Written Answers Nos. 21 - 38
21. Deputy Donnchadh Ó Laoghaire asked the Minister for Health his position on the re-allocation of €12 million from the mental health budget for 2016 to other projects; and if he will make a statement on the matter. [13720/16]
Amharc ar fhreagraThe last Government provided additional ring-fenced mental health funding of €160 million over 2012 to 2016 inclusive. In 2015, the National Service Plan Budget for mental health was €791 million and the outturn was €785 million. The €826 million budget for mental health in the 2016 National Service Plan therefore represents an increase of €41 million or 5.2% over the 2015 outturn. The 2016 budget includes €35 million in heldback funding for new developments.
The €35m allocation for mental health will fund new service developments. The HSE National Service Plan 2016 identifies priorities for allocation of the €35 million, including the continued development of early intervention and counselling services across both primary and secondary care; the provision of new Jigsaw mental health services in Cork, Dublin City Centre and Limerick; the continued development of Community Mental Health teams; improved 24/7 response and Liaison Services; services for Psychiatry of Later Life; Perinatal Mental Health, and two new mental health clinical programmes, specifically for ADHD in Adults and Children, and for Dual Diagnosis of those with Mental Illness and Substance Misuse. The Department of Health is currently examining proposals from the HSE relating to the development of these specific enhanced priority services, as well as proposals for the ongoing development of a range of existing and new specialist mental health services. It is expected that a decision on the release of the 2016 development funding will be made shortly.
Staff recruitment is a key element of these developments. I am informed that, as staff recruitment takes time, the 2016 HSE National Service Plan envisages that time-related savings of approximately €12m from the mental health development funding will be used, on a once-off basis, to maintain services in home care and transitional care beds, and for vaccine procurement. The detailed use of all development funding is currently being examined and will be the subject of decisions shortly.
22. Deputy Joan Collins asked the Minister for Health the Health Service Executive's plans for clearing the scoliosis waiting lists in Crumlin children's hospital in Dublin and in Galway University Hospital, including the filling of vacancies. [13669/16]
Amharc ar fhreagraOur Lady's Children's Hospital Crumlin is the largest provider of scoliosis surgery for children and young people. On 4 May 2016, there were 172 patients on the waiting list at Crumlin.
In order to address waiting lists at Crumlin, over €1m was allocated in 2015 for additional consultant posts and support staff, and 10 additional WTE staff are now in place including a consultant orthopaedic surgeon, consultant anaesthetist, clinical nurse specialist and other nursing staff. Separately an additional €1m approximately has been allocated in 2016 on a full year basis for orthopaedics and trauma to address waiting lists for orthopaedics in the Children's Hospital Group. This funding will also assist in improving access for scoliosis patients.
Capital funding has also been provided by the HSE for a new theatre on site at Crumlin to expand capacity further. Construction is now complete and the building is currently being commissioned with handover expected in the coming weeks. The 2016 Service Plan specifically provides for support for the new theatre capacity and the continued development of paediatric scoliosis services to address ongoing capacity deficits.
External capacity has also been identified in order to address waiting times while internal capacity is being built up, and patients from Crumlin have been transferred to other hospitals in Ireland and the UK, where capacity is available and where it is clinically appropriate. The HSE continues to work actively with Crumlin and the Children's Hospital Group to improve access to spinal surgery for children and young people.
I am advised there are currently 7 patients on the public waiting list for scoliosis procedures at Galway. Galway University Hospital is working actively to identify additional theatre sessions when available to address current waiting list needs.
I share the Deputy's concern that difficulties in accessing such a vital service as scoliosis surgery are resolved. There is a very active programme of measures underway to address the underlying issues speedily and comprehensively.
23. Deputy Martin Ferris asked the Minister for Health to support the provision of additional crisis houses as oulined in A Vision For Change. [13726/16]
Amharc ar fhreagraCrisis houses are designed for those who are in need of acute intervention but who do not require hospital care. A key objective is the provision of a safer, less stigmatising alternative to hospital care that provides refuge and support in a more communal, family-like environment. The HSE Operational Plan for Mental Health 2016 highlights the need to expand services for those who are homeless, and who also have mental health issues, through an improved multi-agency approach.
The current development of Crisis Houses, and Crisis Intervention Teams, form part of a spectrum of service supports for individuals with a mental illness presenting in crisis. One of the objectives of the HSE Mental Health Division has been to improve the response of mental health services for individuals in such circumstances. This includes accommodation and treatment for an individual in the most appropriate setting, relevant to their presenting need.
The new Programme for Government commits to further enhancing 24/7 service support and liaison teams in primary and emergency care, building on the commitment in the HSE National Service Plan 2016 for this area, including the development and staffing of crisis houses, and enhanced 24/7 access to specialist services where a psychiatric assessment considers this necessary.
24. Deputy Clare Daly asked the Minister for Health the steps he will take to prevent instances of children with intellectual disabilities and autism spectrum disorder being held in hospitals under chemical restraint because of problems with the Health Service Executive releasing funding for residential placements. [13686/16]
Amharc ar fhreagraI have been advised that individual cases are managed in the most clinically appropriate way for the particular child. I am also advised that cases can arise where a child who is ready for discharge and who is waiting for a residential placement/accommodation can remain in hospital for longer than clinically required. In such cases, all agencies involved in the care of the child work together to address any issues in order to speed up discharge pathways.
I am aware that the Deputy has contacted my office about a specific case which may be related to question she has now raised. I have asked for the HSE to provide me with a report on this matter and I will contact the Deputy directly once I have received their response.
25. Deputy Eamon Scanlon asked the Minister for Health his estimate of the likely overrun in the health budget in 2016; the status of the financial situation of the Health Service Executive; and if he will make a statement on the matter. [13800/16]
Amharc ar fhreagraSignificant additional resources have been made available to the HSE in 2016. Despite this, the health sector is facing challenges in managing expenditure within budget in some areas. The HSE's financial information for March, the latest available, shows net expenditure of €3,284 million against a €3,164 million profile, resulting in an overspend of €120 million for the three months. The acute hospital sector deficit of €81 million represents 68% of the overall deficit. Other significant deficits arise in respect of the State Claims Agency of €17 million and Social Care of €21 million.
The HSE has established seven cost management groups to develop short and medium term actions to address specific areas of financial challenge across the acute hospital sector. These groups are expected to report their findings in the coming weeks. Patient safety and maintenance of service levels are key objectives to be satisfied when establishing savings measures.
The nature of the State Claims Agency scheme means that determining trends and projections from three months' data is not conclusive. Pressures in the social care area arise from costs associated with compliance with disability standards and meeting demands for home care packages and home help.
With only three months of data, the ability to determine expenditure trends and derive a projected outturn is limited. The Department of Health will continue to work with the HSE to ensure that every effort is made to maximise cost containment and cost avoidance measures to mitigate any overruns to the greatest degree possible.
26. Deputy Maurice Quinlivan asked the Minister for Health the status of the provision of funding for intensive dementia-specific home care packages provided through a joint Health Service Executive/Atlantic Philanthropies programme as part of the national dementia strategy; how many local health offices were funded; how many persons benefited from the package; the funding available to fund this further; and if he will make a statement on the matter. [13709/16]
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.
27. Deputy Catherine Murphy asked the Minister for Health his measures to immediately address the significant number of persons leaving accident and emergency departments without being treated; if he has analysed the subsequent costs to the health service of delayed treatments being carried out; and if he will make a statement on the matter. [13668/16]
Amharc ar fhreagraPressures on Emergency Departments have been rising, given our ageing and growing population. ED attendances have been significantly higher this year, particularly in Quarter 1. To date, the HSE has reported an average increase in attendances of nearly 6% compared with the same period last year. Despite attendance increases, TrolleyGar numbers in Quarter 1 2016 are similar to those for 2015. Furthermore, figures for May 2016 show total numbers of patients on trolleys are approximately 18% lower in May 2015, with numbers waiting over 9 hours approximately 24% lower.
The HSE maintains records on service users who register at an ED and choose to leave without actively discharging themselves. Figures for March 2016 indicate that 3.9% of ED patients ‘did not wait’ to complete their episode of care, which is within the internationally accepted safe target of less than 5%.
It is important to note that patient experience times have improved in April 2016, with 67.6% of patients being admitted or discharged within 6 hours and 81.7% within 9 hours. Reducing the wait times for patients attending EDs is a priority for this Government. Investments in capital expansion are ongoing (new EDs have been completed in the Mater and Wexford Hospitals and are planned in Beaumont and Galway). 366 extra beds have been opened or re-opened. A review of bed capacity in our health service, coupled with a review of Medical Assessment Unit hours are further key commitments intended to alleviate ED overcrowding.
28. Deputy David Cullinane asked the Minister for Health if the new policy strategy and integration unit established within his Department will support in its work the new Oireachtas committee that will be established to develop cross-party consensus on the future of the health service over ten years, as per the programme for Government and Government approval; and if he will make a statement on the matter. [13704/16]
Amharc ar fhreagraI welcome the establishment of the Committee on the Future of Healthcare which is a key commitment in the Programme for a Partnership Government. It is envisaged that the Committee will be established in the coming weeks and will devise a single long-term vision for health care and the direction of health policy in Ireland.
The staffing and resourcing of the Committee is entirely a matter for the Committee and the Houses of the Oireachtas. However, my Department will be happy to assist and advise the Houses of the Oireachtas, as appropriate.
29. Deputy Kathleen Funchion asked the Minister for Health his plans to support the extension of the Traveller primary health care teams. [13724/16]
Amharc ar fhreagraMy Department understands that the Health Service Executive intends to conduct a general evaluation of Traveller health services. The evaluation will be undertaken in consultation with the Traveller community and other relevant statutory agencies. The outcome of the evaluation will, inter alia, inform the operation of the Traveller Primary Healthcare Teams in order to address the health needs within the Traveller community.
30. Deputy Martin Heydon asked the Minister for Health if he will review the rules of the fair deal scheme as they apply to family farms and family businesses, given that the current rules can cause difficulties for family members taking over these businesses, particularly where the three-year cap does not apply; and if he will make a statement on the matter. [13764/16]
Amharc ar fhreagraWhen the Nursing Homes Support Scheme commenced in 2009, a commitment was made that it would be reviewed after three years. The Report of the Review was published in July 2015. The Review included a general examination of the operation of the Scheme, as well as the balance between residential care and care in the community. A number of key issues have been identified for more detailed consideration across Departments and Agencies.
An Interdepartmental/Agency Working Group has been established to progress the recommendations contained in the Review. This Group is chaired by the Department of Health and includes representatives from the Department of the Taoiseach, the Department of Public Expenditure and Reform, the HSE, the Revenue Commissioners, and when required, the National Treatment Purchase Fund. These recommendations include the implementation of administrative reforms to the Scheme, including the treatment of business and farm assets for the purposes of the financial assessment element of the Scheme. This matter is also referenced in the Programme for a Partnership Government. The Working Group is due to make a preliminary report on its progress to the Cabinet Committee on Health in June 2016. Any significant changes ultimately deemed necessary to the Nursing Homes Support Scheme will require legislation and will accordingly be addressed together at the conclusion of the Review implementation process.
31. Deputy Sean Fleming asked the Minister for Health the plans he has in place to reduce emergency department services in Portlaoise hospital in County Laois; and if he will make a statement on the matter. [13754/16]
Amharc ar fhreagraI am committed to securing and further developing the role of Portlaoise Hospital as a constituent hospital within the Dublin Midlands Hospital Group.
Patient safety and outcomes must come first. There have been a number of reports on Portlaoise Hospital in recent years. These reports pointed to the need for reconfiguration of some services to ensure that patients are treated in the most appropriate setting by specialist staff that can safely meet their needs.
Since 2014 the focus has been on supporting the hospital to develop and enhance management capability, implementing changes required to address clinical service deficiencies, and incorporating the hospital into the governance structures within the Dublin Midlands Hospital Group. Governance and management arrangements in Portlaoise have been strengthened, additional clinical staff have been appointed and staff training, hospital culture and communications have improved.
The Dublin Midlands Hospital Group has recently produced a draft plan which sets out a proposed service design for a new model of clinical service delivery at Portlaoise. The draft plan has been discussed with my Department and is currently the subject of further work and consideration within the HSE.
Any change to services at Portlaoise Hospital, including plans for service reconfiguration, will be undertaken in a planned and orderly manner and will take account of current use of services, demands in other hospitals, and the need to develop particular services at Portlaoise in the context of overall service reconfiguration in the Dublin Midlands Hospital Group.
The important point to note is that this work is being done to strengthen services in Portlaoise from a patient safety and quality perspective and to ensure that services currently provided by the hospital that are not viable are discontinued and that services that are viable are safe, adequately resourced and developed based upon health needs. I am confident that these changes will improve services for patients at Portlaoise Hospital.
32. Deputy Joan Burton asked the Minister for Health if he has undertaken a cost-benefit analysis of the re-activation of the National Treatment Purchase Fund; if he will publish this; the number of patients who will be treated in public beds using the fund; how he will ensure that the diverting of millions of euro in funding from the public health system will address the underlying causes of excessive waiting lists; and if he will make a statement on the matter. [13736/16]
Amharc ar fhreagraCurrently, in accordance with Reg 4(1) of the NTPF Board (Establishment) Order 2004, the NTPF is directed to carry out activities in respect of data and analytics, audit and quality assurance of waiting lists and pricing under the Nursing Home Support Scheme. The NTPF supports the management of in-patient, day-case and outpatient waiting lists, by working with the HSE to assist hospitals in developing local demand and capacity planning and providing technical guidance materials to ensure the highest standard of data quality and practice.
The expertise amassed by the NTPF in respect of waiting lists has proven invaluable in assisting the HSE to administer previous waiting list initiatives and in carrying out smaller-scale targeted initiatives in areas such as endoscopy. In respect of the commitment in the Programme for Partnership Government to provide €15m to the NTPF in 2017 to address waiting lists, this commitment seeks to utilise the expertise of that agency to further assist the HSE in addressing specific waiting list pressures.
The future role of the NTPF will be considered in the context of the wider Health Reform Programme. No decision has been taken as to whether this will include direct procurement of patient treatment by the NTPF and therefore a requirement for a cost benefit analysis of the reactivation of the NTPF has not arisen.
My Department will engage with the NTPF and the HSE regarding the development of the Programme for a Partnership Government initiative. As has been the case with previous initiatives, Hospital Groups will be requested to identify insourced capacity in the first instance, with activity outsourced only where insufficient capacity and/or consultant availability exists to ensure patient treatment in a timely fashion.
33. Deputy Pat Buckley asked the Minister for Health his position on the re-allocation of €12 million from the mental health budget and the rationale for this given the current under-funding of mental health services. [13730/16]
Amharc ar fhreagraThe last Government provided additional ring-fenced mental health funding of €160 million over 2012 - 16 inclusive. Funding for mental health in 2016 will increase from the 2015 outturn of €785m, to a projected budget of €826m in the 2016 NSP, an increase of €41m or 5.2%, which includes €35m ring-fenced for mental health in 2016.
The €35m allocation for mental health will fund new service developments. The HSE National Service Plan 2016 identifies priorities for allocation of the €35 million, including the continued development of early intervention and counselling services across both primary and secondary care; the provision of three new Jigsaw mental health services in Cork, Dublin City Centre and Limerick; the continued development of Community Mental Health teams; improved 24/7 response and Liaison Services; services for Psychiatry of Later Life; Perinatal Mental Health, and two new mental health clinical programmes, specifically for ADHD in Adults and Children, and for Dual Diagnosis of those with Mental Illness and Substance Misuse. The Department of Health is currently examining proposals from the HSE relating to the development of these specific enhanced priority services, as well as proposals for the ongoing development of a range of existing and new specialist mental health services. It is expected that a decision on the release of the 2016 development funding will be made shortly.
Staff recruitment is a key element of these developments. As staff recruitment takes time, however, the 2016 HSE National Service Plan envisages that time-related savings of approximately €12m from the mental health development funding will be used, on a once-off basis, to maintain services in home care and transitional care beds, and for vaccine procurement. As the initiatives planned for mental health identified in the Service Plan are approved, arrangements will be made for the release of funding, having regard to the overall Service Plan requirement.
34. Deputy Aindrias Moynihan asked the Minister for Health his plans to increase the number of personal assistant hours for persons with disabilities; and if he will make a statement on the matter. [13824/16]
Amharc ar fhreagraThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
With regard to assisted living services, the Health Service Executive's priority in the 2016 National Service Plan is to protect the level of services provided in 2015 and to provide 1.3 million hours of Personal Assistant services to 2,000 people with a physical/sensory disability and 2.6 million hours of Home Support to 7,300 people with a range of disabilities. The provision of Personal Assistant services has an annual cost of €30 million, with an annual cost of €52 million for Home Support services.
Personal Assistant hours are reviewed on an ongoing basis to ensure that the service is at all times responsive to clients needs and that the hours available are allocated appropriately and in a timely manner. In 2015, the HSE exceeded the expected activity level for Personal Assistant hours by approximately 100,000 hours. This reflects the responsive nature of the service provided and takes account of the fluctuation of assessed need over time. The need for increased Personal Assistant services is acknowledged and the HSE continues to explore various ways of responding effectively to this need from available resources.
35. Deputy Charlie McConalogue asked the Minister for Health why he is not providing the necessary infrastructure and staff to the orthodontic department at Letterkenny University Hospital, County Donegal, resulting in clinics being cancelled on a continuous basis and waiting lists growing; why no radiography equipment is available in-house for the department; when he will provide a full complement of six dental nurses for it; and if he will make a statement on the matter. [13675/16]
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 Mick Wallace asked the Minister for Health if the eight selective serotonin re-uptake inhibitors and serotonin and norepinephrine reuptake inhibitors, Fluoxetine, Citalopram, Paroxetine, Sertraline, Fluvoxamine, Escitalopram, Venlafazine and Duloxetine, that the Health Service Executive prescribes to 249,900 persons are completely safe for human consumption; if, in prescribing them, the executive is adhering to the precautionary principle; and if he will make a statement on the matter. [13670/16]
Amharc ar fhreagraThe Health Products Regulatory Authority (HPRA) is the regulatory body charged with protecting and enhancing public health by regulating medicines, medical devices and other health products. The HPRA grants licences for medicines following a review of their safety, quality and effectiveness. Medicines licensed by the EU's European Medicines Agency can be marketed across the EU; decisions to grant these licences are based on an evaluation by experts from the national authorities, including representatives from the HPRA.
The HPRA regularly monitors and re-evaluates the benefits and risks of medicines in conjunction with the EMA, regulatory authorities for medicines in other EU Member States, and the pharmaceutical companies that make and market medicines.
My Department oversees the regulatory framework which grants prescribing rights to health professionals. All prescription medications dispensed to patients in this country are prescribed by GPs and other licensed clinicians, rather than by the HSE. A decision to prescribe a medicine for a patient is based on clinical judgement and expertise, and it is the clinical responsibility of the prescriber to comply with the regulatory framework and safe prescribing guidance.
37. Deputy Jack Chambers asked the Minister for Health the timeframe for publishing the next national drugs strategy; when the Misuse of Drugs Act will be amended to facilitate substances being declared as controlled; the provisions under which ministerial orders and regulations are made; and if he will make a statement on the matter. [13813/16]
Amharc ar fhreagraThe Department of Health has commenced work on the development of a new Strategy for the period after 2016. This process will involve a comprehensive consultation with key stakeholders and the public on the current national drugs policy and future priorities.
A Steering Committee with an independent chair has been set up to oversee the development of the new Strategy and focus groups are being established to advise the Committee on priorities for the next Strategy in relation to supply reduction, continuum of care, education and prevention and evidence and best practice. It is anticipated that the final report of the Steering Committee will be submitted to the Minister with responsibility for the National Drugs Strategy by the end of the year.
Following a Court of Appeal decision on 10 March 2015 which declared unconstitutional the section of the Misuse of Drugs Act empowering the Government to declare substances to be controlled under the Act, the Misuse of Drugs (Amendment) Act 2015 was urgently enacted to recontrol all substances which had previously been declared controlled by Government order.
A further Bill to amend the Misuse of Drugs Act to allow the Government to declare substances to be controlled, including prescription medicines, is currently being drafted and it is the intention to publish before the House rises for the summer.
38. Deputy Frank O'Rourke asked the Minister for Health if he is aware of difficulties with the Health Service Executive patient transfer scheme; and if he will make a statement on the matter. [13760/16]
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.
