Written Answers Nos. 39-53
39. Deputy Charlie McConalogue asked the Minister for Health if the €8 million funding announced for therapy services for young persons in the 2016 Health Service Executive service plan has been released; and if he will make a statement on the matter. [13819/16]
Amharc ar fhreagraThe HSE have been advised that a sum of €58.5 million is being held back by the Department for specific initiatives as outlined in the 2016 National Service Plan. This includes €8 million for initiatives in therapy services for young people. The two initiatives are the continued implementation of the Progressing Disabilities Services Programme, including development of early intervention services to facilitate the integration of children with disabilities in mainstream preschool settings (€4 million), and a primary care speech and language waiting-list initiative (€4million). The release of held-back funding is subject to the HSE submitting a plan to the Department for approval, prior to the funding then being released.
A proposal was provided by the HSE in relation to continued implementation of the Progressing Disabilities Services Programme. The proposal was examined and approval was subsequently given to release the €4m in funding, which equates to approximately 75 additional therapy posts. Approval was also based on the understanding that 50 of these 75 posts are to be used to focus on developing early intervention services, including the implementation of the important new model on supporting access to Early Childhood Care and Education (ECCE) Programme, which is being lead by the Department of Children and Youth Affairs.
In terms of Primary Care services nationally, the HSE has developed proposals to improve access to primary care speech and language therapy services and to address the waiting lists for assessment and therapy treatment. The details are currently being finalised by the HSE and my Department. The proposed initiative will include the appointment of new posts to address the current waiting lists for speech and language therapy services for 0 - 18 year olds. The additional capacity will address pending initial assessments and therapies. The HSE National Service Review Group is also examining primary care speech and language services so that decisions can be taken in relation to the longer term resource allocations which may require a redistribution of resource. Details of proposals will be announced shortly.
40. Deputy Lisa Chambers asked the Minister for Health the reason for the 65% increase in the number of outpatients waiting more than a year for an appointment between December 2015 and April 2016; and if he will make a statement on the matter. [13753/16]
Amharc ar fhreagraThe numbers of patients on waiting lists must be considered in the context of overall demand. Every year there are 3.2m outpatient attendances at our hospitals. 100,000 patients have elective inpatient procedures and 800,000 have planned day case procedures.
In 2015 my predecessor introduced a maximum waiting time of 15 months to be attained by the end of December 2015, focussing on patients waiting longest. Under the 2015 Waiting List Initiative, almost 36,000 additional outpatient appointments were provided, to achieve 93% compliance with the 15 month maximum waiting time.
Whilst acknowledging that the numbers waiting over 12 months increased between December 2015 and April 2016, it is important to note that greater demand for emergency care arises in the peak winter period. This, in turn, impacts the number of outpatient appointments available. Despite this challenge, 94% of patients currently wait less than 15 months, with over 60% of patients waiting less than 6 months for their required care. We also continue to see reductions in outpatient waiting times year on year.
The HSE has established a Scheduled Care Governance Group to coordinate initiatives to reduce waiting list numbers, focussing on chronological scheduling and administrative and clinical validation procedures to ensure that patients are available for treatment.
In addition, my Department is currently engaging with the NTPF and the HSE in planning a dedicated 2016 waiting list initiative. Finally, my Department is engaging with the NTPF and the HSE regarding the Programme for Partnership Government commitment to provide €15m to the NTPF in 2017 to address waiting lists.
41. Deputy Eoin Ó Broin asked the Minister for Health his plans for the governance arrangements of hospital groups; if, how and when he will enact legislation to put the administrative arrangement of hospital groups on a statutory basis; and if he will make a statement on the matter. [13698/16]
Amharc ar fhreagraSeven Hospital Groups have been established on a non-statutory administrative basis. Pending the enactment of legislation, Hospital Groups will continue to operate within existing legislative frameworks governing the health services and the policy and accountability frameworks of the Department of Health and the HSE.
The implementation of Hospital Groups will progress in a phased manner, which will provide for devolved decision-making, fostering flexibility, innovation and local responsiveness, while also adhering to prescribed national service objectives and standards. As Hospital Groups are implemented, of key importance is the early demonstration of progress towards a more co-ordinated approach to the planning and delivery of services within and across the groups.
The establishment of Hospital Groups is one component of a complex health reform programme. As set out in the Programme for Government, an Oireachtas All-Party Committee is to develop a long-term vision for healthcare over a 10 year period. I intend to progress discussions in this regard before giving further consideration to the issue of establishing Hospital Groups on a statutory basis.
42. Deputy Jonathan O'Brien asked the Minister for Health when he will finalise and publish the misuse of drugs (amendment) Bill 2016; when he will establish the pilot supervised injecting facility arising from this; and if he will make a statement on the matter. [13702/16]
Amharc ar fhreagraGovernment policy in relation to drugs emphasises the importance of providing the opportunities for people to move on from illicit drug use, through drug treatment and rehabilitation, to a drug-free life where that is achievable. The provision of harm reduction measures, such as needle and syringe programmes and methadone maintenance treatment, reduce drug-related harm and facilitate recovery by providing a pathway into services.
However, there is a problem with street injecting in Dublin and elsewhere. This practice is unhygienic and poses a significant health risk for the drug users themselves and results in discarded needles which present a public health risk to others.
The establishment of supervised injecting facilities has been proposed to ameliorate this problem. The Government has committed to supporting a health-led rather than criminal justice approach to drugs use including legislating for supervised injection facilities.
A supervised injecting facility works to prevent injury and death, and connect people with help, by the provision of a supervised space where drug users may self-administer drugs by injection in safer conditions, and where immediate care can be given in the event of overdose. Unlike other forms of Drug Consumption Rooms, it does not make provision for consumption by other routes of administration, such as smoking.
On the 15 of December 2015, the Government decided to include additional Heads in the Misuse of Drugs (Amendment) Bill to provide enabling provisions for supervised injecting facilities. These provisions would enable the Minister for Health to issue licences permitting the establishment of supervised injecting facilities to provide enhanced clinical support to, and mitigate the problem of public injecting by, chronic drug users.
Drafting of the Bill by the Office of Parliamentary Counsel is at an advanced stage and, subject to approval by Government, it is anticipated that it will be published in coming months. The Bill and the subsequent Ministerial regulations made thereunder, will allow for the licensing, provision and operation of supervised injecting facilities under specific circumstances, whilst protecting the public health and ensuring that the prohibition on possession and supply of illicit drugs outside of such facilities is adequately maintained.
It is envisaged that initially one supervised injecting facility would be established on a pilot basis in Dublin city centre. An independent evaluation would be an intrinsic element to this initiative; determining the utility, safety and cost-effectiveness of the supervised injecting facility in an Irish context. The outcome of such an evaluation will inform any decision to licence further facilities. In line with the experience of other countries which have established such facilities, it would be expected that the numbers would be few and the locations carefully selected to address most effectively the requirements and concerns of the service users and the wider community.
43. Deputy Louise O'Reilly asked the Minister for Health the status of the task force on staffing and skill mix for nursing; the status of the pilot of the framework for safe nurse staffing and skill mix in general and specialist medical and surgical care settings in adult hospitals in Ireland; the hospitals in which this is being piloted; the timeframe for completing reporting and making recommendations on the pilot; and if he will make a statement on the matter. [13692/16]
Amharc ar fhreagraIn February 2016, the Taskforce on Staffing and Skill Mix for Nursing, developed an Interim Report and Recommendations for Safe Nurse Staffing and Skill Mix in general and specialist surgical care settings in adult hospitals in Ireland. One of the reports’ key recommendations was the necessity to undertake a pilot test of the framework in 2016. In February 2016, a Taskforce Pilot Planning and Implementation Group was established to oversee the pilot. Currently, the pilot test is being undertaken across three acute hospitals, representing the various different hospital sizes, and includes: Beaumont Hospital, Our Lady of Lourdes Hospital Drogheda and St Colmcille's Hospital in Louglinstown. The timeframe for the completion of the pilot is December 2016 with reporting on the outcomes and recommendations from the pilot in January 2017.
44. Deputy Kathleen Funchion asked the Minister for Health his plans to roll out a programme of mental health awareness training for general practitioners and other general health workers so that they are better equipped to assist persons in mental distress who are seeking referral or advice on their care. [13725/16]
Amharc ar fhreagraAs this is a service issue, this question has been referred to the HSE for direct reply. If you have not received a reply within 15 working days, please contact my Private Office and they will follow up the matter with them.
45. Deputy Lisa Chambers asked the Minister for Health the measures he is putting in place to improve rheumatology services at Mayo University Hospital; and if he will make a statement on the matter. [13752/16]
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.
46. Deputy Mick Barry asked the Minister for Health if personnel of the Health Service Executive will conduct the assessments under the proposed fit for work programme contained in the programme for Government or if it will outsource this work; and if he will make a statement on the matter. [13747/16]
Amharc ar fhreagraUnder the Programme for Partnership Government published in May 2016, the Government committed to supporting the Departments of Health and Social Protection in working together to pursue a 'Fit for Work Programme' to support people to get back to work if they have an illness or disability.
The 'Fit for Work' proposal is based on the findings of a pan European study, which examined the impact of musculoskeletal disorders (MSDs) on an individual’s ability to work. The Irish module of this study was progressed by a coalition of key stakeholders and was led by Arthritis Ireland. The Irish College of General Practitioners, ICTU, IBEC and the Health & Safety Authority also contributed to the study. While specific proposals for a “Fit for Work Programme” require further development and scoping out, I would like to assure the Deputy that any such proposals will be in line with the wealth of evidence which shows that generally employment is good for one’s mental and physical health and wellbeing and, conversely, that unemployment is damaging. It is not possible at this early stage to identify what assessments may be required or how they would be delivered as the Departments have not yet developed any proposals to bring to Government.
A healthy population is essential to allow people to live their lives to their full potential. My Department will work with the Department of Social Protection in the development of supports for employees which are in line with the vision and goals of Healthy Ireland- A Framework for Improved Health and Wellbeing 2013-2025.
47. Deputy Martin Heydon asked the Minister for Health how he can help to resolve the serious delays in the registration of nurses, which are preventing many qualified nurses from home and abroad from taking up available positions. [13746/16]
Amharc ar fhreagraAt the outset, I would like to say that the delay in the Nursing and Midwifery Board of Ireland (NBMI) responding to your previous question of 21 April 2016 is regretted. This reply encompasses both this question and your previous question of 21 April 2016.
As of 31 May, 2016, a total of 803 nurses and midwives have been registered by the NMBI since 1 January 2016. In addition, 681 applicants have been issued with decision letters setting out what they must do to progress to the final stage of registration.
The NMBI fully recognises the challenges being experienced by health service employers in the public and the private sector and the NMBI is meeting and liaising with employers to address the registration issues. The NMBI is also liaising with a large number of recruitment agencies on a daily and weekly basis to support the recruitment and registration process. Senior NMBI staff are also endeavouring to explore the best ways of improving the efficiency of the existing process, whilst still maintaining the standards of education and professional competence required to enable registration. A new streamlined application form and information booklet was also launched earlier this year.
Various measures including enhanced website functionality, additional staff appointments and ongoing process improvement work by NMBI staff is assisting in making headway in the management of the increasing volumes of applications received by the NMBI to facilitate new nurses and midwives entering the Irish health system as quickly as possible without compromising standards.
While NMBI has registered 803 nurses and midwives in 2016 to date and issued 681 applicants with decision letters, there are a further 1,947 applications unable to progress to assessment stage due to incomplete documentation being submitted by applicants who have all been contacted in this regard. It should be noted that as well as a completed application form, overseas applicants must send in identity documents and arrange for other supporting documents to be sent directly to NMBI. These include a transcript of their education programme, a certificate confirming registration and good standing as a nurse, as well as a reference from their current or most recent employer. Only when these documents have been received can the application for registration be assessed. It is incumbent on recruitment agencies and employers to emphasise to applicants that it is their responsibility to ensure all relevant documents are sent to NMBI. Since March 1, applicants have six months from the date of application to submit all of their documentation, otherwise their application will be closed. Previously, applicants had twelve months to submit their documentation.
It is important to note that the decision following this assessment may not always be registration. The outcome can be to seek further information/clarification from the applicant, to register, to refuse registration, or to advise the applicant they must successfully complete a period of adaptation and assessment as a pre-requisite to registration. In late 2015, the NMBI approved, on a pilot basis, an aptitude test developed by the RCSI as an alternative option to undergoing a period of adaptation and assessment and this is proving a successful and popular alternative. NMBI has now approved the initiative for a further two years, which will facilitate 40 applicants to take the test monthly.
It should also be noted that the NMBI is working with Nursing Homes Ireland (NHI) to explore ways of encouraging the large amount of nurses on the inactive part of the Register in Ireland to recommence practising. The provision of Return to Nursing Practice programmes by the HSE is also supporting this initiative.
48. Deputy Anne Rabbitte asked the Minister for Health when he will appoint a paediatric diabetes specialist at University Hospital Galway in County Galway; and if he will make a statement on the matter. [13763/16]
Amharc ar fhreagraA Consultant Paediatrician with a Special Interest in Diabetes has been recognised as a priority post for Galway University Hospital. The post was approved, recruited and a Consultant has been appointed to GUH. Due to previous work commitments, the successful candidate will take up their post in March 2017.
The current arrangement, whereby all infants and children under 5 years of age with newly diagnosed diabetes are referred for special services to Limerick University Hospital, will continue until March 2017, when the new post holder will take up position.
In addition, the Saolta Healthcare Group is seeking to recruit a locum Consultant in the intervening period.
The Saolta Group continues to develop paediatric diabetes services across the Group. An Insulin Pump Therapy Service for Children in the Northwest commenced in early 2015. In addition, children commenced continuous insulin infusion therapy at Sligo University Hospital in 2015, with subsequent outreach clinics being delivered at Letterkenny University Hospital.
My Department continues to work with the HSE regarding waiting list performance. In 2016 the HSE has established a Scheduled Care Governance Group to drive improvements in chronological scheduling and minimise non-attendances, ensure that consistent clinical and administrative validation of waiting lists is undertaken by hospitals and to provide care and follow-up monitoring in settings other than a hospital, including by GPs.
49. Deputy Carol Nolan asked the Minister for Health the number of children on public waiting lists for extractions under general anaesthetic; the cost of sending children to private hospitals for extractions under general anaesthetic; the cost for each year since the closure of the children’s dental clinic at St. James’s; his plans to source a new location for this service; and if he will make a statement on the matter. [13713/16]
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.
50. Deputy Anne Rabbitte asked the Minister for Health if he is aware of difficulties with many children being unable to access essential medical and dental services; and if he will make a statement on the matter. [13762/16]
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.
51. Deputy Mattie McGrath asked the Minister for Health his views on access to abortion within this State as outlined to the United Nations Human Rights Council on 11 May 2016; and if he will make a statement on the matter. [10045/16]
Amharc ar fhreagraAbortion is prohibited in Ireland unless there is a real and substantial risk to the life of a pregnant woman that can only be averted by the termination of her pregnancy. Article 40.3.3 of the Irish Constitution (Eighth Amendment) provides as follows:
‘The State acknowledges the right to life of the unborn and, with due regard to the equal right to life of the mother, guarantees in its laws to respect, and, as far as practicable, by its laws to defend and vindicate that right.’
The interpretation of 40.3.3 was considered by the Supreme Court in Attorney General v X in 1992. Further, in December 2009, the European Court of Human Rights heard a case brought by three women in respect of the alleged breach of their rights under the European Convention on Human Rights in regard to abortion in Ireland. This action was known as the A, B, and C v Ireland case.
The Protection of Life During Pregnancy Act, 2013 was enacted on 30th July 2013 and commenced on 1st January 2014. It regulates access to lawful termination of pregnancy in accordance with the X case and the judgement of the European Court of Human Rights in the A, B and C v Ireland case. Its purpose is to confer procedural rights on a woman who believes she has a life-threatening condition, so that she can have certainty as to whether she requires a termination.
The Government has made a commitment in the most recent Programme for Government to establish a Citizen's Assembly to make recommendations to the Dáil on further constitutional changes and they will consider the Eighth Amendment as part of this work.
52. Deputy Richard Boyd Barrett asked the Minister for Health if he will consider establishing a State pharmacy to source best value pharmaceuticals for supplying hospitals, general practitioners and pharmacies, and to estimate the savings that would be made to the Exchequer with this measure; and if he will make a statement on the matter. [13766/16]
Amharc ar fhreagraMost drugs and medicines reimbursed by the HSE are supplied to patients through over 1,800 contracted community pharmacies which, in turn, purchase them from wholesalers or, to a lesser extent, directly from manufacturers. The community pharmacist is paid a fee for dispensing medicines to patients.
The HSE maintains a Reimbursement List of all products reimbursed under the Community Drug Schemes, under the provisions of the Health (Pricing and Supply of Medical Goods) Act 2013. The Act permits the HSE to set the prices of all products on the Reimbursement List, subject to certain conditions. All medicines on the list which are off patent are subject to generic substitution and reference pricing.
In relation to High Tech drugs, the HSE purchases these drugs directly from the manufacturer for supply through community pharmacies; pharmacists are paid a patient care fee for dispensing these drugs.
The HSE keeps the price of medicines under ongoing review, and works continuously to achieve greater efficiencies in the areas of drug pricing, supply and distribution. The Executive has a number of initiatives already underway or in development, particularly under the National Drug Cost Management Programme and the Medicines Management Programme, which provides national leadership relating to issues such as the quality of the medicines management process, access to medicines and overall expenditure on medicines.
In addition, my Department has recently created a new Community Pharmacy, Dental, Optical and Aural Policy unit to bring a renewed focus to the development of policy in relation to community pharmacy and the issues associated with achieving maximum benefit to patients.
53. Deputy Pearse Doherty asked the Minister for Health in respect of activity-based funding, the transition arrangements that are currently in place in the hospital system to reflect the difference between hospitals' current costs and national average costs; how he will phase out these arrangements; what will happen to hospitals that are unable to address the differences in their costs base; and if he will make a statement on the matter. [13706/16]
Amharc ar fhreagraThe way that public acute hospital services are funded is in the process of being reformed through the implementation of an Activity Based Funding (ABF) system. The purpose of ABF is to change the model of funding from the previously existing block grant budget system to a new approach where hospitals are paid based on the quantity and quality of the services they deliver to patients within a fixed budget system. This model is designed to increase transparency, promote efficiency, and ensure a fairer system of resource allocation. Currently ABF is being applied to Inpatient and Day Case activity in 38 hospitals which account for the majority of hospital expenditure. Given the scale of the change being undertaken the full roll out of ABF will take place over a number of years.
The HSE published the “Activity Based Funding Programme Implementation Plan 2015-2017” in May 2015. In order to ensure financial stability during the process of moving to ABF, this Implementation Plan includes a provision for transition payments to be made. These are adjustments/payments that will be made to hospitals which are currently operating above the national average price for activity. They can occur for many reasons, which fall into two categories - issues within the control of the hospital (e.g. low Day of Surgery Admission rates or higher than average patient Length of Stay), or those that are not (e.g. structural issues such as geographic location).
A major Benchmarking exercise encompassing all ABF hospitals was carried out during 2015, two of the main purposes of which were to calculate the level of transition adjustments to apply in 2016 and to begin the process of identifying the reasons for the price disparities. Hospitals will be required to develop plans to reduce their costs and address the need for transition adjustments related to issues within their control, which will be phased out over a period of time. Other structural type issues will continue to be funded.
As this is the conversion year and therefore the first year that ABF is in operation, the time frame under which transition payments will be eliminated has not yet been determined. However, the transition payments will continue for a number of years to allow hospitals to address any issues with their cost base. Hospitals will be supported to better understand and therefore address such issues through the implementation of new Patient Level Costing and ABF reporting systems.
