Written Answers Nos. 32 - 42
32. Deputy Seamus Kirk asked the Minister for Health if the next Health Service Executive service plan will provide for a dementia case worker in the Louth local health office; the number of dementia related intensive home care packages being provided in County Louth in 2015; and if he will make a statement on the matter. [43010/15]
Amharc ar fhreagraAs this is a service matter it has been referred to the Health Service Executive for direct reply. 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.
33. Deputy Thomas Pringle asked the Minister for Health his plans to bring in greater access to health services in County Donegal and thereby establish regional balance within the Government's health policy; if he will grant special recognition of the peripherality of County Donegal and the health needs of the county, as a result of consistent under-investment in health infrastructure in the region; and if he will make a statement on the matter. [42930/15]
Amharc ar fhreagraThe provision of health care in Ireland is not planned on a regional basis, it is considered on the basis of need. The objective of the ongoing health reform programme is to maximise the amount of care delivered locally while ensuring that specialist and complex care is safely provided in larger specialist centres. Under the reform programme, Community Health Care Organisations have been established to improve the way in which primary care in the community is delivered. Likewise the re-organisation of public hospitals into hospital groups is designed to deliver improved outcomes for patients. Each group of hospitals will work together to provide acute care for patients in their areas, integrating with community and primary care. The reform programme will be further progressed in 2016 with, for example, plans for General Practitioner direct access to ultrasound and x-ray services as well as the provision of minor surgery by GPs.
I am, however, aware of the particular challenges in the delivery of health services in Donegal. In fact, I visited Donegal in October this year to see at first hand the redevelopment that has been undertaken at Letterkenny General Hospital and to assess the health facilities on Arranmore Island and see how island residents deal with health issues. Health services in the area continue to improve and there have been some notable developments in 2015 over and above the improvements to Letterkenny General Hospital, including the opening of a new Community Mental Health base in Donegal town in March and a new Health Campus and Primary Care Centre in Ballyshannon in September. I understand that the HSE is also advancing a number of initiatives to address particular issues including the development of a new community hospital/nursing unit in Letterkenny, strengthening services for older persons at home and the provision of additional resources for mental health services.
34. Deputy Billy Kelleher asked the Minister for Health the measures that will be taken to put general practice on a sustainable basis, especially in rural areas; the progress that is being made on a new contract for general practitioners; and if he will make a statement on the matter. [42983/15]
Amharc ar fhreagraThe Government is committed to ensuring that patients throughout the country continue to have access to GP services, especially in remote rural areas, and that general practice is sustainable in such areas into the future. It is also imperative that services meet patient needs, that existing GP services are maintained and that general practice remains an attractive career option for newly-qualified GPs.
Under the current General Medical Services contract, GPs who practise in remote rural areas of low population qualify for special rural practice concessions, including an annual Rural Practice Allowance of just over €16,200, practice support subsidies towards the employment of certain practice staff at the maximum applicable rate regardless of the size of their patient panel, and the maximum applicable contribution towards locum costs for periods of leave.
Where a GP currently holds the allowance but the circumstances underpinning this have changed, the GP retains the allowance while they continue to practise in that location. When a new GP commences in the area, their application for the allowance is considered afresh by the HSE.
The HSE has recently reviewed its guidelines for dealing with applications for a Rural Practice Allowance. The purpose of the new guidance is to ensure consistency, transparency and fairness in decision-making in respect of the relevant discretionary provisions of the GMS contract pertaining to the granting or otherwise of the allowance to new applicants. The new guidance does not affect existing holders of the allowance.
The HSE, Department of Health and Irish Medical Organisation are currently engaged in a comprehensive review of the GMS and other publicly-funded health sector contracts involving GPs. Among the many topics being considered under this review process is the issue of supports for General Practice, especially in remote rural areas.
35. Deputy Charlie McConalogue asked the Minister for Health his plans to ensure that there is a full complement of six dental nurses attached to the orthodontic department in Letterkenny University Hospital and that the necessary dental equipment required to manage an effective department is maintained; if he is aware that orthodontic clinics are being cancelled on a continuous basis in Letterkenny University Hospital, and as a result waiting lists are continuing to soar; and if he will make a statement on the matter. [42720/15]
Amharc ar fhreagraAs this is a service matter, it has been referred to the Health Service Executive for direct reply to the Deputy. 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.
36. Deputy Terence Flanagan asked the Minister for Health the action he is taking to address the overcrowding crisis in the accident and emergency unit in Beaumont Hospital in Dublin 9; and if he will make a statement on the matter. [42712/15]
Amharc ar fhreagraI convened the ED Taskforce in December 2014 to assist in dealing with the challenges presented by ED overcrowding. Significant progress has been made to date on the ED Taskforce.
Additional funding of €117m has been provided in 2015 to relieve pressures on acute hospitals including reducing delayed discharges, lowering the waiting time for Fair Deal funding and providing additional transitional care beds and home care packages. Funding has been made available to support the acute hospital system over the winter period by providing additional bed capacity and other initiatives to support access to care. This includes additional funding for Beaumont Hospital to enable St. Josephs Raheny Day Hospital to provide 5 day service to prevent ED presentation and admission of elderly patients.
Six of the beds at Beaumont which had been closed for refurbishment or infection control purposes during 2015 have re-opened and a further 21 beds are to re-open in December. Beaumont Hospital is one of the sites that have been the subject of particular focus with the SDU in supporting them to implement solutions. Delayed discharge numbers at the hospital have reduced from 95 on 25 November 2014 to 70 on 24 November 2015, thus freeing up 25 beds every day for acutely ill patients.
All hospitals, including Beaumont. have escalation plans to manage not only patient flow but also patient safety in a responsive, controlled and planned way that supports and ensures the delivery of optimum patient care. I co-signed the ED Congestion Escalation Directive recently to ensure that progress made to date on overcrowding is sustained and deepened. The Directive requires hospitals to implement their Escalation Plan whenever the Emergency Department experiences overcrowding and it is expected that this will add to the progress made on overcrowding so far.
37. Deputy Michael Moynihan asked the Minister for Health the timeframe for the upgrading of public nursing homes in County Cork to meet Health Information and Quality Authority standards; and if he will make a statement on the matter. [43002/15]
Amharc ar fhreagraThe Government is committed to ensuring that long term residential services for older people meet the relevant 'National Quality Standards for Residential Care for Older People in Ireland. The Standards and the associated National Regulations that underpin them encompass issues relevant to the privacy, dignity and respect of residents and seek to support the provision of a physical environment that meets modern day standards and the needs of vulnerable people living in designated services.
The Government's recently published Capital Plan, Building on Recovery: Infrastructure and Capital Investment 2016-2021, commits to a major multi-annual programme of capital investment in public and voluntary provided social care facilities. A total of €200 million in Exchequer funding has been made available to assist residential services for older people to meet the relevant National Standards by 2021.
The HSE is now formulating plans for the application of this additional funding, following which detailed discussions will take place with HIQA. In advance of that it is not possible to comment on specific facilities or locations.
38. Deputy John McGuinness asked the Minister for Health if the Camphill communities and L’Arche organisations will receive the support they need from the Health Service Executive; and if he will make a statement on the matter. [42997/15]
Amharc ar fhreagraThe Government is committed to protecting frontline health and personal social services needs for people with disabilities. The Government currently provides funding of approximately €1.5 billion to the Disability Services Programme through the Health Service Executive's National Service Plan for 2015.
In 2015, the HSE is seeking to maximise the provision of services within available resources and to maintaining a consistent level to that provided in 2014, by providing the following specialist disability services:
- residential services to around 9,000 people with a disability;
- day services to over 22,000 people with intellectual and physical disabilities;
- respite residential support of 190,000 overnights for people with intellectual and physical disabilities;
- 3.9 million hours of Personal Assistant/Home Support Hours.
Additional funding of €6 million has been allocated in the HSE National Service Plan in 2015 to provide day places for an estimated 1,400 young people finishing school and rehabilitative (life-skills) training. €4m in additional funding has also been allocated in the Plan to deliver an increase in the services for children with disabilities and reduce waiting lists under the Progressing Disability Services for Children and Young People (0-18s) Programme.
I have been informed that the HSE is acutely aware of the resource shortfall presented by Camphill and is currently engaging with them to develop an agreed set of proposals to resolve the challenges over an agreed period of time. This includes a commitment to supporting the organisation to re-configure the current model of service and funding arrangements to a more sustainable model while still maintaining the particular ethos of the service.
I understand that as part of this process of engagement, the HSE requested Camphill to consider how its model of service provision may change over the coming years as Disability Services are reformed. The HSE will work closely with Camphill to shape a five year plan to secure the additional resources required to ensure the future of the organisation in a sustainable way.
The HSE provides funding to L'Arche Community for the provision of health and personal social services under Section 39 of the Health Act 2004.
I am aware of the financial challenges facing L’Arche Community at this time and that the HSE has been in ongoing contact with the management of L’Arche in an effort to find a solution to these difficulties.
I understand from the HSE that these difficulties stem from compliance issues with the regulatory environment, which require that the model of service previously provided by L’Arche be reviewed and enhanced. The HSE has been working with all voluntary service providers on improving compliance during 2015, addressing the highest risk areas as a priority. These efforts will continue in 2016 and preparation of the HSE’s Service and Operational Plans will be underpinned by a focus on making the best use of the resource invested in disability services.
I have been assured by the HSE that it will continue to work with Camphill and L’Arche Organisation and be as supportive as possible within current financial constraints.
39. Deputy Clare Daly asked the Minister for Health the status of the implementation of an improved procedure for disclosure by hospitals and the Health Service Executive when reporting on tragic and adverse incidents within maternity services, to make them fully open to public scrutiny; and if he will make a statement on the matter. [42717/15]
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.
As I have previously indicated the safety of service users is of paramount importance and steps need to be taken to anticipate and avoid things going wrong and to reduce the impact if they do. All employees including medical staff are required to disclose and report incidents in line with the HSE's Safety Incident Management Policy. Creating a culture of open disclosure and learning from the things that go wrong is the bedrock of making systems safer. Open Disclosure is defined as 'an open consistent approach to communicating with patients and their families when things go wrong in healthcare. This includes expressing regret for what has happened, keeping the patient informed, providing feedback on investigations and the steps taken to prevent a recurrence of the adverse event'.
I recently announced that the Government has given its approval to the drafting of provisions to support open disclosure of patient safety incidents. This will be included in the Department of Justice and Equality’s draft Bill on Periodic Payment Orders which is well advanced. The legislation is part of a broader package of reforms aimed at improving the experience of those who are affected by adverse events.
This legislation builds on the joint development by the HSE and State Claims Agency of the National Policy on Open Disclosure (2013). The HSE is progressing the implementation of the Policy across all health and social care services. We all know that when error or harm is experienced by a patient, the trust and confidence of that patient and their family are compromised. That is why honest, open disclosure and communication, which demonstrate empathy and sensitivity, are so essential. The intent of this legislation is to provide certain legal protections for healthcare staff for open disclosure, which is undertaken in good faith and in compliance with national standards. This will give further support to those staff in their communications with patients and family members if an adverse event occurs. The Ethical Code of Practice set out by the Medical Council also makes clear the responsibilities of doctors in relation to open disclosure.
Open disclosure is now HSE policy and therefore any unjustified breach of the policy (as with any HSE policy) will be managed in line with the HSE disciplinary procedures. Where potential deviations have been identified the Healthcare records must be reviewed to ascertain any documentation in relation to communication with the patient about the adverse event and to establish if any rationale for non-disclosure has been documented. Where there is no evidence that open disclosure has occurred the incident must be reviewed with the staff involved in the event. The patient must be informed of the event and the impact of the event explained and acknowledged. The patient should also be informed of the initial failure to disclose and an appropriate acknowledgement, explanation and apology provided.
From a patient safety perspective the key focus of open disclosure is on learning so that systems and processes can be improved in order to reduce potential future harms to patients. If a person is not satisfied that a health professional or administrator has fulfilled their obligations regarding open disclosure then that person has recourse to the HSE's complaints procedures. It is also open to a person to raise a complaint with the appropriate professional regulatory body or with the Ombudsman.
40. Deputy Billy Kelleher asked the Minister for Health the measures being put in place to boost services in arthritis and rheumatology for both adults and children; and if he will make a statement on the matter. [42986/15]
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.
41. Deputy Clare Daly asked the Minister for Health if he has considered the publicly-voiced concerns of survivors of symphysiotomy regarding the administration of the symphysiotomy payment scheme; if he will amend the terms of the scheme to require the taking of oral testimonies, where requested; and if he will make a statement on the matter. [42718/15]
Amharc ar fhreagraThe Surgical Symphysiotomy Payment Scheme is operating 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 20 November 2015, 332 offers have been made.
The Scheme has brought to an end years of uncertainty and costs for women who have undergone surgical symphysiotomy. The Scheme was designed following meetings with all three support groups, two of which have welcomed its establishment. It was set up to give women who do not wish to pursue their cases through the courts an alternative option in which payments are made to women who have had a surgical symphysiotomy, whether or not negligence is proven. The Scheme is voluntary and women did not waive their rights to take their cases to court as a precondition to participating in the Scheme.
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. The level of proof required is clearly set out in the terms of the Scheme. As the Scheme is designed to be simple, straight forward and non-adversarial, the women are not expected to give oral testimonies as they might do in a court setting. I understand, however, that Judge Clark, Assessor for the Scheme has met with women in different parts of the country, where she considered it necessary, particularly in cases where women had been unable to locate hospital records.
I believe that Judge Clark operates the Scheme in a person-centred manner within its terms and in accordance with the principles of justice and fairness.
The Government has given careful and detailed consideration to this complex and sensitive matter. It believes that the implementation of the Scheme, together with the ongoing provision of medical services by the HSE, including medical cards, represents a comprehensive response to this issue, which should help bring resolution for the women, many of whom are elderly, and their families.
42. Deputy Mary Lou McDonald asked the Minister for Health the envisaged spend on health infrastructure as proposed under Building on Recovery; and if he will make a statement on the matter. [40610/15]
Amharc ar fhreagraThe Government announced the national capital envelope for the multi-annual period 2016-2021 in September 2015. The notified health capital envelope for this period is €3,061 million which includes an increase of €568m. The following table shows the annual allocation.
|
Multi-annual period |
2016 |
2017 |
2018 |
2019 |
2020 |
2021 |
Total |
|
- |
€m |
€m |
€m |
€m |
€m |
€m |
€m |
|
Health capital envelope |
414 |
454 |
473 |
550 |
570 |
600 |
3,061 |
Following this announcement the HSE is working on its next multi-annual Capital Plan 2016-2021 which, from a good practice perspective, must involve a review of all projects. This Plan requires my approval together with the consent of the Minister for Public Expenditure and Reform. It will include a schedule of projects to be delivered. The HSE will publish this schedule on its website when it has been approved.
Increased funding becomes available in the later years and therefore there is potential scope for additional investment concentrated towards the end of the period.
