Written Answers Nos. 54-64
54. Deputy Caoimhghín Ó Caoláin asked the Minister for Health the steps he has taken to encourage inclusion of a dedicated acquired brain injury pathway of care, supported by a specific programme of investment, in the 2016 Health Service Executive annual service plan; his plans for the development of regional and community based rehabilitation services; and if he will make a statement on the matter. [42907/15]
Amharc ar fhreagraBrain injury health services are provided across a range of health settings, by different organisations and by many health professionals and carers. The Health Service Executive (HSE) Clinical Strategy and Programmes Directorate have a number of clinical programmes that are working in the area of brain injury, including neurology, epilepsy, stroke and rehabilitation medicine. The clinical programmes are focusing on reducing waiting times/lists, addressing disease specific pathways and models of care with a view to developing a national framework for the management of long-term neurological conditions. The HSE also provide services for those with acquired brain injury through Primary Care Teams with community based therapy services and personal social services, often funded through partner agencies in the non-statutory sector.
A Steering Group led by the HSE Social Care Division, with representation from the National Clinical Programmes for Rehabilitation Medicine and Neurology, Department of Health, Primary Care, Therapy Professions and the Neurological Alliance of Ireland has been assigned the task of developing an implementation framework for the National Policy & Strategy for Neuro-Rehabilitation Services. Once the implementation framework has been agreed by the Steering Group, it will then go for consultation to the wider stakeholder interest groups. Following consultation, the framework will be revised and will guide and oversee the reconfiguration and development of neuro-rehabilitation structures and services at national and local level.
In August 2015, my colleague, the Minister for Health, announced an additional €15 million for the redevelopment of the National Rehabilitation Hospital (NRH) in Dun Laoghaire. This allocation will now enable the NRH and the HSE to proceed with a new 120 bed building on the Dun Laoghaire campus. The redeveloped facility will be purpose built to accommodate integrated therapy services, hydrotherapy and sports facilities.
The financial position in relation to the HSE National Service Plan for 2016 has yet to be finalised. It is not possible at this time to give an indication of the funding to be allocated by the HSE through the Disability Services Programme for acquired brain injury services.
In relation to plans for the development of regional and community based rehabilitation services, as this aspect of the Deputy's question relates to service matters, I have arranged for the question to be referred to the HSE for direct reply to the Deputy. If the Deputy has not received a reply from the HSE within 15 working days, he can contact my Private Office and they will follow the matter up with the HSE.
55. Deputy Billy Kelleher asked the Minister for Health the process of consent that is sought from persons living with dementia who are moved into long-term residential care, with particular regard to when they have expressed a choice to remain living at home in the community; the obligation there is to provide care in the community in these circumstances; and if he will make a statement on the matter. [42985/15]
Amharc ar fhreagraThe policy of Government is to support older people to live in dignity and independence in their own homes and communities for as long as possible, and every effort is made to do this.
More specifically the Irish National Dementia Strategy notes that 66% of all people with dementia live in the community. The Strategy commits to supporting them to live in their own homes and to maintain existing roles and relationships for as long as possible, supported by the wider community along with primary, secondary and community care services. There is also a commitment to giving as much support as possible to informal and family carers who care for people with dementia at home.
Unfortunately, there will come a time for many when the levels of care or support needed or the level of dependency of the person in question mean that residential care is the most appropriate option. At all stages, every effort is made to respect the wishes of the person themselves.
A 'specified person' may apply for a care needs assessment on behalf of an applicant where it appears to the specified person that an applicant may need care services and, by reason of ill health, physical disability or mental condition, such as dementia, is unable to make an application for the assessment on their own behalf. The HSE must be satisfied that the specified person is acting in the best interests of the person. The following categories of person may act as a specified person:
- The Committee of a Ward of Court;
- A person appointed under a valid, registered enduring power of attorney who is not restricted from applying for the scheme;
- A care representative appointed under the Nursing Homes Support Scheme Act;
- The applicant's spouse or partner;
- A relative of the applicant who is 18 years of age or over;
- A next friend appointed by a court;
- The applicant's legal representative; or
- A registered medical practitioner, nurse or social worker.
There is, however, no obligation for the individual to take up nursing home residence even if the care needs assessment indicates that they require long-term nursing home care.
The Assisted Decision-making (Capacity) Bill, which is currently before the Oireachtas, is designed to protect and empower individuals who may lack the mental capacity to make their own decisions about their care and treatment.
56. Deputy Brendan Griffin asked the Minister for Health if the process in which the State deals with medical negligence cases will be reviewed, given a number of recent high profile cases which have highlighted the prolonged suffering of families who were victims of negligence, due to lengthy court cases and delays in apologies being issued; and if he will make a statement on the matter. [42842/15]
Amharc ar fhreagraThe management of clinical negligence cases taken against the HSE is delegated to the State Claims Agency (SCA) which has a statutory mandate to investigate and manage these cases to completion. I am advised that the SCA, wherever it is proper to do so, based on expert medical and legal advice, admits breach of duty at the earliest possible opportunity to avoid distress to patients and their families. Many of these cases however, particularly those involving catastrophic injuries, are very complex in nature and require time to investigate the liability and causation issues. This inevitably involves some delay before a formal admission of liability, if appropriate, can be made.
A suite of reform measures is currently being advanced by the Government which will result in a positive impact on the tort system and the management of clinical negligence claims. The Government agreed also in October that there will be a review of the State Claims Agency and how claims are handled. The review will be undertaken by the Department of Finance as it has overall responsibility for the State Claims Agency. It is expected that the terms of reference for this review will be drawn up shortly.
57. Deputy Willie O'Dea asked the Minister for Health the plans in place to provide a statutory entitlement to a home care package; and if he will make a statement on the matter. [42999/15]
Amharc ar fhreagraThe creation of a statutory entitlement would not be possible in this context as services can only be provided in line with the resources that are available. It is my objective to ensure that available resources are deployed to achieve the best possible outcomes for older people.
A priority for 2016 will be the development of an integrated model of care with a strong emphasis on home and community care. Details of the budget allocation for home care services, including Home Care Packages, will be outlined in due course, in the HSE's 2016 National Service Plan.
58. Deputy Robert Troy asked the Minister for Health the status of the provision of orthodontic services in the midlands region; and if he will make a statement on the matter. [43001/15]
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.
59. Deputy Brendan Smith asked the Minister for Health the additional supports he is putting in place to support general practitioners, especially in rural areas; and if he will make a statement on the matter. [42991/15]
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.
60. Deputy Billy Kelleher asked the Minister for Health his plans on funding models in the wake of the abandonment of the universal health insurance model proposed in the 2011 programme for Government and the 2014 White Paper; and if he will make a statement on the matter. [42984/15]
Amharc ar fhreagraThe reports detailing the estimated cost of the UHI model outlined in the White Paper on Universal Health Insurance were published on the 18 November. Having deliberated on the findings, I concluded that the high costs involved in introducing the White Paper model of UHI are not acceptable and have, therefore, decided that there is a need for further research and cost modelling in relation to the best means to achieve universal health care.
The next phase of research will include deeper analysis of the key issue of unmet need and a more detailed comparative analysis of the relative costs and benefits of alternative funding models. This work will be carried out under the auspices of the joint Department of Health/ESRI Three-Year Research Programme on Health Reform. Both the research undertaken to date and that planned in the next phase of the costing exercise will assist Government in deciding on the best long-term approach to achieving its goal of universal health care.
61. Deputy Bernard J. Durkan asked the Minister for Health the number of nurses employed throughout the public health sector in each of the past ten years to date; the extent to which he expects to be in a position to augment the numbers in line with demographic requirements in the course of the next 12 months, with particular reference to the need to identify particularly sensitive areas, such as overcrowding at accident and emergency departments and other areas within the hospital service; and if he will make a statement on the matter. [42886/15]
Amharc ar fhreagraAs stated in the HSE’s National Service plan, the staff of the health services continue to be its most valuable resource. There are almost 120,000 personnel involved in the delivery of public health care, of which over 34% are nurses.
Details for nurse staffing over the last 10 years are set out in the following table:
Nurse Employment Dec 2005 to October 2015
|
Division |
Nursing WTE |
|
Dec-05 |
35,248 |
|
Dec-06 |
36,737 |
|
Dec-07 |
39,006 |
|
Dec-08 |
38,108 |
|
Dec-09 |
37,466 |
|
Dec-10 |
36,503 |
|
Dec-11 |
35,902 |
|
Dec-12 |
34,637 |
|
Dec-13 |
34,178 |
|
Dec-14 |
34,509 |
|
Oct-15 |
35,163 |
|
Change since Dec 05 |
-86 |
|
% Change since Dec 05 |
-0.2% |
|
% Change since Dec 14 |
+653 |
|
% Change since Dec 14 |
+1.9% |
Source: Health Service Personnel Census
Note1: All figures are expressed as whole-time equivalents
The decade covered by this question spans a period of extensive health sector reform, including the creation of seven hospital groups.
Reducing overcrowding in Emergency Departments is a key priority for Government. I convened the Emergency Department (ED) Taskforce last year and the resulting ED Taskforce Action Plan published in April contains a range of time-defined actions that are being implemented to alleviate overcrowding in EDs.
Recruitment of additional nurses and consultants is also a priority for the HSE. Recruitment campaigns are underway in Ireland and abroad. The HSE Census returns for the end of October 2015 show that we have over 750 more nurses employed in the public health services than a year ago - 35,163 whole time equivalent's compared with 34,404 in October 2014. As part of the recruitment campaign the HSE is offering 2015 graduates permanent posts. The Nursing Degree Programme is designed to provide a sufficient number of graduating nurses each year, 1,570, to meet future needs.
With regard to workforce planning, Action 46 of Future Health (DoH, 2012) provides for the Department to work with the HSE to implement an effective approach to workforce planning and development with the objectives of: recruiting and retaining the right mix of staff; training and upskilling the workforce; providing for professional and career development; and creating supportive and healthy workplaces. 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 opportunities 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.
62. Deputy John Browne asked the Minister for Health if the next Health Service Executive service plan will provide for a dementia case worker in the Wexford local health office; the number of dementia-related intensive home care packages being provided in County Wexford in 2015; and if he will make a statement on the matter. [43008/15]
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.
63. Deputy Dara Calleary asked the Minister for Health if the next Health Service Executive service plan will provide for a dementia case worker in the Mayo local health office; the number of dementia-related intensive home care packages being provided in County Mayo in 2015; if he will ensure that the Community Action on Dementia in Mayo project will continue to be supported after 18 December 2015; and if he will make a statement on the matter. [42992/15]
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.
64. Deputy Seán Kyne asked the Minister for Health when the specific projects to be funded under the capital investment plan and the additional funding for health services will be published, and if a new accident and emergency department for University Hospital Galway is among the priorities. [42950/15]
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. Funding has been made available to begin the development of this large project which incorporates an new ED. However in advance of the approval of the Plan, it is not possible to indicate with any certainty when projects will be finalised.
