Written Answers Nos. 44-61
48. Deputy Tom Hayes asked the Minister for Health the actions taken to reduce waiting times for children awaiting inpatient and day care surgery; the impact of these measures; and if he will make a statement on the matter. [7541/13]
Amharc ar fhreagraIn July 2011, I announced the establishment of the Special Delivery Unit as a key part of my plans to radically reform the health system in Ireland. The Unit’s purpose is to improve access to the emergency and elective care system. Since it was established last year, it has been working to unblock public access to acute services by improving patient journeys through the system and by streamlining public hospital waiting lists. I am pleased to be able to say that very significant progress has been made by the SDU in relation to scheduled care waiting times.
The initial focus for the SDU's Scheduled Care Team has been on waiting times for in-patient and daycase elective surgery. For children, the target in 2012 was that no child should be waiting longer than 20 weeks for inpatient or daycase surgery. At the end of 2012, the number of children waiting over 20 weeks for inpatient or daycase surgery was down to 89 from 1,759 in December 2011, a 95% decrease. The 89 children waiting over 20 weeks can be attributed to two hospitals, with the remainder achieving the 20 week target.
While maintaining this progress will of course be challenging, the significant improvement in access is being achieved despite the economic and budgetary pressures which must be dealt with and managed. The progress made reflects my commitment, and that of this Government, to ensuring patients can access the acute hospital services they need, when they need them.
50. Deputy Martin Ferris asked the Minister for Health the reason bilateral cochlear implants are not funded in this State; if he will acknowledge the significant benefits of this procedure in comparison to unilateral implants; if he will address this issue; and if he will make a statement on the matter. [7458/13]
Amharc ar fhreagraBeaumont Hospital is the centre for delivering Ireland’s national cochlear implant programme with surgical provision for patients under six (6) years carried out in the Children’s University Hospital at Temple Street. Since the programme commenced seventeen years ago, over 700 patients have received cochlear implants. I am advised that Beaumont Hospital carried out ninety cochlear implants in 2012.
In 2009 the UK’s National Institute for Health and Clinical Excellence (NICE) recommended simultaneous bilateral cochlear implantation as best practice for children. No dedicated programme for simultaneous or sequential implantation is being carried out in Ireland at this time. However, some bilateral implantation has already occurred for patients, mainly very young children with certain medical conditions such as a history of meningitis or blindness.
I understand that Beaumont Hospital, HSE Management and the HSE’s Audiology Clinical Care Programme (ACCP) have met recently to discuss a joint process to identify the options for developing and resourcing a programme of simultaneous cochlear implantation in children into the future. An important element of this will be the development of clear clinical criteria to prioritise clients for assessment and follow on implantation.
51. Deputy Jonathan O'Brien asked the Minister for Health the way he intends to deliver on the reduction of fees payable to health professionals of some €70 million as outlined in the national service plan 2013; and if he will make a statement on the matter. [7468/13]
Amharc ar fhreagraOn Budget Day, it was announced that the fees and allowances payable to certain health professionals will be reviewed. The professionals concerned are General Practitioners, Pharmacists, Dentists, Ophthalmologists, Optometrists and Dispensing Opticians who hold contracts with the HSE, Smeartakers contracted under the CervicalCheck programme and Consultant Psychiatrists who hold contracts with the Mental Health Commission.
On 13 December 2012, the Department of Health placed a notice in the National newspapers and on the Department’s website advising that a review of payments to the above health professionals was being carried out under the Financial Emergency Measures in the Public Interest Act 2009. Interested parties were invited to provide written submissions by Friday 4 January 2013. The consultation period ended on 11 January 2013.
Following careful consideration of submissions made during the review and having due regard to Section 9 of the Financial Emergency Measures in the Public Interest (FEMPI) Act 2009, the Minister for Health will decide whether any reductions in fees/allowances will be made, and, if so, the scale of reductions that would be fair and reasonable in the circumstances.
Should the Minister decide that reductions are warranted, Regulations will be made under the FEMPI Act with the approval of the Minister for Public Expenditure and Reform.
52. Deputy Heather Humphreys asked the Minister for Health the actions taken to tackle overcrowding and the use of trolleys in accident and emergency departments nationally; the impact of these measures; and if he will make a statement on the matter. [7546/13]
Amharc ar fhreagraImmediately following my appointment, I established the Special Delivery Unit, as set out in the Programme for Government. The aim of the SDU is to unblock access to acute services by improving the flow of patients through the system.
There was significant progress during the course of 2012 in reducing the number of patients waiting on trolleys. In December 2012, there were 23.5% fewer patients waiting on trolleys compared to December 2011. This equates to more than 20,000 patients whose experience of our acute hospitals has been significantly improved.
Since before Christmas hospitals have seen a significant increase in the number of very sick patients needing admission. The increase in norovirus in hospitals has been well publicised; we are also seeing high levels of admissions of frail elderly people and of patients presenting with respiratory related illnesses.
However, evidence from the last year has proven that the health system has the capacity to respond to these challenges and to continue to improve emergency care. The situation is being actively managed at a national level, while all staff including consultants, nurses, allied health staff and management is working extremely hard to address the pressures experienced by hospitals since the New Year.
53. Deputy Martin Ferris asked the Minister for Health the way he will reduce the State's drug bill; if he will detail the savings that will be made over the next three years; the legislation and agreements that will be necessary to deliver these savings; and if he will make a statement on the matter. [7465/13]
Amharc ar fhreagraFollowing intensive negotiations involving the Irish Pharmaceutical Healthcare Association (IPHA), the HSE and the Department of Health, a major new deal on the cost of drugs in the State was concluded in October last. It will deliver a number of important benefits, including
- significant reductions for patients in the cost of drugs,
- a lowering of the drugs bill to the State,
- timely access for patients to new cutting-edge drugs for certain conditions, and
- reducing the cost base of the health system into the future.
The gross savings arising from this deal will be in excess of €400m over 3 years. €210 million from the gross savings will make available new drugs to patients over 3 years. Thus, the deal will result in a net reduction in the HSE expenditure on drugs of about €190m.
The Department of Health and the HSE have also successfully finalised discussions with the Association of Pharmaceutical Manufacturers in Ireland (APMI), which represents the generic industry, on a new agreement to deliver further savings in the cost of generic drugs. It is estimated that the combined gross savings from the IPHA and APMI deals will be in excess of €120 million in 2013.
The IPHA agreement provides that prices are referenced to the currency adjusted average price to wholesaler in the nominated EU member states in which the medicine is then available. The prices of a range of medicines were reduced on 1 January 2013 in accordance with the agreement.
The Health (Pricing and Supply of Medical Goods) Bill 2012, which is currently before the House, provides for the introduction of a system of generic substitution and reference pricing. The Bill provides that when the HSE is setting a reference price for, or reviewing a reference price set for, a relevant group of interchangeable medicinal products it shall take into account the following criteria:
- the ability of suppliers to meet patient demand for the relevant item;
- the value for money afforded by the relevant item;
- the equivalent prices of the relevant item in all other Member States where the product is marketed;
- the prices of therapeutically similar items; and
- the resources available to the HSE.
It is important to balance achieving best value for money for the taxpayer with assuring continuity of supply for critical medical products, particularly in a small market like Ireland. Consequently, the Bill aims to achieve value for money while avoiding disruption in the availability of medicines on the Irish market.
54. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he continues to examine the possibility of the greater use of part-time or temporary nursing staff as a means of achieving economies in order to work within budget; if he will provide an adequate spread of nursing cover throughout the health service; if he intends to examine alternative options with a view to achieving this objective with particular reference to the number of graduate nurses registered following his recent initiative in this regard; if he intends to re-examine the cohort of qualified nurses available in sufficient numbers to meet current and future requirements; if he expects to be in a position to make further announcements in this regard; and if he will make a statement on the matter. [7537/13]
Amharc ar fhreagraThe Government has decided that the numbers employed across the public service must be reduced in order to meet fiscal and budgetary targets. The health sector must make its contribution to that reduction. Subject to compliance with national policy, particularly in relation to the employment control framework, it is a matter for the HSE to determine the composition of its staffing complement.
The HSE is continually pursuing measures to achieve staffing economies. The National Service Plan for 2013 identifies a range of objectives to be advanced, including work practice changes for identified health disciplines, systematic reviews of rosters, skill-mix and staffing levels, increased use of re-deployment, further productivity increases and a focused approach to addressing absenteeism and implementing revised new sick leave arrangements.
The Plan also provides for tight control of the use of higher-cost staffing arrangements and in particular the use of agency staffing and overtime working. The graduate nurse placement initiative will provide participants with frontline working experience and professional development opportunities, while at the same time providing additional nursing capacity at service level.
The Minister for Public Expenditure and Reform approved this employment initiative on the basis that participants would not be counted in health service staff numbers and that it would contribute to savings on unsustainable levels of agency and overtime expenditure. The HSE's National Service Plan for 2013 provides for a saving of €10m in the current year, arising from the introduction of this scheme. Given the requirement on the HSE to reduce numbers employed and to maximise savings, there is only very limited scope to offer permanent nursing posts at present.
55. Deputy Catherine Murphy asked the Minister for Health his role with regard to the development of the annual Health Service Executive budget; his powers of review and oversight in relation to same; the methodology for allocating the HSE budget on an annual basis; and if he will make a statement on the matter. [7443/13]
Amharc ar fhreagraThe level of funding available for the health budget is determined as part of the Estimates and budgetary process for that year. The Health Act 2004 requires that, within 21 days after the publication by Government of the Estimates, the Health Service Executive (HSE) prepares a National Service Plan and submits it to me for my approval. The preparation of the Plan is undertaken by the HSE, in consultation with my Department. The Plan must indicate the type and volume of health and personal social services to be delivered by the HSE for the monies allocated under its Vote. In accordance with the Act I am required to lay a copy of the Plan before both Houses of the Oireachtas within 21 days of approving it. Throughout the year my Department monitors and evaluates the implementation of the Plan by the HSE, including its level of expenditure. There is constant engagement between my Department, the HSE and the Department of Public Expenditure and Reform regarding these matters with a view to ensuring the Plan is delivered within the resources available. In addition, there are regular reports submitted to Government regarding the HSE's budgetary position.
57. Deputy Jonathan O'Brien asked the Minister for Health the way the waiting list for the nursing home support scheme will be administered; and if he will make a statement on the matter. [7469/13]
Amharc ar fhreagraThe Nursing Homes Support Scheme is a demand-led, resource capped system of financial support for individuals who are assessed as requiring long-term nursing home care. The total gross budget for long-term residential care was €994.7m in 2012. The final budget for 2013 will not be available until the Revised Estimates for Public Services are published by the Department of Public Expenditure and Reform.
The HSE operates a national list to enable it to operate within the budget for the Scheme. All applicants who are approved for funding are put on the placement list in chronological order by the date of determination of their application. Funding issues to applicants in this chronological order to ensure equity nationally. Funding is currently being released on a weekly basis.
The 2013 Service Plan sets a target of 22,761 people to be in receipt of financial support at end-2013, compared to 22,065 at end-2012. Approvals will continue to be granted and the position will be kept under constant weekly review. The HSE is already monitoring the Scheme on a weekly basis and has demonstrated its ability to manage this process effectively.
59. Deputy Pádraig Mac Lochlainn asked the Minister for Health the reason the Expert Group set up to monitor the implementation of A Vision for Change has been disbanded; which of its sixth and final report recommendations, if any, have been implemented; and if he will make a statement on the matter. [7463/13]
Amharc ar fhreagra100. Deputy Charlie McConalogue asked the Minister for Health if the expert group monitoring a Vision for Change is still active; and if he will make a statement on the matter. [7508/13]
Amharc ar fhreagraI propose to take Questions Nos. 59 and 100 together.
I presume the Deputy is referring to the Independent Monitoring Group for A Vision for Change (AVFC) which ceased its three year term in June 2012. This Group was appointed to oversee implementation of the Report. AVFC contained a commitment that it would be reviewed after seven years and we have now reached that 7-year anniversary. The current priority, however, is to review the Mental Health Act 2001 after which urgent consideration will be given to reviewing AVFC and establishing independent monitoring arrangements. I expect that the review of the Act will be completed and presented to me in quarter two of this year. In the interim, the HSE continues to implement AVFC with substantial additional funding provided in 2012 and 2013, and reports on this on a monthly basis, through the HSE National Service Plan.
The recommendations of the Independent Monitoring Group are consistent with the recommendations in A Vision for Change, our National Strategy for mental health. Implementation of the Strategy and the reform of our mental health services is a priority for this Government. However, implementation has been slower than originally expected as it has been delayed by a number of factors including the changed economic context, constraints in public spending and the moratorium on recruitment. It is expected that the appointment of a Director for Mental Health, which was advertised recently by the HSE, will greatly accelerate the pace of implementation.
Nonetheless, a great deal of progress has been made with the accelerated closure of old psychiatric hospitals and their replacement with bespoke new facilities, better suited to modern mental health care. Progress also includes shorter episodes of in-patient care and the involvement of service users in all aspects of mental health policy, service planning and delivery. In addition, Clinical Care Programmes for the treatment and care of patients with Eating Disorders, Early Intervention in Psychosis and the Management of Self Harm Presentations to Emergency Departments are being progressed by the HSE. The clinical care programme plan will provide service models that implement AVFC. Core to the overall plans will be the principles of recovery, individualised care delivered in partnership with voluntary agencies and based on early intervention and evidence based practice.
A modern mental health service is best delivered in the community and in 2012 a special allocation of €35m was provided primarily to further strengthen Community Mental Health Teams in both adult and children’s mental health services, to advance activities in the area of suicide prevention, to initiate the provision of psychological and counselling services in primary care, specifically for people with mental health problems and to facilitate the re-location of mental health service users from institutional care to more independent living arrangements in their communities.
Budgetary pressures within the HSE delayed the full utilisation of this funding, but this sum is now available to mental health services along with an additional €35m allocated in Budget 2013 for the continued development of mental health services across a range of headings, including the further ongoing development of community services. This represents a total of €70m additional revenue to modernise and reform our mental health services in 2013. Over 850 new mental health professionals are being employed to strengthen these services.
60. Deputy John McGuinness asked the Minister for Health when the programme for Government commitment to establish a patient safety authority will be honoured; and if he will make a statement on the matter. [7495/13]
Amharc ar fhreagraMy Department is examining the appropriate structures for the responsibilities that might be assigned to the Patient Safety Agency (PSA) taking account of the international experience and the existing structures and organisations in the Irish health system. The role and inter-relationship of the PSA with the reforming health system needs to be carefully designed and developed. My Department is liaising with the Health Service Executive on the details surrounding the establishment of the PSA to ensure an identifiable and distinct leadership responsibility for patient safety and quality at national level having regard to the need for a robust quality and safety function within the new delivery structures of the Reform Programme. The intention is to establish a Patient Safety Agency on an administrative basis in 2013.
61. Deputy Gerry Adams asked the Minister for Health in view of promised restoration of the pre-September 2012 level of funding for home help hours, if he will instruct the Health Service Executive to arrange an assessment or reassessment of the home help hours provision for all those whose hours were cut in the last quarter of 2012 with a view to restoring the withdrawn hours to the greatest number of people possible, commensurate with freshly assessed need; and if he will make a statement on the matter. [7449/13]
Amharc ar fhreagraI have already indicated that care provision in 2013 for Home Help, Home Care Packages and Personal Assistant hours will be restored to 2012 levels.
In line with its normal procedures for the allocation or review of Home Support services at individual level, the HSE will review as appropriate those who have a medically assessed requirement for services, to ensure that these services are provided on a prioritised basis in line with assessed need. The review process also facilitates adjustments in the service provision to allow for changes in health or other circumstances. The HSE will continue to target services at the most vulnerable and to recycle hours and care packages from people whose needs reduce or come to an end.
