Written Answers Nos. 28-49
28. Deputy Mattie McGrath asked the Minister for Health when he will complete improvements to radiology services at South Tipperary General Hospital; the investment cost of these improvements; and if he will make a statement on the matter. [20602/16]
Amharc ar fhreagraSignificant investment has been made to improve radiology services at South Tipperary General Hospital. I understand that building work, to extend current facilities, commenced in November 2015 and is expected to be substantially completed by September 2016. A new CT Unit has been purchased and is in storage pending completion of the building works.
I have asked the HSE to respond directly to the Deputy with any more detailed information which might be available.
29. Deputy Mattie McGrath asked the Minister for Health his assessment of mental health services in south Tipperary since the closure of St. Michael's psychiatric unit in Clonmel, County Tipperary; if he will consider re-opening this unit; and if he will make a statement on the matter. [20603/16]
Amharc ar fhreagraAs this is a service issue, this question has been referred to the HSE for direct reply. If the Deputy has not received a reply within 15 working days, he should contact my Private Office and they will follow up the matter with them.
30. Deputy Alan Kelly asked the Minister for Health if he has examined the Alzheimer Society of Ireland's recent pre-budget submission, in particular if he notes the request for an additional €67 million in budget 2017 to provide additional home care packages for persons suffering from dementia; and his views on whether this proposal should be implemented in budget 2017; and if he will make a statement on the matter. [20609/16]
Amharc ar fhreagraThe Irish National Dementia Strategy was launched in December 2014, with the objective of increasing awareness, ensuring early diagnosis and intervention and developing enhanced community based services.
In parallel with the Strategy the Department of Health and the HSE have agreed a joint initiative with the Atlantic Philanthropies to implement significant elements of the Strategy over the period 2014-2017. This Implementation Programme represents a combined investment of €27.5m, with the Atlantic Philanthropies contributing €12m and the HSE €15.5m.
Key elements of the initiative include:
- the roll-out of a programme of Intensive Home Supports and Home Care Packages for people with dementia valued at €22.1 million over a three year period;
- the provision of additional dementia-specific resources for GPs, to include training materials and guidance on local services and contact points valued at €1.2 million;
- measures to raise public awareness, address stigma and promote the inclusion and involvement in society of those with dementia valued at €2.7 million.
The roll out of Intensive Home Care packages commenced in January 2015 and monitoring of the allocation and uptake of these packages to persons with dementia is ongoing. To date 133 people living with dementia have benefitted under the funding allocated from the National Dementia Implementation Programme at an average cost of €1,000 per package per week. There are currently 85 people with dementia in receipt of an Intensive Home Care Package. In addition to the Intensive Home Care Packages the HSE will continue to provide mainstream home help and routine Home Care packages to people with dementia whose needs have been assessed as requiring these supports and within available resources. Up to 500 people with dementia and their families are expected to benefit from Intensive Home Care Packages over the lifetime of the implementation programme.
It is Government policy that, wherever possible and appropriate, people should be cared for in their own homes and communities, and the National Dementia Strategy specifically restates this commitment to those living with dementia.
The HSE’s National Service Plan for 2016 provides for a target of 10.4 million Home Help Hours to support about 47,800 people. It also provides for 15,450 Home Care Packages and 130 Intensive Home Care Packages for clients with complex needs. A further 60 clients with dementia will be supported with co-funding from Atlantic Philanthropies under the Irish National Dementia Strategy.
Home support services across the country are being stretched by demands from more people, and for more hours at times outside of core hours, in the evenings and at weekends, all of which cost more. Activity in the first quarter of 2016 was ahead of the same period last year as efforts continued to alleviate pressure on the acute hospital system.
I am delighted that the Government has been able to respond to this demand by providing an extra €40m for home care in 2016. This will ensure that the home support services provided in 2015 are maintained and that the rate of service allocation can be maintained during the summer months. €10m of this money has been ring-fenced for home care as part of the new winter initiative. The targets for 2016 will be reviewed in light of these additional resources.
The Programme for a Partnership Government also commits to increasing provision for home care in the years ahead. While the proposal from the Alzheimer Society will be considered in the context of the forthcoming Estimates exercise for 2017, at this stage I cannot predict what the outcome of that consideration will be.
31. Deputy Clare Daly asked the Minister for Health to amend the terms of the treatment abroad scheme to include medical treatment in relation to termination of pregnancy, reasonable travel, accommodation and subsistence for the woman and a travel companion, particularly as the State's forcing of a woman to rely on her own financial resources entirely outside the public health care system in a case (details supplied) constituted discrimination and a violation of human rights. [20615/16]
Amharc ar fhreagraEntitlement to travel for the purpose of receiving medical treatment in an EU/EEA Member State or Switzerland is provided for by EC Regulation 883/2004, which has as its objective the coordination of national social security systems within the EU/EEA and Switzerland. One of the conditions set out in this Regulation is that authorisation for treatment in another Member State will be allowed "where the treatment in question is among the benefits provided for by the legislation in the Member State where the person concerned resides..."
In Ireland, fatal foetal abnormality is not a lawful ground for termination of pregnancy; terminations are lawful only in cases where there is a real and substantial risk to the life of the pregnant woman which may only be averted by termination of the pregnancy.
EU Regulations are binding in their entirety and directly applicable in all Member States. This means that a Regulation becomes part of each Member State's national legal system at the same time and without the need for transposition, thus ensuring uniformity of law throughout the EU. The Regulation has legal effect in each of the Member States simultaneously and independently of any national law. A Member State cannot unilaterally amend or ignore the provisions of an EU Regulation without breaching its obligations under EU law. Such a breach may lead to the State being liable in damages before the courts.
32. Deputy Carol Nolan asked the Minister for Health the consultation that has taken place with the Department of Health in Northern Ireland with respect to working towards interoperability of cross-Border e-health services; and if he will make a statement on the matter. [20919/16]
Amharc ar fhreagra45. Deputy David Cullinane asked the Minister for Health the action being taken to address the differing legal frameworks, lack of legal clarity and lack of interoperability to facilitate health data exchange to ensure co-ordinated care across borders in respect of barriers to the deployment of e-health; and if he will make a statement on the matter. [20934/16]
Amharc ar fhreagra50. Deputy Gerry Adams asked the Minister for Health the progress made to date in the development of e-prescribing, online referrals and scheduling, telehealth and the development of summary patient records; and if he will make a statement on the matter. [20924/16]
Amharc ar fhreagra81. Deputy Eoin Ó Broin asked the Minister for Health the progress made to date on the e-health strategy for Ireland; the actions that have been taken to date to bring this strategy in line with the European Union e-health action plan 2012-2020; and if he will make a statement on the matter. [20920/16]
Amharc ar fhreagra90. Deputy Carol Nolan asked the Minister for Health following approval to proceed in 2016 with an initial phase that will facilitate the electronic transfer of prescriptions, utilising Health Information and Quality Authority standards developed to date, and the national message broker health link, the current progress with this initiative; the progress being made with phased implementation towards a national e-prescribing solution; and if he will make a statement on the matter. [20918/16]
Amharc ar fhreagra110. Deputy Donnchadh Ó Laoghaire asked the Minister for Health the level of implementation of electronic health records, EHR, system allowing the access and update of EHRs by different health professionals in an interoperable structure; the policy initiatives under way to move towards a shared EHR system; and if he will make a statement on the matter. [20928/16]
Amharc ar fhreagraI propose to take Questions Nos. 32, 45, 50, 81, 90 and 110 together.
The importance of and the opportunity for eHealth or digital health to support health care reform and the delivery of a modern health care system has been recognised for quite some time. In 2013, the Government approved and published a strategy for developing eHealth capability in the Irish health system called the eHealth strategy for Ireland, 2013.
This strategy sets out a number of objectives and a roadmap for the delivery and implementation of eHealth to the benefit of both the citizen and the economy. The Government eHealth strategy draws heavily on and incorporates many aspects of the work done by the EU Task Force set up in 2011 to look at the potential for eHealth and its context in cross border health care resulting in the EU eHealth Action Plan 2012-2020, Innovative Health Care for the 21st Century.
Amongst the key objectives of the eHealth strategy was the setting up within the HSE, of an entity called eHealth Ireland to implement the strategy, the recruitment of a Chief Information Officer and the setting up of an Office of the Chief Information Officer, reporting to the Director General of the HSE. The CIO has been in place since late 2014 and eHealth Ireland is operating under his leadership. A Knowledge and Information Plan setting out the implementation objectives for eHealth was published in spring 2015.
The eHealth strategy also highlights the potential of cross border collaboration on eHealth and in particular the considerable experience of eHealth deployment in Northern Ireland. It highlighted an all-island opportunity for eHealth. Northern Ireland was a focus of attention amongst a number of case studies on eHealth implementation in the strategy. My Department has been engaged since 2013 in sharing and learning from Northern Ireland’s experience in this area. There is also engagement by HSE in eHealth initiatives in the context of the INTERREG Programmes and other opportunities such as Horizon 2020. The HSE and the Northern Health and Social Care Trust are progressing the implementation of cross border Radiotherapy services. This will be facilitated by the deployment of technology to ensure that the relevant patient data is available where the patient is being treated on either side of the border. I understand that officials from HSE will be partaking in a workshop with their counterparts from Northern Ireland shortly on the eHealth agenda in both parts of the island.
The eHealth strategy also called for the setting up of an eHealth ecosystem to develop eHealth linkages and stakeholder engagement including patient engagement similar to one already working in Northern Ireland and several other jurisdictions. The eHealth Ireland Ecosystem has been operating for over a year and is a very useful platform to provide stakeholder engagement on a range of issues as well as economic connectivity for the SME community in Ireland. In addition, in the context of the implementation of the eHealth strategy, the HSE has set up an eHealth Ireland Advisory Committee comprised of a number of academic, technology and healthcare experts whose role is to support and guide implementation of the eHealth Strategy through the implementation of the Knowledge and Information Plan.
Interoperability of computer systems is a major challenge facing the implementation of eHealth whether within health care services or in the context of cross border health services. A key component needed for delivery of successful eHealth solutions is the adoption of a standards based approach to the implementation of ICT systems. The Health Information and Quality Authority have developed a range of standards to support eHealth. My Department is also actively engaged with the EU eHealth Network which was established in 2011 to pursue solutions to interoperability and standardisation between Member States. Under the auspices of the eHealth Network, the Joint Action to Support the eHealth Network (JASEHN) has been established. My Department is actively involved in a number of related work streams of the Joint Action, whose overall aim is to provide the optimum environment, both technical and legal, to allow for interoperability of health care systems in the context of cross border services. As part of the HSE eHealth work, the Office of the CIO has established an Enterprise Architecture Unit dealing with interoperability and standards based in many instances on EU related work on summary care records and ePrescribing. The eHealth Ireland team have created a clinically focused function that is known as a Chief Clinical Information Officers Council. This function takes lessons learnt from other jurisdictions globally and ensures that technology is deployed with clinical engagement and leadership.
With regard to Electronic Health Records, the Office of the Chief Information Officer has recently submitted a detailed business case for a national electronic health record programme for Ireland. My Department is currently evaluating how this might be progressed particularly in delivering an EHR in the context of the work being planned for the New Children’s Hospital which aspires to be the first digital hospital facility in the country. In developing a national electronic health record programme we must build on the progress to date in ICT deployment but also the lessons learnt from other jurisdictions in developing an optimum solution for Ireland. This programme, if progressed, will require a substantial investment in ICT. It also offers the opportunity for re-configuration of services with the potential of a safer, patient centred and more integrated approach along with significant efficiencies.
I am glad to say that since 2013 and the publication of the eHealth strategy for Ireland substantial progress is being made in furthering the eHealth agenda and I look forward to further progress, particularly in regard to electronic health records. The capital programme for health care ICT has been increased from €40m in 2014 to €55.0m in 2015 and 2016. The new eHealth structures are progressing well with the planned roll-out of new health care ICT infrastructure and solutions across the health services including key clinical systems such as a new national laboratory information system (LIMS), maternal and new born information system (MN-CMS) the Medical Oncology Clinical Information System (MOCIS) due to go live in the next 12 months. MOCIS will provide digital support for prescribing and administration of chemotherapy treatments.
In addition, the eReferrals Programme has delivered a solution to provide electronic referrals between primary and acute hospitals using the Health Link facility. To date 48 hospitals have been connected and the programme is working well. Other work that is being progressed is in the area of ePrescribing. The HSE are currently evaluating work done across various regions on ePrescribing and a National ePharmacy programme has been established to develop the components for a business case for a national ePrescribing solution. Further work is required to develop and define a national drugs file as a key building block for a national ePrescribing solution. The progress achieved to date on eHealth and specifically ePrescribing can be followed up on the eHealth Ireland website www.eHealthIreland.ie.
The delivery of digital health care services and the roll-out of an electronic health record (EHR) will require a further robust legal framework to ensure confidentiality and security of patient data consistent with the new EU data protection regulation, Regulation (EU) 2016/679. Two current legislative initiatives by my Department are intended to support eHealth amongst other issues. The Health Identifiers Act, 2014 is providing a legal basis for a robust system of identifiers in the health sector and the Health Information and Patient Safety Bill, currently being drafted, includes provisions to support interoperability. My Department is currently examining the appropriate information framework that will provide the optimum environment to support eHealth and the deployment of electronic health records in the future. The health care delivery system straddles both the public and private domains and requires a robust information governance environment to ensure the right information about the right patient is available securely, in the right place and at the right time.
33. Deputy Róisín Shortall asked the Minister for Health the way he proposes to cut the costs of medication to the State and to the general public. [20949/16]
Amharc ar fhreagra521. Deputy Alan Kelly asked the Minister for Health the measures being taken to reduce the cost of drugs for patients here; to estimate the amount he believes can be saved by the Health Service Executive in 2016 through reduced drug prices; and if he will make a statement on the matter. [20785/16]
Amharc ar fhreagraI propose to take Questions Nos. 33 and 521 together.
The Programme for a Partnership Government includes a commitment to examine opportunities for leveraging purchasing power either through national or European initiatives and for making greater use of effective but less costly medicines. It also commits to considering a reduction in the prescription charge, having regard to the funding available to facilitate such measures.
We will also continue to build on a number of measures implemented in recent years to reduce the cost of medicines; these measures include the establishment of the HSE's Medicines Management Programme, which has a particular focus on cost-effective prescribing, and the continued implementation of generic substitution and reference pricing.
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.
Negotiations and agreements with industry represent just one element of the Government’s strategy to reduce expenditure on medicines; other initiatives will continue to be pursued in the coming months and years to ensure that we achieve affordable prices for medicines for both patients and the State.
A negotiating team representing the State has reached agreement in principle with the Irish Pharmaceutical Healthcare Association on a new drug pricing and supply agreement. Work will continue between the parties over the coming days to finalise the terms of the agreement, which will deliver real savings in the area of patented medicines. Until the agreement is finalised, I cannot comment on anticipated savings.
34. Deputy Mary Butler asked the Minister for Health the reason for the substantial increase between December 2015 and May 2016 in the number of outpatients waiting more than a year for a consultation in Waterford University Hospital. [20964/16]
Amharc ar fhreagraA key challenge for our health system is to ensure timely access to health services. This Government recognises that a sustained commitment to improving waiting times is required with a particular focus on those waiting longest. While waiting list numbers nationally have increased in the first half of the year, this must be seen in the context of increased demand for care in our health system. There has been a 4% increase in inpatient and day-case activity in acute hospitals and an almost 6% increase in attendances at EDs in comparison with last year. The key issue for patients is how long they wait. Approximately 60% of patients wait less than 6 months for a required outpatient appointment or inpatient/day-case procedure.
Regarding 2016, my Department is currently engaging with the NTPF and the HSE to finalise a dedicated waiting list initiative focussed on endoscopy. In addition, my Department has asked the HSE to implement an action plan to address waiting times with hospitals and Hospital Groups. This will focus on improving chronological scheduling, clinical and administrative validation of lists and optimising existing capacity.
The Deputy may also wish to note that the Programme for a Partnership Government commits to €15m funding for the NTPF in 2017 to address waiting lists for those waiting longest, as part of a continued investment of €50m per year to reduce waiting times. My Department is currently engaging with the NTPF and the HSE to deliver on the Programme's waiting list commitments.
In relation to waiting lists at University Hospital Waterford as this is a service matter, I have asked the HSE to respond to the Deputy directly. If the Deputy has not received a reply from the HSE within 15 working days she should contact my Private Office and my officials will follow the matter up.
35. Deputy Ruth Coppinger asked the Minister for Health to report on the implementation of the action plan of the national ambulance service capacity review; and if he will make a statement on the matter. [20950/16]
Amharc ar fhreagraThe Capacity Review was published in May along with a comprehensive action plan which incorporates the recommendations of both the Capacity Review and the 2014 HIQA Report on the National Ambulance Service (NAS). As the Action Plan will be implemented over a number of years, a phased investment in a multi-annual programme involving manpower, vehicles and technology will be required. To that end, the Programme for Government commits to additional annual investment in the ambulance service in terms of personnel and vehicles. The Deputy can be assured that my Department engages on an ongoing basis with the NAS in relation to service requirements and performance, and will continue to do so to ensure that the action plan is implemented.
I should perhaps mention that many of the key recommendations in the Capacity Review, and the HIQA Report, were already being addressed as part of a significant programme of reform and modernisation of the NAS which has been under way in recent years. Additional funding of €7.2m has been provided for the NAS in 2016, which includes €2m for new developments.
36. Deputy James Browne asked the Minister for Health his plans to review arrangements for funding of section 38 agencies in view of recent events. [20956/16]
Amharc ar fhreagraI would like to inform the Deputy that a review of all Section 38 providers being conducted by external consultants, is already under way. The purpose of these reviews is to establish the standard of governance in place in these organisations and to confirm independently that the governance practices and procedures accord with those set out in their respective Annual Compliance Statements. These reviews involve an examination of key governance processes and documents, including obtaining confirmation that internal financial controls and formal written financial procedures are in place in these organisations. Six of these reviews are currently under way. The outcomes of the reviews will both inform the HSE’s relationship with the agency concerned and any further enhancement of the HSE’s overall governance framework.
The HSE provides funding in return for services to some 40 agencies under Section 38 of the Health Act. The HSE also provides funding to a much wider group of generally smaller agencies under Section 39. In relation to Section 38 there are some forty agencies delivering services ranging in size from the Daughters of Charity with an annual budget of just over €2 million to St. James’s Hospital with a budget of almost €357 million. Section 38 agencies have played a very important role in the development of our health and social care services. Some agencies delivering services under Section 38 arrangements are amongst the very best we have in terms of the quality of care provided and the systems of governance employed. However, there is a requirement for all such agencies to continually review their governance processes in order to ensure these are sufficiently robust.
The HSE has taken significant steps to enhance its system for performance oversight of Section 38 agencies.
The HSE has a formal national governance framework which governs grant funding provided to agencies under section 38 of the Health Act 2004. This governance framework seeks to promote the consistent application of good governance principles to ensure that both the HSE and the grant-funded agency meet their respective obligations.
Policy in relation to financial governance is outlined in the HSE’s National Financial Regulation pertaining to Grants to Outside Agencies. The regulation and the supporting documentation developed by the HSE detail the requirements for performance review, including submission and review of financial accounts and Code of Governance statements and periodic performance review meetings with each agency.
An Annual Compliance Statement process is in place whereby the Board Chairs of each Section 38 agency are required to certify on an annual basis that they are compliant with the necessary governance requirements or in cases where they are not compliant, they are obliged to explain why that is the case. If an organisation is found not to be compliant, the HSE has powers under the Service Level Agreements to initiate a process that could include potential termination of agreement unless conditions are met.
The HSE’s Internal Audit Division is responsible for ensuring that a comprehensive programme of audit work is carried out. The Internal Audit Division of the HSE conducts audits of a number of agencies each year and several such audits are currently in progress. At present Internal Audit Reports are routinely issued under FOI. My officials have been informed by the HSE that the reports for the second half of 2015 will issue shortly. The Office of the C&AG also has access to all internal audit reports and it is regularly briefed by the HSE on their content.
The following revision was received from the Department on 20 July 2016
The Reply at that time indicated that there were 40 Section 38 agencies. This was incorrect; there are 39 section 38 agencies. Annual funding to these agencies ranges between €1.7 million to Cork University Dental School and Hospital and €361.4 million to St James’ Hospital. Total funding allocated by the HSE in each year to those agencies was €2.69 billion, €2.7 billion and €2.84 billion respectively.
37. Deputy Pat Buckley asked the Minister for Health his plans to introduce a regulatory framework to allow for the registering of all residential mental health and drug and alcohol units to ensure that standards are being observed and proper evidence based care is being provided, especially where Health Service Executive funding is being allocated. [20946/16]
Amharc ar fhreagraThe Mental Health Act 2001 currently provides that the Inspector of Mental Health Services visit, inspect and report on every approved centre at least once in each year. In addition, the Inspector may also inspect any other service, where mental health services are being delivered under the direction of a consultant psychiatrist.
The Expert Group Review of the Mental Health Act 2001 was published last year. The Group recommended that the Mental Health Commission should develop a risk based approach to inspection to ensure maximum effectiveness and efficiency in the use of scarce resources. As part of this new approach, the Group recommended that community mental health services be registered and inspected at reasonable intervals using this risk based system starting with all community mental health teams. In addition, it is also recommended that the Mental Health Commission be provided with specific powers to make standards in respect of all mental health services and to inspect against those standards. Work on the General Scheme of a Bill to amend the Mental Health Act 2001 and to include the recommendations I have mentioned, is under way in my Department.
The Department of Health is also currently in the process of developing a new National Drugs Strategy that will take effect in 2017, when the current policy expires. A Steering Committee has been established to oversee the process. One of the issues raised in this context is the need to ensure that there are quality standards and evidence-based care across all treatment services, including residential units. These issues are being further explored within multi-stakeholder Focus Groups centred on Continuum of Care and Evidence & Best Practise that will soon be reporting their recommendations to the Steering Committee for consideration. My colleague, Minister Catherine Byrne is expecting the final report of the Steering Committee by the end of the year.
38. Deputy Catherine Connolly asked the Minister for Health the reason the independent monitoring group set up to monitor the implementation of A Vision for Change and which sat for two periods, 2006-2009 and 2009-2012, did not sit after 2012 given that it was a fundamental recommendation in A Vision for Change; his plans, if any, to reconvene such a monitoring group; and if he will make a statement on the matter. [20607/16]
Amharc ar fhreagraIn January 2006, the Government adopted the Report of the Expert Group on Mental Health Policy 'A Vision for Change' as the basis for the future development of mental health services in Ireland. In March 2006, the Government, in line with a recommendation in 'A Vision for Change', established the First Independent Monitoring Group for a three-year period to monitor progress on the implementation of the report recommendations. The term of the first group ceased in April 2009 and in June 2009 the Government appointed the Second Independent Monitoring Group for a further three-year period. The Second group delivered its final report in 2011 and subsequently the Government dissolved the group as the three year term had come to an end.
'A Vision for Change' has guided national mental health policy for the past 10 years and its term comes to an end this year. The Department published a request for tender on 27th June 2016 for a review and analysis of international evidence and best practice in the development of mental health services, including a review of current delivery of services in Ireland. This review will provide evidence to determine the policy direction for a revision of 'A Vision for Change'. The review will also have regard to both human rights and health and well-being objectives. At that stage, the exact timeframe for completion of the revised policy direction will be determined by the planned analysis outlined above. When the review is completed, the Department will examine the output and will then decide on the need for a monitoring group to oversee any required policy changes.
39. Deputy Niamh Smyth asked the Minister for Health if it is acceptable to allow an eight year old child who is deaf in one ear and partially deaf in the other wait two years on the public waiting list for an ear, nose and throat appointment within the Cavan and Monaghan Hospital Group; and if he will make a statement on the matter. [20601/16]
Amharc ar fhreagraUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
In relation to the specific case raised, 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.
40. Deputy Margaret Murphy O'Mahony asked the Minister for Health the measures being taken to reduce waiting times for speech and language therapy. [20960/16]
Amharc ar fhreagra103. Deputy Mick Wallace asked the Minister for Health the measures he is taking to reduce waiting lists for children in need of speech and language therapy, which increased by 20% in 2015 alone; and if he will make a statement on the matter. [20610/16]
Amharc ar fhreagraI propose to take Questions Nos. 40 and 103 together.
I acknowledge to the Deputies that waiting lists for speech and language therapy have been very difficult for families and it is an issue about which I am very concerned.
In this regard, I am happy to advise the Deputies that my Department approved an initiative developed by the HSE to appoint new recurring posts in primary care to address Speech and Language Therapy (SLT) waiting lists in Primary Care and Social Care for 0-18 year olds.
The HSE’s National Service Plan 2016 provides €4 million for this initiative and this additional investment in primary care services will deliver more initial assessments and therapies. This represents a real long-term increase in speech and language capacity that will be maintained into 2017 and beyond at an annualised cost of €4 million.
The HSE National Service Review Group is undertaking a complete review of the current model of service delivery which will inform decisions in relation to the longer term resource allocations.
The National Purchase Treatment Fund (NTPF) sits on the National Service Review Group and has undertaken diagnostic reviews in Dublin North, Kildare West Wicklow and Wexford. An overall report is expected shortly in this regard.
The purpose of the diagnostic reviews is to establish whether (i) waiting list volume returns are complete and accurate and (ii) areas have implemented key internal management practices to manage referrals, demand, capacity and productivity ensuring equitable access to services for clients on waiting lists. Further diagnostic reviews are planned in Dublin West, North Lee, South Lee and Clare over the coming months
I am confident that the €4m investment and the outcome of the diagnostic reviews will have a positive impact on the delivery of speech and language therapy throughout the country.
41. Deputy Denise Mitchell asked the Minister for Health the progress being made in the ongoing negotiations with the Irish Medical Organisation on a new general medical services, GMS, contract; if the National Association of General Practitioners will be included in the ongoing negotiations for a new GMS contract; and if he will make a statement on the matter. [20940/16]
Amharc ar fhreagraThere have been significant developments in the general practice service recently, with more services being made available to our citizens and additional support provided by the HSE. Under a Framework Agreement, signed in 2014, the HSE, the Department of Health, and the Irish Medical Organisation (IMO) are currently engaged in a comprehensive review of the General Medical Services (GMS) and other publicly funded health sector contracts involving GPs.
As a first step in this process, universal GP care without fees for all children under the age of 6 years was successfully introduced in 2015. Shortly afterwards, the second phase implemented universal GP care without fees for all people aged 70 years and over. This has resulted in approximately 800,000 people now being eligible for GP care without fees, without having to undergo a means test. The under-6s GP service contract also included age-based preventive checks focused on health and well-being and also introduced a cycle of care for children with asthma. In October 2015, a specific Diabetes Cycle of Care provided by GPs for adult patients with Type 2 diabetes who hold a medical card or GP visit card was launched.
Earlier this year, an enhanced supports package for rural GP practices was agreed between the IMO, the HSE and the Department of Health. The enhanced package included improved qualifying criteria for rural support and an increase in the financial allowance from €16,216 to €20,000 per annum. In order to support additional services being provided by GPs, the IMO, the HSE and the Department of Health also agreed to revisions to the list of special items of GP service. The revised special items include increased rates of payment for suturing and bladder catheterisation, reflecting the costs and time associated with these services, and the introduction of a 24-hour blood pressure monitoring service by GPs.
In order to ensure that primary healthcare will be enhanced for our citizens by a new contract for general practice services, I am currently considering a number of options around this process, including the possibility of broader consultations with stakeholders.
42. Deputy Pat Buckley asked the Minister for Health his progress in establishing 24/7 crisis intervention supports in adult mental health, such as introducing a seven-day week in day units or opening crisis houses as laid down in the A Vision for Change strategy. [20945/16]
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.
44. Deputy Catherine Connolly asked the Minister for Health the number of persons on the waiting list for ultrasounds; the backlog that exists for ultrasounds in Galway University Hospital for infants up to four months; the reason there is a backlog for such an essential service; the steps being taken to resolve this backlog; and if he will make a statement on the matter. [20605/16]
Amharc ar fhreagraPaediatric ultrasounds can be used to examine the causes of abdominal pain, to investigate a mass of tissue or lump, to assess normal cranial development and for diagnosis of joint problems, particularly developmental dysplasia of the hip joint, if indicated during the 6-8 week post-natal examination. Kidney and or urogenital ultrasounds are often performed where there is a history of repeated urinary tract infections.
Babies undergo an external hip examination in the days immediately following their birth, and again at the 6 week check-up. They are then scheduled for an ultrasound, if it is considered that there is a risk of hip dysplasia. However, the ultrasound is not carried out before the infant is 8 weeks of age. Galway University Hospital provides a specialised ultrasound service for infants aged four months or under. I am advised by the HSE that the Hospital runs two specialised ultrasound sessions for infants per week, resulting in the treatment of approximately 14 patients each week.
The protocols for the imaging of infant hips were amended at a national level in 2015, to the effect that imaging is to be carried out using ultrasound. This amendment to the protocol resulted in an increase in referrals. Accordingly, the National Paediatric Hip Programme has approved a sonographer post for Galway University Hospital. To date, two recruitment campaigns have been carried out with no success; a new campaign is to be relaunched with the National Recruitment Service.
The HSE has advised that there are currently 58 children under the age of four months on the ultrasound waiting list and ultrasound procedures are carried out once the baby is 8 weeks old. This waiting list is being managed within the current resources of the Radiology Department, until such as time as the new radiographer post can be filled.
46. Deputy Louise O'Reilly asked the Minister for Health his plans to legislate for a distinct new medical need ground for eligibility for the medical card with an assessment involving the establishment of a threshold of medical need and not tested against a household’s financial means or against diagnosis titles; and if he will make a statement on the matter. [20916/16]
Amharc ar fhreagraOn foot of the Keane Report, Report of the Expert Panel on Medical Need for Medical Card Eligibility, the HSE established a Clinical Advisory Group to develop clinical oversight and guidance for the operation of a more compassionate and trusted medical card system. Its establishment followed the completion of the work of the Expert Panel on Medical Need for Medical Card Eligibility. The 2014 "Keane" Report of the Expert Panel on Medical Need for Medical Card Eligibility found that it is not feasible, desirable, or ethically justifiable to list medical conditions for medical card eligibility. The membership of the Clinical Advisory Group includes clinical experts from specialist services and professions, as well as patient representatives. The Group reports to the National Director of Primary Care on a quarterly basis. The Clinical Advisory Group is continuing its work on the development of guidance on assessing medical card applications involving significant medical conditions. It is expected that the Group will make a report to the Director General of the HSE shortly.
47. Deputy Robert Troy asked the Minister for Health the Health Service Executive plans in place to support North Westmeath Hospice and palliative care in the county generally. [20995/16]
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.
48. Deputy John Lahart asked the Minister for Health the reason for the substantial increase between December 2015 and May 2016 in the number of children waiting more than a year for an outpatient consultation in Temple Street Children's University Hospital, Dublin 1. [20974/16]
Amharc ar fhreagraA key challenge for our health system is ensuring timely access to health services. This Government recognises that a sustained commitment to improving waiting times is required, with a particular focus on those waiting longest.
While waiting list numbers have increased nationally in the first half of the year, this must be seen in the context of increased demand for care in our health system. There has been a 4% increase in inpatient and day-case activity in acute hospitals and an almost 6% increase in attendances at EDs in comparison with last year. The key issue for patients is how long they wait. Approximately 60% of patients wait less than 6 months for a required outpatient appointment or inpatient/day-case procedure.
My Department has asked the HSE to implement an action plan addressing waiting times with hospitals and Hospital Groups. This will focus on improving chronological scheduling, clinical and administrative validation of lists and optimising existing capacity.
The Programme for a Partnership Government commits to €15m funding for the NTPF in 2017 to address waiting lists for those waiting longest, as part of a continued investment of €50m per year to reduce waiting times. My Department is currently engaging with the NTPF and the HSE to deliver on the Programme's waiting list commitments.
In relation to waiting lists at the Temple Street Children's Hospital, as this is a service matter, I have asked the HSE to respond to you directly. If you have not received a reply from the HSE within 15 working days please contact my Private Office and my officials will follow the matter up.
49. Deputy James Lawless asked the Minister for Health if he will extend the list of the current conditions covered under the long-term illness scheme to include chronic and severe asthma. [20953/16]
Amharc ar fhreagraThe Long Term Illness (LTI) Scheme was established under Section 59(3) of the Health Act, 1970 (as amended). Regulations were made in 1971, 1973 and 1975 specifying the conditions covered by the LTI Scheme, which are: acute leukaemia; mental handicap; cerebral palsy; mental illness (in a person under 16); cystic fibrosis; multiple sclerosis; diabetes insipidus; muscular dystrophies; diabetes mellitus; parkinsonism; epilepsy; phenylketonuria; haemophilia; spina bifida; hydrocephalus; and conditions arising from the use of Thalidomide. There are no plans to extend the list of conditions covered by the LTI Scheme.
Under the Drugs Payment Scheme, no individual or family pays more than €144 per calendar month towards the cost of approved prescribed medicines. The scheme significantly reduces the cost burden for families and individuals incurring ongoing expenditure on medicines.
Under the provisions of the Health Acts, medical cards are provided to persons who are unable, without undue hardship, to arrange health services for themselves and their dependants. In the assessment process, the HSE can take into account medical costs incurred by an individual or a family.
