it is important to recognise that not all NAMA controlled buildings and sites are appropriately located or suitable. The outcome of this review requires my approval with the consent of the Minister for Public Expenditure and Reform.

Both Minister Shortall and I have had meetings with NAMA with a view to building on potential synergies between NAMA controlled land and property and the requirements of the health sector, not just in the area of primary care, but in other areas also. The Health Service Executive and NAMA also engage constructively in this regard. Minister Shortall has had informal discussions with the OPW regarding unused Garda stations and other buildings. The Health Service Executive has also explored the possibility of making use of vacated Garda stations as Primary Care Centres. To date none have been deemed suitable by the Executive.

Health Insurance Community Rating

Ceisteanna (1576)

Billy Kelleher

Ceist:

1576. Deputy Billy Kelleher asked the Minister for Health if his attention has been drawn to the fact that private insurers are designing policies to be less attractive to older persons thereby evading community rating policies; and if he will make a statement on the matter. [37116/12]

Amharc ar fhreagra

Freagraí scríofa

I am concerned that private health insurance is becoming harder to afford, especially for older people, as insurers increasingly tailor their insurance plans towards younger, healthier customers. I am strongly committed to protecting community rating, whereby older and less healthy customers should pay the same amount for the same cover as younger and healthier people.

Community Rating means that the level of risk that a particular consumer poses to an insurer does not directly affect the premium paid. It also means that premiums for younger or healthier lives are typically higher than their expected claims would require, whereas for older or less healthy lives, premiums are typically lower than the expected claims would require. It is also useful to note that older people who have been paying health insurance premiums for many years will have supported the older generation when they were younger and could reasonably expect to benefit in a similar way as they themselves now become older.

Community Rating needs a robust system of risk equalisation. Otherwise, insurers will have a strong incentive to avoid older customers. Without risk equalisation insurers would have a clear incentive to attract and retain only healthy customers who are less likely to make claims. The Interim Scheme of Age-Related Tax Credits and Community Rating Levy was introduced in 2009 in order to provide direct support to community rating. It achieves this by way of a mechanism which provides for a cost subsidy from the young to the old.

The Interim Scheme provides that health insurers receive higher premiums in respect of insuring older people, but that older people (in six age bands ranging from 60-64 yrs to 85 yrs+) receive an age-related tax credit equal to the amount of the additional premium so that all people continue to pay the same net amount for a given health insurance product. The tax credit is provided as a tax relief at source - that is, the cost of the policy is reduced by the amount of the age-related tax credit. The Scheme is funded by an annual levy on health insurers based on the number of lives insured by them. The Scheme is designed to be Exchequer neutral, neither a cost nor a benefit to the State. It is a matter for the insurance companies as to the extent, if any, they pass the levy on their clients.

In order to keep down the cost of health insurance for older people, I was pleased to increase significantly the age-related income tax credit for insured persons aged 60 years and over, from 1 January 2012. Without this support, health insurers would have had an even stronger financial incentive to 'segment' the market by offering policies targeted at young people, to the disadvantage of older customers. It must be stressed that the measures taken are designed to result in no overall increase of premiums in the market and to spread the risk more evenly between the healthy and the less healthy, the old and the young. The increased levy is balanced by a corresponding increase in tax credits for older people to that the system is Exchequer neutral.

The Programme for Government contains a commitment to introduce a permanent scheme of risk equalisation. This is a key requirement for the existing private health insurance market and also in the context of plans to introduce Universal Health Insurance from 2016. In December 2011, the Government agreed to introduce a new Risk Equalisation Scheme (RES) with effect from 1 January 2013 which will replace the present Interim Scheme of Age-Related Tax Credits and Community Rating Levy. The new scheme will allow for a greater number of risk factors than the Interim Scheme, including a measure of health status. The legislation is currently being drafted and a Bill will be published in the coming weeks.

The new RES will be operated prospectively by the Health Insurance Authority (HIA). Funds will be collected via a stamp duty by the Revenue Commissioners. In terms of financial arrangements, the main difference between this and the current Interim Scheme is that risk equalisation payments will be disbursed by the HIA rather than by the Revenue Commissioners. The rates will be set each year by an Act of the Oireachtas.

The Health Insurance Authority (HIA) is the independent regulator of the private health insurance market in Ireland. It provides information to policy holders in relation to rights and health insurance plans and the benefits provided. The HIA's website is www.hia.ie and has a very useful health insurance plans comparison tool which may assist the public in finding the most suitable and competitive health insurance plan to meet their individual needs. The telephone number of the HIA is Lo-Call 1850 929 166 or +353(0)1 406 0080.

Primary Care Centres Provision

Ceisteanna (1577)

Billy Kelleher

Ceist:

1577. Deputy Billy Kelleher asked the Minister for Health the number of primary care centres by county in February 2011; the number now; the same figures for primary care teams in February 2011 and now; and if he will make a statement on the matter. [37117/12]

Amharc ar fhreagra

Freagraí scríofa

The information sought by the Deputy is collated by the HSE on an Integrated Service Area (ISA) basis and is set out in the attached tables. The HSE had identified a need for 518 Primary Care Teams (PCTs) by the end of 2012. This number has now been reduced to 485 PCTs, following realignment of team boundaries in some HSE areas.

Number of Primary Care Teams

Start of February 2011

End of July 2012 Out-turn

Dublin South East Wicklow

30

38

Dublin South Central

18

30

Dublin South West Wicklow

25

31

Midlands

21

20

94

128

Cavan/Monaghan

9

8

North Dublin

26

23

Dublin North City

34

22

Louth/Meath

9

17

78

70

Kilkenny South Tipperary

18

20

Kerry

8

10

Cork

45

56

Waterford/Wexford

18

23

89

109

Midwest

37

38

Donegal

12

15

Galway/Roscommon

18

30

Mayo

12

14

Sligo/Leitrim

8

10

87

107

Total

348

414

Number of Primary Care Centres

By February 2011

By August 2012

Dublin South East Wicklow

2

2

Dublin South Central

2

4

Dublin South West Wicklow

1

1

Midlands

3

4

8

11

Cavan/Monaghan

1

2

North Dublin

Dublin North City

1

1

Louth/Meath

1

3

3

6

Kilkenny South Tipperary

1

3

Kerry

Cork

2

4

Waterford/Wexford

2

3

5

10

Midwest

1

2

Donegal

1

2

Galway/Roscommon

2

3

Mayo

1

2

Sligo/Leitrim

5

9

Total

21

36

Hospital Waiting Lists

Ceisteanna (1578, 1583)

Billy Kelleher

Ceist:

1578. Deputy Billy Kelleher asked the Minister for Health if he will provide, in tabular form by each hospital, the number of patients who have had their operations cancelled or rescheduled since March 2011; and if he will make a statement on the matter. [37118/12]

Amharc ar fhreagra

Billy Kelleher

Ceist:

1583. Deputy Billy Kelleher asked the Minister for Health if he will provide, in tabular form, the number of patients who have been transferred to another hospital waiting list; and if he will make a statement on the matter. [37123/12]

Amharc ar fhreagra

Freagraí scríofa

I propose to take Questions Nos. 1578 and 1583 together.

As these are service matters, they have been referred to the Health Service Executive for direct reply.

Hospital Waiting Lists

Ceisteanna (1579)

Billy Kelleher

Ceist:

1579. Deputy Billy Kelleher asked the Minister for Health the basis on which waiting list category definitions have been changed; the definition of each category in terms of recommended operation time before and after the change; the number of patients in each category before the change; the number in each category after the change; and if he will make a statement on the matter. [37119/12]

Amharc ar fhreagra

Freagraí scríofa

I can confirm that to date there have been no changes to the waiting list data capture categorisation since the patient treatment register (PTR) was established in 2005. As you are aware a new target of 9 month maximum waiting time for daycase and inpatient surgery has been implemented. The challenge for 2012 is firstly to maintain the 12 month maximum waiting time target for in patient and day case procedures and then to continually improve and move to a 9 month maximum waiting time target.

At present the categorisation of patients within the scheduled care system is neither defined with sufficient clarity nor enacted for each patient with sufficient consistency. The lack of clarity is contributed to by some ambiguity and vagueness within the existing definitions; and the lack of consistency by insufficiently rigorous attributions within hospital data sets, and inadequate audit and review processes. Unless we succeed in introducing much higher levels of clarity and consistency, effective systems management will be impossible. In that context it is the intention later in 2012 to request clinicians to categorise their referrals as either 'urgent' or 'routine'. It is important to emphasise that determining urgency will always rest with clinicians.

Hospital Waiting Lists

Ceisteanna (1580)

Billy Kelleher

Ceist:

1580. Deputy Billy Kelleher asked the Minister for Health inclusive of inpatient, outpatient and elective treatment, the mean average length of time in terms of days for patients on waiting lists in March 2011; the same figure for July 2011; the figure now; and if he will make a statement on the matter. [37120/12]

Amharc ar fhreagra

Freagraí scríofa

The NTPF only uses the median in its calculation of waiting list times as this is the international standard for presentation. National medians waiting times for the dates requested by the Deputy are as follows:

Date

Length of time

March 2011

3 .0 months

July 2011

3.0 months

June 2012

2.8 months

The NTPF has not fully assumed responsibility for measuring outpatient waiting times. Therefore I have forwarded the question to the HSE who will respond directly to the Deputy in this regard.

Hospital Waiting Lists

Ceisteanna (1581)

Billy Kelleher

Ceist:

1581. Deputy Billy Kelleher asked the Minister for Health if he will provide, in tabular form for each hospital, inclusive of inpatient, outpatient and elective treatment, the number of patients on waiting lists in March 2011 waiting for three to six months, for six to nine months, for nine to 12 months, for 12-24 months, and for longer the 24 months; the same figures for July 2011; the figures now; and if he will make a statement on the matter. [37121/12]

Amharc ar fhreagra

Freagraí scríofa

The overall figures for inpatient waiting lists requested by the deputy is set out in the table below; I have asked the HSE to reply to the deputy directly regarding outpatient waiting lists.

National Waiting List Analysis by hospital > 3 months as at 24th March 2011

 -

3 - 6 mths

6 -9 mths

9 - 12 mths

12 - 24 mths

24 mths plus

Totals

Beaumont Hospital Dublin

1,822

537

249

208

24

2,840

Cappagh Orthopaedic Hospital

284

90

32

16

0

422

Cavan General Hospital

170

19

8

5

3

205

Connolly Hospital Blanchardstown

347

27

2

0

0

376

Cork University Hospital

488

255

110

209

41

1,103

Kerry General Hospital

29

0

0

0

0

29

Letterkenny General Hospital

372

194

62

27

0

655

Lourdes Orthopaedic Hospital Kilcreene

129

34

14

5

0

182

Louth County Hospital

102

50

1

2

0

155

Mater Hospital Dublin

1,141

660

273

32

6

2,112

Mayo General Hospital

184

81

3

0

0

268

Mercy University Hospital Cork

400

167

97

67

4

735

Merlin Park Hospital Galway

320

159

92

51

0

622

Mid Western Regional Hospital Croom

76

12

3

1

0

92

Mid Western Regional Hospital Dooradoyle

734

381

237

99

7

1,458

Midland Regional Hospital at Mullingar

383

133

42

18

6

582

Midland Regional Hospital at Portlaoise

95

31

8

1

0

135

Midland Regional Hospital at Tullamore

535

267

160

72

1

1,035

Naas General Hospital

16

1

0

0

0

17

Our Lady of Lourdes Hospital Drogheda

252

108

91

24

8

483

Our Lady's Hospital for Sick Children Crumlin

530

239

119

152

42

1,082

Our Lady's Hospital Navan

74

33

13

20

3

143

Royal Victoria Eye and Ear Hospital

271

74

18

4

0

367

Sligo General Hospital

402

140

66

58

3

669

South Infirmary Victoria University Hospital Cork

248

73

11

10

0

342

South Tipperary General Hospital

33

2

0

0

0

35

St. James's Hospital

1,154

3

0

0

0

1,157

St. John's Hospital Limerick

178

33

6

7

1

225

St. Luke's General Hospital Kilkenny

339

125

48

27

0

539

St. Vincent's University Hospital Elm Park

220

45

20

18

1

304

Tallaght Hospital (AMNCH)

722

148

66

30

4

970

The Childrens University Hospital Temple Street

118

56

22

27

6

229

University College Hospital Galway

1,778

1,167

961

415

12

4,333

Waterford Regional Hospital

671

420

279

210

23

1,603

Wexford  Hospital

98

7

0

3

2

110

Total

14,715

5,771

3,113

1,818

197

25,614

National Waiting List Analysis by hosptial > 3 months for 28/06/2012

 -

3 - 6 mths

6 - 9 mths

9 - 12 mths

12 - 24 mths

24 mths plus

Total

Bantry General Hospital

33

10

0

0

0

43

Beaumont Hospital Dublin

1,453

787

428

42

2

2,712

Cappagh Orthopaedic Hospital

368

60

0

0

0

428

Cavan General Hospital

185

13

16

0

0

214

Connolly Hospital Blanchardstown

252

153

49

0

0

454

Cork University Hospital

682

460

216

53

0

1,411

Ennis General Hospital

195

35

15

0

0

245

Kerry General Hospital

213

34

0

0

0

247

Letterkenny General Hospital

685

607

139

2

0

1,433

Lourdes Orthopaedic Hospital Kilcreene

92

25

6

0

0

123

Louth County Hospital

149

21

10

0

0

180

Mallow General Hospital

26

11

3

0

0

40

Mater Hospital Dublin

1,459

1,227

596

30

0

3,312

Mayo General Hospital

266

154

0

0

0

420

Mercy University Hospital Cork

401

239

70

2

0

712

Mid Western Regional Hospital Croom

31

3

1

0

0

35

Mid Western Regional Hospital Dooradoyle

691

481

279

1

0

1,452

Mid Western Regional Hospital Nenagh

350

78

12

0

0

440

Midland Regional Hospital at Mullingar

130

34

9

0

0

173

Midland Regional Hospital at Portlaoise

58

16

4

0

0

78

Midland Regional Hospital at Tullamore

523

224

60

0

0

807

Naas General Hospital

10

0

2

0

0

12

Our Lady of Lourdes Hospital Drogheda

336

107

32

4

0

479

Our Lady's Hospital for Sick Children Crumlin

329

126

32

3

0

490

Our Lady's Hospital Navan

67

47

0

0

0

114

Portiuncla Hospital

62

1

0

0

0

63

Roscommon County Hospital

105

32

10

1

1

149

Royal Victoria Eye and Ear Hospital

310

75

7

0

0

392

Sligo General Hospital

445

200

48

1

0

694

South Infirmary Victoria University Hospital Cork

282

114

36

2

0

434

South Tipperary General Hospital

68

4

0

0

0

72

St Columcille's Hospital, Loughlinstown

22

8

0

0

0

30

St. James's Hospital

1,109

831

107

0

0

2,047

St. John's Hospital Limerick

213

119

35

0

0

367

St. Luke's General Hospital Kilkenny

205

56

20

2

0

283

St. Vincent's University Hospital Elm Park

371

112

28

0

0

511

Tallaght Hospital (AMNCH)

1,015

304

11

1

0

1,331

The Childrens University Hospital Temple Street

60

40

13

6

0

119

University College Hospital Galway

1,688

989

543

13

3

3,236

Waterford Regional Hospital

517

293

182

0

0

992

Wexford  Hospital

82

30

0

0

0

112

Total

15,538

8,160

3,019

163

6

26,886

Hospital Waiting Lists

Ceisteanna (1582)

Billy Kelleher

Ceist:

1582. Deputy Billy Kelleher asked the Minister for Health inclusive of inpatient, outpatient and elective treatment, the length of time the longest waiter on waiting lists has been waiting, the county the person resides in; and if he will make a statement on the matter. [37122/12]

Amharc ar fhreagra

Freagraí scríofa

The National Treatment Purchase Fund (NTPF) has advised that the longest waiter was placed on the waiting list for surgery on 5th August 2009. The patient is unsuitable for treatment in another hospital and therefore could not be referred to the NTPF. The patient previously declined one offer of a surgery date and is now scheduled for surgery on the 19th September 2012. It would be inappropriate for the NTPF to advise you of the hospital or the county that the patient resides in as this would pose a risk of that patient being identified.

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