Written Answers Nos. 291-303
291. Deputy Bernard J. Durkan asked the Minister for Health to outline the extent to which he remains satisfied that adequate nursing and medical staff remain available throughout public sector hospitals to ensure maximum efficiency and ability to meet demand for both medical and surgical beds; and if he will make a statement on the matter. [37111/15]
Amharc ar fhreagra297. Deputy Bernard J. Durkan asked the Minister for Health to outline the extent to which sufficient doctors and nurses can be recruited to ensure the efficiency and efficacy of the public health system, with particular reference to the utilisation of all space available in public hospitals and allied to staffing level ratios, thereby ensuring a smooth operational service; and if he will make a statement on the matter. [37117/15]
Amharc ar fhreagra298. Deputy Bernard J. Durkan asked the Minister for Health to explain his view on the comparisons that have been made between the public and private health sectors to ascertain the extent to which the public sector can recruit the necessary staff to meet requirements, based on relative workloads; and if he will make a statement on the matter. [37118/15]
Amharc ar fhreagraI propose to take Questions Nos. 291, 297 and 298 together.
The number of consultants has grown significantly in recent years to 2,700 WTE. This includes an increase of 300 consultants since the Government came into office, in spite of the economic crisis. The number of NCHDs has also increased significantly, by over 1,000 since the end of 2010, and now exceeds 5,400. There are currently 500 more nurses employed by the HSE in September 2015 than in September 2014 bringing the total number of nurses and midwives employed to 34,852 (WTEs).
Targeted efforts are underway to address current recruitment and retention issues in the public health sector. These include the implementation of the Strategic Review of Medical Training and Career Structure, and the work of the Taskforce on Staffing and Skill Mix for Nursing. My Department has also committed to developing a National Integrated Strategic Framework for health workforce planning, in collaboration with other Government Departments and agencies. The main objectives of this framework will be the recruitment and retention of the right mix of staff, provision of career and professional development and the creation of supportive and healthy workplaces. A Cross-Sectoral Working Group is in the process of being established and will begin its work early next year. It is expected that an implementation plan will be delivered before the end of 2016.
Implementation of the recommendations of the Strategic Review will support the more efficient delivery of services through, for example, transfer of non-core tasks and the matching of new posts to requirements. The Taskforce on Staffing and Skill Mix for Nursing was established to develop a framework that will determine safe staffing and skill mix requirements for the nursing workforce in a range of major specialties. Phase I of its work has focused on the development of a Framework for safe nurse staffing and skill mix in general and specialist adult medical and surgical care settings in acute hospitals. The primary focus of the Framework is patient safety, by ensuring safe nurse staffing and skill mix levels. The next step is a planning and testing phase, to test the capability of the framework to deliver on its intended outcomes, which will commence in Quarter 4, 2015 with roll-out throughout 2016.
I am aware that there are many differing aspects to working in the public and private health sectors that may influence health professionals in making a decision whether or not to accept an offer to work in the public health sector. Contribution to public service and flexible work patterns can, for example, act as incentive to work in the public health sector.
292. Deputy Bernard J. Durkan asked the Minister for Health to outline the extent to which serious conditions and, in some cases, serious health conditions continue to influence the award of a medical card with a view to ensuring the minimisation of hardship of families faced with such situations; and if he will make a statement on the matter. [37112/15]
Amharc ar fhreagraUnder the Health Act, 1970, medical cards are provided to persons who are, in the opinion of the HSE, unable without undue hardship to arrange GP services for themselves and their dependants and every application must be assessed on that basis. In accordance with the Act, the assessment for a medical card is determined primarily by reference to the means, including the income and expenditure, of the applicant and his or her partner and dependants. Where deemed appropriate in particular circumstances, the HSE may exercise discretion and grant a medical card even though an applicant exceeds the income guidelines but where they face difficult financial circumstances, such as extra costs arising from an illness.
It is clear that there are people with medical needs and it is important that they should be able to access necessary assistance in a straightforward manner. Greater discretion is being exercised by the HSE because the number of discretionary medical cards in circulation has increased from about 52,000 in mid-2014 to over 94,000 at the beginning of October this year. This followed the measures announced by Minister Varadkar and I last year, when the "Keane" Report of the Expert Panel on Medical Need for Medical Card Eligibility was published. The Deputy may be aware that a key recommendation of that report was that a person’s means should remain the main qualifier for a medical card.
Every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines. Social and medical issues are considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services. The HSE affords applicants the opportunity to furnish supporting information and documentation to fully take account of all the relevant circumstances that may benefit them in the assessment, including medical evidence of cost and necessary expenses.
On foot of the Keane Report, the HSE established a Clinical Advisory Group which is continuing its work to develop clinical oversight and guidance for the operation of a more compassionate and trusted medical card system.
We do not have a universal eligibility system for primary and community health services. Until we have universal health care and everyone is entitled to health care, one will always have anomalies and injustices. There will always be somebody who is just above the means threshold, or who does not have the prescribed disease, or whose condition is not sufficiently severe and, as a result, these individuals will not meet the assessment criteria.
293. Deputy Bernard J. Durkan asked the Minister for Health to set out the number of nursing staff recruited at Naas General Hospital in County Kildare; those who have taken up duty; the extent to which adequate provision has been made to ensure the full utilisation of the space available within the hospital and the elimination of overcrowding in the accident and emergency unit and the use of trolleys in lieu of beds; and if he will make a statement on the matter. [37113/15]
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.
294. Deputy Bernard J. Durkan asked the Minister for Health to set out the extent to which staffing levels at Naas General Hospital in County Kildare have fluctuated in the past seven years to date; and if he will make a statement on the matter. [37114/15]
Amharc ar fhreagraI have asked the HSE to respond to the Deputy directly on the matter. If you have not received a reply from the HSE within 15 working days, please contact my Private Office and they will follow up the matter with them.
295. Deputy Bernard J. Durkan asked the Minister for Health when the next development phase of Naas General Hospital in County Kildare will commence; the extent to which work is ongoing in this regard; and if he will make a statement on the matter. [37115/15]
Amharc ar fhreagraThe current project underway at Naas General Hospital will deliver accommodation and ancillary services to support the endoscopy services department, physical medicine, physical therapy, oncology services and day procedures departments.
The HSE has recently completed a review of this project. In this regard the strategic upgrade now made to the specification which the project's design and tender documents will reflect are - a duplex (rather than simplex) reverse osmosis filtration system and two lifts. All stages of capital projects, including the design and tendering processes, are subject to review to ensure that the projects deliver value for money. This includes, where possible, 'future proofing' to ensure that capital developments meet not just current standards but that provision is made for additional capacity and/or improved equipping and that these are addressed appropriately. Currently, HSE Estates is in consultation with the hospital's clinical leads to ensure that the project's specification and building tender documents are fully defined as soon as is possible. In addition work is underway on the Capital Plan for the next multi-annual period 2016-2021 which will take account of the recently announced increased funding which becomes available in the later years of the period. This Plan requires my approval with the consent of the Minister for Public Expenditure and Reform.
The next developments phase at Naas General Hospital must be considered within the overall acute hospital sector infrastructure programme, within the overall capital envelope available to the health service and in the context of the establishment of hospital groups.
296. Deputy Bernard J. Durkan asked the Minister for Health to set out the current status of the building of the new children's hospital; the degree to which preliminary costs associated with previous proposals in this regard can be beneficially utilised in the context of the new proposal, thereby achieving a value-for-money result; and if he will make a statement on the matter. [37116/15]
Amharc ar fhreagraOn 10 August 2015 the National Paediatric Hospital Development Board (NPHDB) submitted a planning application for the new hospital and satellite centres to An Bord Pleanála.
Much of the work undertaken for the project on the Mater site was transferable to the project in its new location. This includes in particular development of activity projections and capacity requirements, development of functional requirements, and decisions on workflow, adjacency planning and logistics. This work has been built on in developing the preliminary Project Brief for the hospital on the St James' campus, which was approved in 2014 and which set out details of the specialties to be provided and the planned accommodation.
Subject to planning, work is scheduled to commence at the main site at St. James's, and at satellite centre sites at Connolly and Tallaght, in early 2016.
299. Deputy Bernard J. Durkan asked the Minister for Health to outline the extent to which the availability of orthodontic treatment can be improved in all areas without exception in light of the need to ensure the availability of the necessary corrective procedures at the appropriate time; the number of children and young adults currently in treatment; the number on waiting lists; the likelihood of early treatment for the latter, and the extent to which patients in categories one, two or three, respectively, can expect treatment within a reasonable time; and if he will make a statement on the matter. [37119/15]
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 (IOTN). Patients with the greatest level of need i.e. Grade 5 or Grade 4 are provided with treatment by the HSE. IOTN grades 1 to 3 are not considered severe enough to be treated within the public health system. The orthodontic waiting list figures for Q2 of 2015 are set out in the following table.
|
Number |
Amount |
|
No. of patients in active treatment |
17,241 |
|
No. of patients in retention following treatment |
5,576 |
|
No. of patients on Treatment Waiting List |
18,206 |
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, a national procurement process is currently underway to provide treatment for certain categories of misalignment by a panel of independent practitioners under contract to the HSE over the next three years, with consideration of an extension to four years. This initiative will especially focus on those waiting for four years or longer. It is expected that this initiative will commence later this year and will have a positive impact on waiting times.
300. Deputy Bernard J. Durkan asked the Minister for Health to outline the extent to which cancellations of hospital appointments have fluctuated in the past seven years to date; and if he will make a statement on the matter. [37120/15]
Amharc ar fhreagraWith regard to the specific query raised by the Deputy, as 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.
301. Deputy Bernard J. Durkan asked the Minister for Health to outline the extent to which the agreement reached in respect of victims of symphysiotomy has been completed to the satisfaction of the victims; and if he will make a statement on the matter. [37121/15]
Amharc ar fhreagraThe Surgical Symphysiotomy Payment Scheme is operating very well since it was established on 10 November 2014. It was estimated that 350 women would apply to the Scheme, but in fact 578 applications have been accepted by the Scheme and as at 16 October 2015, 311 offers have been made.
The Scheme has brought to an end years of uncertainty and costs for women who have undergone surgical symphysiotomy, whose only option prior to its establishment was to take legal action through the courts, with no certainty about the outcome of that action. The Scheme was designed to be simple, straightforward and non-adversarial and aims to minimise the stress for all women concerned. The Scheme was designed following meetings with all three support groups, two of which have welcomed its establishment.
In the interest of accountability, the Scheme requires each Applicant to prove that she had a surgical symphysiotomy or pubiotomy in order to be considered for the assessment of an award of €50,000. It is for the Assessor to determine whether an Applicant has identified and established any significant disability by objective evidence if the Applicant is seeking a higher award of €100,000 or €150,000.
Judge Clark has noted in her most recent progress report that failure by the applicants' legal representatives to provide a Notice of Discontinuance to the Scheme in a timely manner (in relation to the applicants' previous court proceedings) means that long delays in some cases have occurred between the acceptance of an offer by the woman and the actual payment of the award. In one recent case, the delay is approaching 7 months. As this is unfair to Applicants, Judge Clark has indicated that as soon as a Notice of Discontinuance of proceedings in being is served on the Scheme, the payment to the Applicant will be recommended even when agreement on fees due to an assisting Solicitor has not been finalised.
The Government has given careful and detailed consideration to this complex and sensitive matter. It believes that the provision of the Scheme, together with the ongoing provision of medical services by the HSE, including medical cards, represents a comprehensive and fair response to this issue, which should help bring resolution for the women, many of whom are elderly, and their families.
302. Deputy Billy Kelleher asked the Minister for Health to set out in tabular form the number of children hospitalised for dental treatment, by county and by local health office, in each of the past four years and in 2015 to date. [37135/15]
Amharc ar fhreagraThe Department does not routinely collect such data. I have asked the HSE to collate the data and 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.
303. Deputy Bernard J. Durkan asked the Minister for Health to outline the extent to which he and his Department continue to monitor private health insurance with the objective of the continued implementation of lifetime community rating; if he remains satisfied that all insurers incur their fair share of the responsibility to provide for patients across the age spectrum; and if he will make a statement on the matter. [37139/15]
Amharc ar fhreagraMy Department and the Health Insurance Authority oversee the maintenance of a competitive and sustainable health insurance market, under the provisions of the Health Insurance Acts 1994 to 2014, and monitor developments on an ongoing basis to ensure that the market is regulated appropriately. Community rating is a fundamental cornerstone of the Irish health insurance system. Under community rating, the level of risk that a particular consumer poses to an insurer does not directly affect the premium paid. This means that people who are old or sick do not have to pay more for the same insurance plan than the young and healthy.
Community rating requires a constant influx of younger people taking out health insurance to help keep premium prices down for everybody. Lifetime community rating, which came into operation on 1 May 2015, modifies community rating so that the premium that individuals pay for health insurance increases with the age at which they enter the health insurance market. Late entry loadings now apply for people aged 35 and over when taking out health insurance for the first time. Lifetime community rating encourages people to take out health insurance at a younger age, thereby helping to spread the costs of older and less healthy people across all insured persons. Without this measure, there would be a continued deterioration in the age profile of the insured population. The number of people now holding private health insurance is 2.118 million, or 46% of the Irish population (end June 2015). This is an increase of over 93,000 since the start of this year and the number has now risen for four quarters in a row. This increase is extremely welcome, as it helps to control premium inflation and to keep health insurance affordable for all who wish to avail of it.
In addition, a robust Risk Equalisation Scheme is also in place to support community rating by equalising risk across the market. All insurers receive payments from the Risk Equalisation Fund in respect of their older and less healthy customers, and this is funded by stamp duties levied on all policies written. This support to community rating ensures persons continue to pay the same net amount for a given health insurance product, keeping health insurance affordable for older and less healthy members.
