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Wednesday, 21 Jan 2015

Written Answers Nos. 54 - 61

Hospital Waiting Lists

Ceisteanna (54)

Paul Murphy

Ceist:

54. Deputy Paul Murphy asked the Minister for Health his views on reports (details supplied) of hospitals that have denied treatment to new public patients in an attempt to lower waiting lists; the timeframe within which this practice has been practised; the number of patients who have been denied treatment or have had treatment delayed as a result of this policy; the measures in place to end this practice; and if he will make a statement on the matter. [2381/15]

Amharc ar fhreagra

Freagraí scríofa

It is not acceptable that any hospital should attempt to lower their waiting list by denying patients clinically warranted treatment. Hospitals are expected to accept all patient referrals and prioritise on the basis of strict chronological order, other than in cases of evidenced clinical urgency including relevant cancer cases. It is not unreasonable for larger tertiary referral centres to query why patients are bypassing recently developed suitable services in hospitals closer to them. Attendance at the larger centre may well result in the patient travelling longer distances, to a hospital which is under greater pressure and may have longer outpatient waiting times.

The Special Delivery Unit protocol on the management of outpatient services sets out the process for referral and management of outpatient services. The protocol also helps to maximise efficiency and reduce duplications. In any instance where a decision has been made to refuse referrals, each hospital Clinical Director has to be apprised of the situation and the decision to issue notice to GPs should be done by the senior management team, within the context of good clinical governance.

Improving waiting lists for in patient and day case treatment is a key priority for me and for the Government. My Department is working with the HSE to put in place a plan to eliminate very long waiters by the end of the year. This will involve both productivity improvement and rigorous waiting list management. Further increasing day case surgery rates for specific procedures will be important in improving elective access within available capacity. Priority will be given to adherence to the guidelines in relation to the scheduling of patients for surgery, including chronological scheduling, and this will be monitored by the HSE throughout the year.

The management of competing demands for emergency and scheduled care requires changes in how and where patients are treated. The movement of care and treatment from in-patient to day case and from day case to Outpatient Departments is most important, as is ensuring the appropriate ratio of new to return appointments, reducing unnecessary return appointments. Limiting elective surgery in preparation for, or as a response to, increased Emergency Department attendances is intended to help manage the need for immediate emergency or trauma care. Where it is necessary to prioritise cancer and other complex cases, the HSE assures me that this is being done. Inevitably this will affect waiting lists. The challenge is to minimise the need for cancellation at short notice and to manage the impact of such cancellations effectively, within the hospital and in collaboration with other hospitals. As I have stated publicly in the context of significant emergency pressures currently being experienced by hospitals, realistically I do not envisage significant improvement in elective waiting times in the early part of the year. However based upon the high priority attached to this area in the HSE Service Plan and the first overall increase in the HSE budget in 7 years, it is expected that improvement will occur later in the year.

Hospital Waiting Lists

Ceisteanna (55)

Joan Collins

Ceist:

55. Deputy Joan Collins asked the Minister for Health the reason a person (details supplied) in County Mayo cannot access scoliosis surgery; and if he will make a statement on the matter. [2361/15]

Amharc ar fhreagra

Freagraí scríofa

The National Waiting List Management Policy, A standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the Health Service Executive, sets out the processes that hospitals are to implement to manage waiting lists.

In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to you directly. If a reply is not received from the HSE within 15 working days please contact my Private Office and my officials will follow the matter up with them.

National Children's Hospital Status

Ceisteanna (56)

Liam Twomey

Ceist:

56. Deputy Liam Twomey asked the Minister for Health if he will provide an update on the new children’s hospital; and if he will make a statement on the matter. [2354/15]

Amharc ar fhreagra

Freagraí scríofa

The National Paediatric Hospital Development Board is the statutory body responsible for planning, designing, building and equipping the new children's hospital. The new hospital will be co-located with St. James's Hospital, and ultimately tri-located with a maternity hospital to be developed on campus. In addition to the main hospital, the project includes two satellite centres at the campuses of Tallaght and Connolly Hospitals.

The Project Brief has now been completed and approved. The Project Brief sets out details of the specialties to be provided and the planned accommodation. This will include 384 in-patient beds, all in single en-suite rooms with in-room parent accommodation, a further 85 daycare beds and 14 theatres, including three hybrid theatres to facilitate access to imaging during surgery, all in the main hospital. There will be 111 outpatient consulting examination rooms across both the main hospital and the two satellite centres, as well as ED and urgent care facilities.

A design team has been procured and is working on detailed design development, with the aim of submitting a planning application in June 2015. Subject to planning, work will commence at the main site at St. James's, and at satellite centre sites at Connolly and Tallaght, in January 2016.

Health Services

Ceisteanna (57)

Timmy Dooley

Ceist:

57. Deputy Timmy Dooley asked the Minister for Health when free general practitioner care for children under six years will be introduced; and if he will make a statement on the matter. [2408/15]

Amharc ar fhreagra

Freagraí scríofa

The Government is committed to introducing, on a phased basis, a universal GP service without fees, as set out in the Programme for Government. The Government has commenced this process in respect of all children under 6 years. The Health (General Practitioner Service) Act 2014, which provides an entitlement for all children aged under 6 to a GP service without fees, was enacted on 25th July 2014. Under a Framework Agreement, the Department of Health, the HSE and the IMO are engaged intensively on the introduction of GP services without fees for children aged under 6. The aim is to have the under-6s phase implemented by Quarter 2, 2015, subject to the conclusion of those discussions and the conclusion of the fee-setting process.

HIQA Inspections

Ceisteanna (58)

Robert Troy

Ceist:

58. Deputy Robert Troy asked the Minister for Health the reason community nursing homes are being treated differently from private nursing homes with regard to the Health Information and Quality Authority standards; and if he will make a statement on the matter. [2396/15]

Amharc ar fhreagra

Freagraí scríofa

The framework for the application of standards by the Health Information and Quality Authority to HSE facilities is set out in the Health Act 2004, Section 7(5)(f) of which provides that, in performing its functions, the HSE shall have regard to “any standards set by the Health Information and Quality Authority, in so far as practicable and subject to the resources available to the Executive". Section 8 (2) (c) of the Health Act 2007 goes on to say that in carrying out its functions, HIQA shall have regard to the resources available to the HSE.

Since 2009 all nursing homes - public, voluntary and private have been registered and inspected by HIQA. In 2013 HIQA issued a regulatory notice in relation to Standard 25, which addresses the physical environment, advising the sector that "where particular criteria regarding premises are not met in the Centre, the provider must provide clear evidence of the other ways by which they are reaching the Standard and must demonstrate to the Chief Inspector that these alternative arrangements are delivering on the Standard for each individual resident. In the case of Standard 25, the Chief Inspector will require substantial and exceptional justification for any premises which purports to meet Standard 25 without implementation of the individual criteria."

Registration renewals for the majority of public nursing homes are due from the middle of this year. Bearing in mind their age and structure, public nursing homes face real challenges and require investment in excess of the funding that will be available in the short to medium term.

It is important that we do everything possible to apply appropriate standards to all facilities. It is also important to recognise that publicly-run facilities provide bed capacity which is critically needed by older people, particularly by those with high or complex care needs for whom public facilities are often the only place that can meet their needs. Notwithstanding the problems that some facilities face with structures and facilities, the vast majority of their residents receive excellent levels of care. Without these public facilities many older people would simply have nowhere to go, other than our acute hospitals which are already under pressure.

Discussions are ongoing between the HSE and HIQA on the issues that arise for facilities around the country in applying the relevant statutory provision.

Medical Aids and Appliances Provision

Ceisteanna (59)

Mary Mitchell O'Connor

Ceist:

59. Deputy Mary Mitchell O'Connor asked the Minister for Health his plans to make EpiPens more widely available; and if he will make a statement on the matter. [2356/15]

Amharc ar fhreagra

Freagraí scríofa

Adrenaline pens, as injectable medicines, may only be supplied on foot of a valid prescription. However, there is provision in the Medicinal Products (Prescription and Control of Supply) Regulations 2003 (as amended) which permits pharmacists, advanced paramedics, paramedics and emergency medical technicians, in emergency circumstances, to supply certain prescription only medicines including adrenaline injections without a prescription.

My Department is currently reviewing policy in this area and will shortly carry out a consultation process on wider availability of a number of prescription only medicines used in emergency situations including adrenaline auto-injectors. This review will explore, among other things the use of guidelines or protocols by means of which non-health professionals may supply and administer adrenaline auto-injectors without a prescription.

HSE Expenditure

Ceisteanna (60)

Patrick O'Donovan

Ceist:

60. Deputy Patrick O'Donovan asked the Minister for Health the total Health Service Executive budget for food and catering; if the HSE has considered a single system for procurement of food and setting of menus in HSE-run hospitals and residences; and if he will make a statement on the matter. [2349/15]

Amharc ar fhreagra

Freagraí scríofa

The reply is as follows:

Procurement

The most recent information provided by the HSE is that the Annual Financial Statements for 2014 are currently being prepared but not yet finalised and consequently national data on the 2014 cost of catering is not available. In 2013 catering non pay cost in the HSE owned hospitals and residences was approximately €54m. The HSE National Procurement Office seeks to negotiate national contracts for food and catering products. Professionally qualified catering managers are employed in all of the HSE run hospitals and residences to ensure that catering services are provided to a high standard appropriate to the clientele availing of the service. This will include engagement with key stakeholders on the issue of patient and staff/visitor food; reviewing current hospital food guidelines and practice; establishing best practice, policy and developing an implementation plan.

Hospital and Patient Food Policy and implementation plan

The HSE has advised that the Health and Wellbeing Division has recently appointed a National Dietetic Adviser to lead on work in this area for the Division. This role will provide expert leadership guidance and support in the context of the delivery of Healthy Ireland and in implementing the actions set out in the HSE’s Service Plan and the Health and Wellbeing Division’s Operational Plan 2015. This will include the development of a Hospital and Patient Food Policy and implementation plan in consultation with colleagues across the service.

HSE Policy initiatives

A procurement policy in relation to fresh, dried, and frozen food has been developed. A Healthy Vending machine policy was approved by the HSE in 2014 and is in the process of being introduced. The policy covers all cold soft drinks, confectionery and snack vending machines (including fruit products) which must carry a greater provision of clearly labelled “Better Choice” and “Other Choice” food and drink products to make the healthy choice the easier choice in all HSE facilities. The purpose of the policy is to promote healthy vended food and drink options to the public and HSE staff using HSE facilities.

Calorie posting on menus is being rolled out – a policy has been developed and is in an approval process at present. All vended products will be calorie posted as part of the Healthy Vending machine policy.

Strategic initiatives - Healthy Ireland Implementation Plans

In addition the Saolta (formerly West North West Hospital Group) 3 year implementation plan for Healthy Ireland outlines the breadth of work that is to be implemented and recommends that “the groups would undertake a review of nutritional adequacy and quality of hospital food for staff and patients and agree nutritional standards in line with policy document "Food and Nutritional care in Hospitals –Guidelines for Preventing under Nutrition in Acute Hospital”. These guidelines will sit hand in hand with policies for staff and visitors such as the vending machine policy and calories posting on menus. It will also encompass food provision for staff at meetings.

Other site specific plans for Hospital Groups and CHOs will be developed in a three year implementation plans as they emerge. This will address actions relating to the provision of healthy and nutritious food across HSE facilities.

The HSE also fund and support the work of the Irish Heart Foundation in delivering the Happy Heart at Work Healthy Eating Award. The objective of the catering audit is to assist a staff restaurant/canteen to adopt healthier cooking practices and provide healthier food choices for staff, without incurring substantial cost.

Health Insurance Regulation

Ceisteanna (61)

Seán Fleming

Ceist:

61. Deputy Sean Fleming asked the Minister for Health when the VHI will receive authorisation from the Central Bank of Ireland; the reasons for the delay in the VHI achieving this; and if he will make a statement on the matter. [2410/15]

Amharc ar fhreagra

Freagraí scríofa

VHI submitted its application to the Central Bank of Ireland (CBI) on 16 May 2014. It continues to engage closely with the CBI in respect of its application, and my Department has also provided a number of clarifications to the Bank to assist it in its understanding of the interaction between the private health insurance market and the health system.

Consideration of the VHI's application for authorisation is a matter for the CBI in its role as independent financial regulator and I cannot anticipate how long that process will take, or its outcome. However, I expect that VHI will be authorised at the earliest opportunity, if approved by the Central Bank.

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