Written Answers Nos. 20 - 27
20. Deputy Caoimhghín Ó Caoláin asked the Minister for Health if it is the case that there are no mental health therapy services available to those in County Clare who do not have a new diagnosis; the action he is taking to ensure that adequate services exist; and if he will make a statement on the matter. [14711/15]
Amharc ar fhreagraSince coming into office, this Government has prioritised the reform and resourcing of our mental health services in line with the recommendations in A Vision for Change. Additional funding totalling €125 million has been provided primarily to strengthen Community Mental Health Teams for both adults and children and to enhance specialist community mental health services for older people with a mental illness, those with an intellectual disability and mental illness, and forensic mental health services.
Alongside secondary services, there are many excellent counselling services currently provided across the country by the both the HSE and voluntary sector. Counselling is provided across the health service including primary care, social care and within mental health. This type of service can be provided by a range of trained health professionals and delivered to meet a clinical need at either primary or secondary care level. The Government, in keeping with its commitment in the Programme for Government to increase access to counselling and psychotherapy, has provided funding totalling €7.5 million to develop the Counselling in Primary Care (CIPC) service, which works closely with the HSE Mental Health Service, under whose aegis this funding is provided.
I wish to confirm that there are mental health therapy services available for people in Co. Clare, and they are not confined only to those with a new diagnosis. I understand that the Deputy may be referring to the availability of Dialectical Behaviour Therapy (DBT) services, which are designed to help reduce self harm and self destructive behaviours, using a combination of group skills training, individual therapy and phone coaching. Unfortunately there is no DBT service available as yet in Co Clare or in the Mid West, however consideration is being given to the training of staff in this regard.
21. Deputy Mattie McGrath asked the Minister for Health if he will reconsider plans to introduce financial penalties for those who do not wish to avail of private health insurance; his views on concerns that such penalties will place an undue burden on those who currently cannot afford to sign up to a private health insurance scheme; and if he will make a statement on the matter. [14704/15]
Amharc ar fhreagraTaking out health insurance is optional. Anyone ordinarily resident in the country is entitled, subject to certain charges, to receive public in-patient and out-patient hospital services. People who do not take out health insurance continue to have the same entitlement to services in the public hospital system.
Community rating, reflecting the principle of intergenerational solidarity, is a fundamental cornerstone of the health insurance system. This means that people who are old or sick do not have to pay more than the young and well. Under community rating, the level of risk that a particular consumer poses to an insurer does not directly affect the premium paid. 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.
For Community Rating to work we depend on adequate numbers of younger people taking out health insurance to help keep premium prices down for everybody. Lifetime Community Rating is being introduced to encourage people to take out health insurance at a younger age, thereby helping to spread the costs of older and less healthy people across society, to support affordable community-rated premiums for everyone who wishes to purchase insurance. It is a necessary measure to help support the viability of community rating within our system of health insurance. I have no intention of reconsidering the introduction of Lifetime Community Rating, as without it there will be a continued deterioration in the age profile of the insured population, which in turn will contribute to claims inflation and higher insurance premiums for all.
It is worth clarifying that those who do not wish to avail of private health insurance will not face a financial penalty. They retain their full entitlement to use of public hospital services. Under Lifetime Community Rating, those who decide to take out health insurance later in life will face an added premium compared to those who have subscribed over a longer period. I am satisfied that this measure is fully justified for the purposes of maintaining a stable insurance market which provides equity of treatment between young and old.
22. Deputy Seán Kyne asked the Minister for Health the progress on extending the remit of the Health Information and Quality Authority to oversee and inspect private health care facilities; and the type of facilities such new powers will cover. [14662/15]
Amharc ar fhreagraI intend bringing proposals to Government shortly seeking approval to draft amendments to the Health Act 2007 to extend the remit of the Health Information and Quality Authority. These amendments will extend HIQA's remit for standard setting and monitoring to the private healthcare sector. This will mean that HIQA’s powers to set and monitor standards and, where necessary, to undertake investigations shall apply to both the public and private healthcare sectors. The extent and type of private facilities to be brought within HIQA's remit will be determined during the process of drafting the necessary amendments to the Heath Act 2007.
23. Deputy Richard Boyd Barrett asked the Minister for Health his views on staffing levels in child and adolescent mental health services teams across the country, detailing his plans to ensure that all vacancies are filled to ensure the protection of vulnerable children; and if he will make a statement on the matter. [14629/15]
Amharc ar fhreagraA core unit of mental health service delivery is the Community Mental Health Team, of which 63 Child and Adolescent Teams are in place nationally.
In line with the Programme for Government, my priority as Minister has been to modernise mental health services, notwithstanding the severe resource constraints overall in recent years, and to prioritise new resources to underpin implementation of A Vision for Change. The prioritising funding has been used to strengthen Community Mental Health Teams for both adults and children, to enhance specialist community mental health services for older people with a mental illness, those with an intellectual disability and mental illness, forensic mental health services, and to enhance access to counselling and psychotherapy in primary care and investment in suicide prevention measures. In this regard, the Government has provided an additional €125 million and some 1,150 posts since 2012, of which around 260 posts have been allocated specifically to the Child and Adolescent Mental Health area. Approximately 80% of CAMHS posts were in place at the end of March 2015, and the remaining posts are at various stages within the recruitment process.
As of December 2014, the number of staff in post in Community Child and Adolescent Mental Health Services was 522. Actual clinical staffing of such teams, including Adolescent Day Hospitals, increased by 47 posts from September 2013 to December 2014.
The HSE is acutely aware of the need to focus on recruitment of frontline staff, and is addressing difficulties to attract candidates to particular specialties and various parts of the country. Several national and international recruitment campaigns are underway for medical consultant posts, senior and staff nurses, as well as a range of required Allied Health Professionals and Support staff, including that relating to the delivery of a multidisciplinary Child & Adolescent Mental Health Service.
24. Deputy Billy Kelleher asked the Minister for Health the proposals in place to address the long waiting times for orthodontic treatment; and if he will make a statement on the matter. [14654/15]
Amharc ar fhreagraThe HSE provides orthodontic treatment to those who have been assessed and referred for treatment before their 16th birthday. It should be noted that the nature of orthodontic care means that immediate treatment is not always desirable. It is estimated that in up to 5% of cases it is necessary to wait for further growth to take place before treatment commences. Patients are assessed by the HSE Orthodontic Service under the modified Index of Treatment Need. Patients with the greatest level of need, i.e. Grade 5 or some with a Grade 4 are provided with treatment by the HSE.
The HSE has established a pilot scheme in Dublin North East which will involve the use of orthodontic therapists in the treatment of a number of eligible children. Consideration will be given to expanding this Scheme to other HSE areas in the future. In addition to the services provided by HSE staff, orthodontic treatment for certain categories of misalignment will be provided by a panel of independent practitioners under contract to the HSE over the next three years. A national procurement process is being finalised. This initiative will especially focus on those waiting for 4 years or longer. It is expected that this initiative will commence later this year and will have a positive impact on waiting times.
25. Deputy Niall Collins asked the Minister for Health the action he is taking to address the prevalence of illegal drug use in Irish society; and if he will make a statement on the matter. [13423/15]
Amharc ar fhreagraGovernment's response to the problem of drug misuse in our society is set out in the National Drugs Strategy 2009-2016. The Oversight Forum on Drugs, which I chair, is responsible for the high-level monitoring of the Strategy, and solid progress is being made in delivering on its objectives.
The Strategy aims to create a safer society through the reduction of the supply and availability of drugs for illicit use. Drug seizures valued at approximately €62m were made by An Garda Síochána last year. This does not include a joint operation involving An Garda Síochána, Revenue Customs Service and the Naval Service which led to the interception of a yacht off Ireland's south-west coast in September 2014 containing cocaine with an estimated street value at that time of over €70m.
Prevention and awareness programmes constitute a significant part of the Government's response to the drug problem. In addition to substance-use education in schools, young people at risk of drug misuse can access diversionary programmes, facilities and services and family support.
The provision of appropriate and timely treatment services is a key goal of the Strategy. At the end of December, 97% of clients over the age of 18 accessed treatment within one calendar month of assessment, and 100% of those under 18 received treatment within one week of assessment. There is much wider coverage of needle exchange services outside the Dublin area, with more than 130 community pharmacies recruited and trained. In a major effort to reduce drug-related deaths, the HSE is undertaking a pilot project to make the life-saving drug naloxone more widely available to treat overdoses. Naloxone reverses the effects of drugs like heroin, morphine and methadone if someone overdoses.
The budget of Drug and Alcohol Task Forces has also been protected, with €29m provided for local drugs initiatives this year. An additional €2.1m has been provided in the HSE budget this year for measures targeting vulnerable problem drug users, including the provision of more residential detoxification and rehabilitation places.
My Department is beginning work on the development of a new Strategy for the period after 2016. The process will include a comprehensive consultation with key stakeholders and the public on the current national drugs policy and future priorities. It will also take account of evidence-based research, information and data sources on the extent and nature of problem drug use in Ireland. As Minister with lead responsibility for drugs policy, I will play an active role in the development of the new Strategy and I look forward to engaging with all interested parties in this work.
26. Deputy Charlie McConalogue asked the Minister for Health if he will reconsider the decision not to provide follow-up funding for the patients of Letterkenny General Hospital in County Donegal, who were outsourced under the 2013 outpatients initiative and who are still waiting on their follow-up treatment; if he will make funding available for these patients in order that they may have their treatment continued in the hospital to which they were referred under the initiative; and if he will make a statement on the matter. [14633/15]
Amharc ar fhreagraAs this is a service matter, I have asked the HSE to respond to you directly. If you have not received a reply from the HSE within 15 working days please contact my Private Office and my officials will follow the matter up.
27. Deputy Richard Boyd Barrett asked the Minister for Health his plans to address the shortfall in services available to children with mental health difficulties, as identified in the recent publication by the Children's Rights Alliance, Report Card 2015; and if he will make a statement on the matter. [14628/15]
Amharc ar fhreagraI have recently published the Expert Group report on the review of the Mental Health Act 2001. The report makes a number of significant recommendations in relation to children with one of the most important being the need to ensure that provisions relating to children should be included in a stand alone part of the Act and any provisions of the Child Care Act 1991 which apply should be expressly included rather than cross referenced.
The Group also recommended a number of child appropriate guiding principles which include issues such as the autonomy and self determination of the child should be respected insofar as practicable, the need to ensure consultation with the child at each and every stage of diagnosis and treatment, due weight being given to his/her views consistent with his/her age, evolving capacity and maturity with due regard to his/her will and preferences and ensuring that where there is an intervention on behalf of a child, his/her best interests must be taken into account.
In addition, Children aged 16 or 17 will be presumed to have capacity to consent/refuse admission and treatment in the future.
I am satisfied that the recommendations of the Expert Group will address the concerns of the publication to which the Deputy makes reference. I have instructed my officials to draw up a general scheme of a bill to reflect all of the recommendations of the Expert Group including those relating to children in revised legislation.
A full copy of the Expert Group Report is available on the Department’s website.
The HSE National Service Plan 2015 aims to improve placement of children in age appropriate mental health settings. The 95% target indicated in the Plan allows for some flexibility surrounding emergency placements in Adult Units. The corresponding target set in the 2014 Service Plan was 75% or above.
It is generally accepted that it will be most challenging for the HSE to meet the ambitious target for 2015, relative to the 2014 outturn position of around 70% for age appropriate placements. However, progress in this area has been significant over recent years, as evidenced by the fact that the number of such admissions to adult units in 2008 was 247, and that the trend has been declining annually since then to the most recent draft figure of 89 admissions for 2014. Clearly, there remains room for improvement and this issue has therefore been flagged as a Key Priority in this year's Service Plan.
At present, there are 58 in-patient beds for children and adolescents in the HSE. Overall, the HSE are targeting an operational capacity of 74 public Child and Adolescent beds nationally by the end of 2015. It should be noted that difficulties with re-opening some existing beds at local level, already resourced in the system, primarily relates to securing or retaining staff rather than the non-availability of funding.
