Jackie Cahill
Ceist:575. Deputy Jackie Cahill asked the Minister for Health his views on a case regarding a medical appointment for a person (details supplied); and if he will make a statement on the matter. [21130/16]
Amharc ar fhreagraHospital Waiting Lists
Ceisteanna (575)
Freagraí scríofa
Under 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.
The scheduling of appointments for patients is a matter for the hospital to which the patient has been referred. Should a patient's general practitioner consider that the patient's condition warrants an earlier appointment, he or she should take the matter up with the consultant and the hospital involved. 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.
Non-Consultant Hospital Doctors Recruitment
Ceisteanna (576)
Mick Barry
Ceist:576. Deputy Mick Barry asked the Minister for Health the number of non-consultant doctors who could not commence their work rotations in acute hospitals and mental health services on 11 July 2016 due to outstanding documentation issues relating to work permits, Garda Síochána checks and international police clearance; his views on the impact on the health service; and if he will make a statement on the matter. [21141/16]
Amharc ar fhreagraFreagraí scríofa
I have asked the HSE to respond to the Deputy directly on this matter. 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.
Question No. 577 answered with Question No. 99.
General Practitioner Contracts
Ceisteanna (578)
Billy Kelleher
Ceist:578. Deputy Billy Kelleher asked the Minister for Health when he will meet and engage with the National Association of General Practitioners on a new contract for its members; his views that the 1,600 members' views and input are essential to advancing and expanding free general practitioner care, in line with the commitments in the programme for Government. [21145/16]
Amharc ar fhreagraFreagraí scríofa
There 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, Department of Health and IMO are currently engaged in a comprehensive review of the GMS and other publicly funded health sector contracts involving GPs. A number of service developments have already arisen out of this process including the implementation in 2015 of a universal GP service for all children under 6 years and all persons aged 70 years and over. In addition, a cycle of care for asthma for children under 6 years, and a cycle of care for diabetes for medical card and GP cardholders were also introduced last year. More recent developments in 2016 were the enhanced support framework for general practices services in rural areas and the revised list of special items of service that can be provided by GPs.
In Budget 2016, the Government has also provided for the extension of GP care without fees to all children aged under 12 years in the latter part of 2016. This extension is subject to negotiation and will be implemented in the context of a new GP contract. In addition, the Programme for Partnership Government, commits to the introduction of free GP care for all under-18s, subject to negotiations with GPs and noting the need for additional GPs to support the additional workload.
I have recently met with GP representative bodies, including the National Association of General Practitioners, to discuss the future development of general practice and I have assured them of the Government's commitment to developing primary healthcare services for all our citizens and the key role of general practice in that context. In order to ensure that the potential benefits of an enhanced, integrated primary care sector can be realised and supported 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.
Charities Regulation
Ceisteanna (579, 583)
Alan Kelly
Ceist:579. Deputy Alan Kelly asked the Minister for Health if he is satisfied with the Health Service Executive's ability to monitor section 38 agencies and organisations; if the system of oversight has been strengthened since 2014 when the executive indicated that the system of oversight for sections 38 and 39 organisations was lacking and that new procedures were needed; and if he will make a statement on the matter. [21151/16]
Amharc ar fhreagraAlan Kelly
Ceist:583. Deputy Alan Kelly asked the Minister for Health the measures he is proposing to strengthen the 2013 governance arrangements the Health Service Executive introduced with the section 38 agencies in particular in terms of strengthening the direct relationship between the executive and the boards of each of these agencies; and if he will make a statement on the matter. [21155/16]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 579 and 583 together.
Section 38 and 39 Service Providers (Providers) in receipt of in excess of €250,000 annually are required to sign a standard Service Arrangement (SA). The SA comprises two Parts: Part 1 sets out the detailed terms and conditions which attach to the release of the funding to Providers and Part 2 (the Schedules) sets out inter alia the annual amount of funding to be released and the quantum of services to be provided for that funding. (In some instances, there may be a number of sets of Schedules per individual Provider). Part 1 generally covers a four-year period; however, the Schedules are renewed annually by local Service Managers with each Provider to reflect the funding for the year in question and the quantum of services to be provided for same.
Providers in receipt of less than €250,000 are required to sign a Grant Aid Agreement (GA) which also sets out the terms and conditions which attach to the release of the funding to these Providers. These GAs are entered into on an annual basis.
The following initiatives have been taken to strengthen the system of oversight for Section 38 and 39 Providers.
The HSE Compliance Unit was established in late 2014 to provide programmatic oversight of the arrangements in place with voluntary agencies funded by the HSE for the provision of health and personal social care services.
A key element of this oversight are the Service Arrangements Part 1 & Part 2, which underpin the HSE's relationship with the Service Providers and in this context, a comprehensive review of the SA documentation (Parts 1 and 2) was conducted in 2014/2015 to further strengthen the governance with Providers. This review involved input from all relevant internal stakeholders and also an extensive engagement took place with representative bodies from the voluntary sector.
As a result of this review, some key changes, as set out below, have been incorporated into the revised SAs (Part 1) to enhance the governance elements of these documents:
- Additional requirements in respect of Internal Audit, Finance, Governance Arrangements and information requirements;
- Requirement to submit an Annual Compliance Statement in respect of the Provider’s governance; (Currently applies to Section 38 Providers – see below)
- A clause which enables the HSE to appoint an individual to, in specific circumstances, assist and provide guidance to the Board of a Provider organisation;
- A detailed mechanism to deal with performance issues which includes the appointment of a manager by the HSE in exceptional circumstances to manage the services in a HSE-funded organisation;
- Requirement for a Provider to request the consent of the Executive where the Provider proposes to reorganise or restructure its organisation;
- Requirement that a Provider shall give 12 months notice where the Provider does not wish to provide services or receive funding;
- Option of mediation between the HSE and the Provider as part of the dispute resolution process.
These changes were occasioned by inter alia an Internal Audit report, Public Sector Pay Policy, various Circulars and other matters that have emerged with Providers in the intervening period since the last documentation review.
The Annual Compliance Statement (ACS) process referred to above is an important element of the oversight process and requires the Board Chairs of each Section 38 Service Provider 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. The ACS process currently applies to Section 38 agencies. However from November 2016, this will be rolled out to Section 39 agencies as well. In addition, as part of the ongoing development of the Compliance Process, and in order to provide external assurances to the HSE, it was decided that a review of governance at Board and Executive level in all Section 38 Providers, to be conducted by external consultants, would be undertaken. The purpose of these reviews is to establish the level/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 ACSs. These reviews involve an examination of key governance processes and documents, including obtaining confirmation that there are internal financial controls and that formal written financial procedures are in place in these organisations. Six of these reviews are currently underway. 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 Compliance Unit also coordinates governance issues within the HSE regarding Service Providers, interfaces with the key stakeholders involved in the governance framework and provides support and advice to staff in the recently established Community Healthcare Organisations and Hospital Groups in relation to governance matters as they apply in the context of Section 38 and 39 Agencies.
The Compliance Unit also has responsibility for the Service Provider Governance (SPG) IT system which has been developed to monitor the completion rates of the Service Arrangements. The system provides regular reports to service managers throughout the HSE on a regular basis. This allows managers to monitor levels of completion of Service Arrangements and Grant Aid Agreements.
Finally, as part of the ongoing development of the governance process within the HSE, the Compliance Unit develops and introduces new measures to deal with matters that may arise in the context of the HSE's ongoing relationship with Section 38 and 39 agencies such as the issues that have arisen in the course of recent weeks.
HSE Governance
Ceisteanna (580, 581)
Alan Kelly
Ceist:580. Deputy Alan Kelly asked the Minister for Health the way the financial management systems of the Health Service Executive have been reformed to ensure more effective oversight of the system for funding sections 38 and 39 organisations, given that it funds over 1,900 voluntary agencies to a value of approximately €3.1 billion, 44 of which are funded under section 38 of the Health Act to the value of €2.5 billion; and if he will make a statement on the matter. [21152/16]
Amharc ar fhreagraAlan Kelly
Ceist:581. Deputy Alan Kelly asked the Minister for Health his views on whether the Health Service Executive employs enough qualified accountants, financial controllers and auditors to ensure an effective monitoring of the funding system to section 38 and section 39 organisations; the number of accountants, financial controllers and auditors specifically tasked with this; and if he will make a statement on the matter. [21153/16]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 580 and 581 together.
In 2015 the HSE funded 40 agencies under section 38 of the Health Act 2004 and 2,392 agencies under section 39 of the Health Act. Total funding allocated to these organisations in 2015 was €3.71 billion and funding to the section 38 agencies accounted for 78% of this sum.
The HSE has a Governance Framework in place which incorporates national standardised documentation, and guidance documents, that enable the HSE to contractually underpin the grant-funding provided to all Non-Statutory Service Providers. This Framework seeks to ensure the standard and consistent application of good governance principles, which are robust and effective, to ensure that both the HSE and the Providers meet their respective obligations. It is reviewed and updated as required.
The HSE aims to ensure that appropriate systems are in place to effectively manage the services and funding, and the Governance Framework provides for national standard governance documentation and administrative processes, which seeks to ensure both the HSE and the recipient organisations comply with their respective obligations, and that the services delivered provide best outcomes for the service user and represent effective use of public exchequer funding.
The HSE has in place a system of Service arrangements (SA) with the recipient organisations which underpin service and governance requirements. These Service Arrangements Part 1 & Part 2 underpin the HSE’s relationship with the Service Providers and, in this context, a comprehensive review was carried out in 2014 / 2015 to further strengthen the Governance Framework. One of the changes made as a result of this review was the introduction of the Annual Compliance Statement (ACS). The Part 1, which contains the terms and conditions which apply, is in place until December 2018. However, the Part 2 (which consists of a number of Schedules) is revised annually and any changes which are considered to be needed in the light of recent events will be incorporated into the Schedules for 2017.
The ACS process referred to above is an important element of the oversight process and requires the Board Chairs of each Section 38 Service Provider 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. The ACS process currently applies to Section 38 agencies. However from November 2016, this will be rolled out to Section 39 agencies as well. In addition, as part of the ongoing development of the Compliance Process, and in order to provide external assurances to the HSE, it was decided that a review of governance at Board and Executive level in all Section 38 Providers, to be conducted by external consultants, would be undertaken. The purpose of these reviews is to establish the level/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 ACSs. These reviews involve an examination of key governance processes and documents, including obtaining confirmation that there are internal financial controls and that formal written financial procedures are in place in these organisations. Six of these reviews are currently underway. 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. As Reviews are finalised they will be considered in detail and in the context of recent events, and if changes need to be made, they will, of course, be introduced without delay.
The HSE is further developing its Service Provider Governance (SPG) IT System, which provides real time compliance reporting and provides embedded best practice guidance for operational service managers tasked with the management of the Service Arrangement and Grant Aid Agreements with funded organisations. Reports, in terms of completion rates, are circulated to the senior management throughout the organisation on a regular basis. The HSE are introducing an Annual Financial Monitoring Return (AMFR) process to improve compliance with required Governance and to ensure probity and transparency in the funding to these organisations. The AFMR will be an addendum to the audited financial statements and will standardise the financial information received from funded organisations. This will facilitate a more effective reporting relationship.
Finally, as part of the ongoing development of the governance process within the HSE, the Compliance Unit develops and introduces new measures to deal with matters that may arise in the context of the HSE's ongoing relationship with Section 38 and 39 agencies such as the issues that have arisen in the course of recent weeks.
The Deputy has asked for specific details on the number of qualified accountants, financial controllers and auditors employed in the HSE to ensure an effective monitoring of the funding system to Section 38 and Section 39 organisations. I do not have this information to hand, but have forwarded it to the HSE for direct reply to the Deputy.
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.
Charitable and Voluntary Organisations
Ceisteanna (582)
Alan Kelly
Ceist:582. Deputy Alan Kelly asked the Minister for Health if employees of section 38 agencies are public servants, members of public service pension schemes and are directly bound by his consolidated pay scales; and if he will make a statement on the matter. [21154/16]
Amharc ar fhreagraFreagraí scríofa
On 27 September, 2013 the Department of Health issued a health sector pay policy (Circular 11/2013), prepared following consultations with the Department of Public Expenditure and Reform, to the HSE which reflects Government Pay Policy as it applies across the public service. The Department of Health Consolidated Salary Scales as sanctioned by the Minister for Health, sets out the current salaries for the public health service. The health sector pay policy states that the Consolidated Salary Scales must be strictly adhered to and in no circumstances should an employee receive remuneration in the nature of pay and allowances of an amount greater than the amount prescribed. This pay policy applies to all employees of the HSE and agencies funded by the HSE, in whole or in part, under Section 38 of the Health Act 2004. In general, employees of Section 38 funded agencies are public servants.
In relation to superannuation arrangements in the public service it should be noted that employment in a Section 38 agency does not confer a right to membership of a particular type of pension scheme.
There are a variety of pension schemes that operate in the public service, including in Section 38 agencies, depending on when and how an individual enters the public service. There are public servants in public service ‘pay as you go’ Defined Benefit (DB) schemes which may have different minimum pension age, accrual terms, contribution rates etc. In addition some employees of Section 38 agencies are members of funded Defined Benefit pension schemes to which the employer contributes while others are members of Defined Contribution (DC) pension schemes with or without employer contributions. New entrants to the public service recruited on or after 1 January 2013 are generally members of the Single Public Service Pension Scheme (SPSPS) and have career average pension benefits.
Question No. 583 answered with Question No. 579.
Questions Nos. 584 and 585 answered with Question No. 99.
Health Services Staff Recruitment
Ceisteanna (586)
Pearse Doherty
Ceist:586. Deputy Pearse Doherty asked the Minister for Health further to Parliamentary Question No. 441 of 14 June 2016, the reason no reply from the Health Service Executive has yet been received; and if he will make a statement on the matter. [21163/16]
Amharc ar fhreagraFreagraí scríofa
I have asked the HSE to respond to the Deputy directly on this matter. 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.
Hospital Waiting Lists
Ceisteanna (587, 588, 591)
Gerry Adams
Ceist:587. Deputy Gerry Adams asked the Minister for Health the current average waiting times in respect of cataract surgery for each hospital. [21164/16]
Amharc ar fhreagraGerry Adams
Ceist:588. Deputy Gerry Adams asked the Minister for Health the average waiting times for persons deemed as priority in respect of cataract surgery for each hospital. [21165/16]
Amharc ar fhreagraGerry Adams
Ceist:591. Deputy Gerry Adams asked the Minister for Health the number of persons currently awaiting initial assessment to be placed on a waiting list for cataract surgery; and if he will make a statement on the matter. [21168/16]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 587, 588 and 591 together.
A 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 in-patient 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 in-patient/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.
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.
Hospital Waiting Lists
Ceisteanna (589)
Gerry Adams
Ceist:589. Deputy Gerry Adams asked the Minister for Health the current waiting times for outpatient appointments at Royal Victoria Eye and Ear Hospital, Adelaide Road, Dublin 2. [21166/16]
Amharc ar fhreagraFreagraí scríofa
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.