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Tuesday, 18 Oct 2016

Written Answers Nos. 36-49

Emergency Departments

Ceisteanna (36)

Seán Fleming

Ceist:

36. Deputy Sean Fleming asked the Minister for Health his views on the substantial increase in overcrowding in the emergency department in the Midland Regional Hospital, Portlaoise; and if he will make a statement on the matter. [30668/16]

Amharc ar fhreagra

Freagraí scríofa

Pressures on Emergency Departments in general have been rising, as the population is both growing and aging. The HSE has reported an overall increase of approx. 5% in patient attendances at EDs nationally this year and an increase of 2% in attendances at the ED in the Midland Regional Hospital, Portlaoise. It is essential that in the coming winter, every effort is made by hospitals to ensure that patients attending EDs experience a safer, better quality service provided in the most appropriate setting.

The HSE has advised that Portlaoise Hospital has developed a wide range of measures to assist in managing capacity pressures in the hospital. This includes an escalation system, which is in place during periods of increased activity, for effective management of beds where elderly patients and patients at risk are prioritised. The hospital has a Winter Capacity Plan to assist in managing the demand for services over the winter period.

The appointment of an Assistant Director of Nursing for Patient Flow will also assist in ensuring the optimal use of available beds in the hospital and facilitate timely patient flow. This appointment is expected shortly. In addition, the recruitment of an Advanced Nurse Practitioner will improve experience time in ED for patients with minor injuries. This post is currently being progressed by the National Recruitment Service.

Furthermore, the Hospital also works closely with the community health colleagues to maximise and prioritise access to long stay and intermediate care beds to ensure timely discharge of patients to the most appropriate setting.

Performance Management Systems

Ceisteanna (37)

Aengus Ó Snodaigh

Ceist:

37. Deputy Aengus Ó Snodaigh asked the Minister for Health if he will provide a definition for underperformance in the context of the performance and accountability framework within the HSE, specifically for those staff who are not regulated by a professional regulatory body; the persons or bodies who, as part of the performance and accountability framework, agree performance targets with the accountable officers; if flexibility exists within the required financial plans for situations where demand for human resources and staff exceeds the targets and funding set under the plan; the recourse that is made in such a situation; and if he will make a statement on the matter. [30508/16]

Amharc ar fhreagra

Freagraí scríofa

The HSE Performance and Accountability Framework makes explicit the responsibilities of health service managers in relation to the four equally important domains of Access to Services, Quality and Safety of those Services, delivery within the Financial Resources available and effectively harnessing the efforts of the Workforce. The Framework ensures that designated managers are explicitly and personally accountable for managing the performance of services within their allocated budget. Accountable officers are named for each Hospital Group, for each Community Health Organisation, for the National Ambulance Service, for the Primary Care Reimbursement Service, and for the Nursing Home Support Scheme.

Key features of the Accountability Framework are the formal Performance Agreements which are in place at two levels. The first level is the National Director Performance Agreement between the Director General and each National Director. The second level is between the Hospital Group CEO's and the National Director of Acute Hospitals and between the Community Health Organisation Chief Officer's and the National Directors for community services. National Directors are accountable for the delivery of their Divisional component of the National Service Plan and this is reflected in each Performance Agreement. The HSE has allocated maximum expenditure levels to Accountable Officers and they are now fully responsible and accountable for managing the performance of services and resources including staffing levels within their allocated budget. Accountable Officers are required to prepare a financial plan in line with their Performance Agreement with the National Director setting out the actions they will take to meet the agreed performance targets within the financial allocation. This is required to be signed off by both the Accountable Officer and their senior manager.

In the context of the Performance and Accountability Framework underperformance includes performance that places patients or service users at risk, fails to meet the required standards for that service or departs from what is considered normal practice. It is important to note that accountability encompasses performance in the areas of service access, quality, finance and human resources and evaluation of performance. Managers are expected to lead the improvement of performance across all dimensions. Flexibility regarding the utilisation of resources exists within the agreed expenditure levels. The Performance and Accountability Framework provides for the HSE to closely monitor the delivery of services in accordance with the agreed targets and within the agreed financial allocation and for the HSE to take appropriate steps in terms of support and/or intervention as and when the need arises.

Health Services Provision

Ceisteanna (38)

Niamh Smyth

Ceist:

38. Deputy Niamh Smyth asked the Minister for Health the cuts which have been imposed on a day care centre (details supplied); the reason these cuts have taken place; if staff were notified of the downgrading of services; the services on offer to service users at present in tabular form; his plans to increase day care at the centre; and if he will make a statement on the matter. [30295/16]

Amharc ar fhreagra

Freagraí scríofa

I have been assured that there have been no cuts to the Day Care Service in Lisdarn. The service is no longer nurse led, however, because the Day Care Centre is adjacent to the long stay care facility where a nurse is available, if required. There has been no change in the services delivered to older people who attend the centre. The service operates 5 days a week and provides personal care, hair care, chiropody and general diversional and social activities.

The Day Care Centre will be closed in October for refurbishment and will reopen in November. All staff and service users have been fully briefed on this. I have requested the Chief Officer for the Community Health Organisation to arrange for contact to be made with the Deputy to provide any further clarifications in relation to this matter.

Maternity Services Provision

Ceisteanna (39)

Eoin Ó Broin

Ceist:

39. Deputy Eoin Ó Broin asked the Minister for Health the status of the roll out of the national maternity strategy; the number of staff required to ensure a full complement of maternity staff across the State; the number of staff that will need to be recruited by grade; the timeline for this recruitment; and if he will make a statement on the matter. [30501/16]

Amharc ar fhreagra

Freagraí scríofa

The National Women & Infants Health Programme will lead the implementation of Ireland's first National Maternity Strategy - Creating A Better Future Together 2016 - 2026. The Programme will scope out the multiprofessional staffing requirement for the new model of care proposed, and prepare a workforce plan to build capacity, and a training needs analysis to build capability, to deliver the new model of service. Work to establish the Programme Leadership Team continues.

Pending the establishment of the Programme, work to facilitate the implementation of the Strategy is ongoing. €3 million development funding provided for maternity services in 2016 has been allocated in line with the Strategy, and includes funding for additional staff, including 100 midwives, for the development of specialist bereavement teams and for the implementation of the Maternal and Newborn Clinical Management System. Such development follows the additional €2 million allocated in 2015. Increased funding will be provided for maternity services in 2017 which will allow for the continued implementation of the Strategy.

I should also draw the Deputy's attention to the progress which is being made in relation to the development of a set of National Clinical Guidelines for maternity services. These guidelines, which will underpin the Strategy, will be quality assured by the National Clinical Effectiveness Committee. My Department is engaged with HSE and the Clinical Lead for Obstetrics and Gynaecology in relation to the guidelines.

National Treatment Purchase Fund Waiting Times

Ceisteanna (40)

Gino Kenny

Ceist:

40. Deputy Gino Kenny asked the Minister for Health the number of persons treated by the National Treatment Purchase Fund, NTPF, who are on a waiting list for treatment from a consultant who also works privately carrying out that treatment for the NTPF; and if he will make a statement on the matter. [30689/16]

Amharc ar fhreagra

Freagraí scríofa

Since 2012 as a matter of policy, the National Treatment Purchase Fund ensures that clinicians contracted or employed by private hospitals do not receive remuneration for the treatment of the same patient from both the referring public hospital, by way of salary, and from the treating private hospital, by way of a fee.

I am advised by the NTPF that this is explicitly prohibited in contractual agreements entered into with private hospitals sourced by the NTPF.

Mental Health Services Provision

Ceisteanna (41)

Pat Casey

Ceist:

41. Deputy Pat Casey asked the Minister for Health the targets in place for child and adolescent mental health service teams staff levels in community healthcare organisation, CHO, Area 6 in 2017 to bring them closer to the target set in A Vision for Change; and if he will make a statement on the matter. [30661/16]

Amharc ar fhreagra

Freagraí scríofa

As this is a service issue, this question has been referred to the HSE for direct reply.

Primary Care Centres Provision

Ceisteanna (42)

Denise Mitchell

Ceist:

42. Deputy Denise Mitchell asked the Minister for Health the reason none of the new 14 primary care centres to be constructed as part of European Investment Bank funding, announced earlier this year, has plans for the recruitment of additional staff; the factors influencing the recruitment of staff in these centres; if staff are planned to be recruited in the medium or long term to supplement the services and staff available currently; and if he will make a statement on the matter. [30512/16]

Amharc ar fhreagra

Freagraí scríofa

As this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.

Mental Health Services Staff

Ceisteanna (43)

Gino Kenny

Ceist:

43. Deputy Gino Kenny asked the Minister for Health the way, in the absence of additional funding for mental health in the budget, A Vision for Change can be implemented when secondary mental health services, adult mental health services and child and adolescent mental health services have only three quarters of the recommended staff in adult services and less than half in children's services, while primary care mental health services are grossly under resourced and even non-existent in many areas; and if he will make a statement on the matter. [30693/16]

Amharc ar fhreagra

Freagraí scríofa

As of August 2016, there were 9, 458 whole time equivalents employed in the HSE Mental Health services. This included an approximate additional 1,150 new posts recruited since 2012. A total of approximately 1,550 were approved but not all posts could be filled due to staff recruitment and retention challenges. However, recruitment to posts approved up to the current year is continuing, and this will continue to narrow the gap between existing staffing levels and the 10,650 WTE posts recommended under A Vision for Change.

The new posts filled in recent years have been directed towards increasing the staffing of adult and Child and Adolescent Mental Health Service teams (CAMHS) in every Community Healthcare Organisation area. There are currently 114 adult teams and 67 CAMHS teams, including 3 Paediatric Liaison teams supported by 66 operational CAMHS beds across the country. New posts have also been allocated towards improved forensic services and for several specialist areas including, Eating Disorders and Psychiatry of Old Age. In addition, funding was set aside in the 2016 National Service Plan to develop early intervention services at Primary Care level, in conjunction with the Mental Health Services, along with significantly increased funding for expansion of Jigsaw services in 5 new locations.

I am committed to continuing to fund our mental health services. I am initiating €35 million in new services in 2017. Key priorities to be addressed in the HSE's 2017 Service Plan include youth mental health, further improvement to child & adolescent and adult services, older people's services and further enhanced out of hours response for those in need of urgent services. Recognising the time lag in new staff taking up posts and the completion of preparations for the introduction of these services, it is estimated that the revenue spend in 2017 associated with this increased allocation will be some €15 million. There will also be a further additional spend in mental health associated with increased pay rates.

In addition, I have secured additional capital funding of approximately €50 million for 2017, to commence the construction of the long-planned new National Forensic Mental Health Campus at Portrane. Despite a significant increase in costs for this project since it was originally initiated in 2000, due mainly to price inflation in the construction sector, I have obtained Government support to proceed with the award of tender. When completed, this project will significantly modernise our forensic services.

Maternity Services Provision

Ceisteanna (44, 67, 78, 86, 101)

Denise Mitchell

Ceist:

44. Deputy Denise Mitchell asked the Minister for Health the availability of the detailed 20-week routine scans for pregnant women per hospital group; and if he will make a statement on the matter. [30511/16]

Amharc ar fhreagra

David Cullinane

Ceist:

67. Deputy David Cullinane asked the Minister for Health the options available for pregnant women who wish to access a mid-pregnancy scan in the public sector; and if he will make a statement on the matter. [30513/16]

Amharc ar fhreagra

Louise O'Reilly

Ceist:

78. Deputy Louise O'Reilly asked the Minister for Health the availability of detailed 20-week routine scans for pregnant women; the details of hospitals where this scan is available; if the scan is used routinely or in exceptional cases; the way this scan is accessed by women, that is, by referral or on request; the reason 20 weeks scans are not available in all hospitals routinely; if this is due to staff and resources or staff training;; and if he will make a statement on the matter. [30499/16]

Amharc ar fhreagra

Dessie Ellis

Ceist:

86. Deputy Dessie Ellis asked the Minister for Health the availability of detailed 20 week routine scans for pregnant women per CHO area; and if he will make a statement on the matter. [30509/16]

Amharc ar fhreagra

Eoin Ó Broin

Ceist:

101. Deputy Eoin Ó Broin asked the Minister for Health the availability of the detailed 20 week routine scans for pregnant women on a hospital basis; and if he will make a statement on the matter. [30502/16]

Amharc ar fhreagra

Freagraí scríofa

I propose to take Questions Nos. 44, 67, 78, 86 and 101 together.

The HSE National Service Plan 2016 commits to the planning and development of equitable access to antenatal anomaly screening in all maternity units in the context of emerging maternity networks. In addition, the National Maternity Strategy is clear that all women must have equal access to standardised ultrasound services. The Strategy will be implemented on a phased basis over the coming years.

The HSE has advised that while the availability of anomaly scans is not consistent around the country at present, where a woman requires a detailed scan, she can be clinically referred to a unit where the full service is available.

In relation to the specific query raised by the Deputy, as this is a service matter I have asked the HSE to respond to you directly.

Hospital Services

Ceisteanna (45)

Mick Wallace

Ceist:

45. Deputy Mick Wallace asked the Minister for Health the status of the promised dialysis unit in County Wexford which is currently being delayed due to a planning permission dispute; the actions he will take in this regard to ensure that persons in need of dialysis in County Wexford are getting the treatment they require; and if he will make a statement on the matter. [30623/16]

Amharc ar fhreagra

Freagraí scríofa

In relation to the specific query raised by the Deputy, as this is a service matter I have asked the HSE to respond to you directly.

Mobility Allowance Decision

Ceisteanna (46)

Willie O'Dea

Ceist:

46. Deputy Willie O'Dea asked the Minister for Health if he will replace the mobility allowance and motorised transport grant which was closed to new applicants in 2013; and if he will make a statement on the matter. [28748/16]

Amharc ar fhreagra

Freagraí scríofa

Conscious of the reports of the Ombudsman in 2011 and 2012 regarding the legal status of both the Mobility Allowance and Motorised Transport Grant Schemes in the context of the Equal Status Acts, the Government decided to close both schemes in February 2013. However the Government is aware of the continuing needs of people with a disability who rely on individual payments which support choice and independence. In that regard, monthly payments of €208.50 have continued to be made by the Health Service Executive to 4,700 people who were in receipt of the Mobility Allowance at the time the scheme closed.

The Government decided that the detailed preparatory work required for a new Transport Support Scheme and associated statutory provisions should be progressed by the Minister for Health. I am pleased to inform the Deputy that the Programme for Partnership Government acknowledges the ongoing drafting of primary legislation for a new Transport Support Scheme. I can confirm that work on the policy proposals in this regard is at an advanced stage and I anticipate that this will be brought to Government shortly.

The proposals seek to ensure that:

- There is a firm statutory basis to the Scheme's operation;

- There is transparency and equity in the eligibility criteria attaching to the Scheme;

- Resources are targeted at those with greatest needs; and

- The Scheme is capable of being costed and is affordable on its introduction and on an ongoing basis.

General Practitioner Services Provision

Ceisteanna (47)

Alan Kelly

Ceist:

47. Deputy Alan Kelly asked the Minister for Health his views on the fact that there has been a closure and reduction of Shannondoc services in County Clare in recent weeks; and if he will make a statement on the matter. [30694/16]

Amharc ar fhreagra

Freagraí scríofa

General Practitioners contracted under the General Medical Services Scheme must make suitable arrangements to enable contact to be made with them, or a locum/deputy, for emergencies outside normal practice hours. While there is no obligation on GPs to participate in GP out-of-hours cooperatives as a means of meeting the contractual requirement, such services have been developed and expanded over time and are now an essential part of our primary care services helping to ensure that, to the greatest extent possible, urgent care needs are met in the primary care setting.

In the Mid West region, the out-of-hours arrangements are discharged through Shannon Doc, a not-for-profit GP cooperative, which is funded by the HSE. Shannon Doc has recently announced that due to a difficulty in attracting GPs, and in particular locum cover, it is no longer able to maintain its existing service across all its centres.

Following discussions with Shannon Doc, the HSE, in order to ensure the sustainability of the service, accepted a proposal from the cooperative to changes in the provision of the service. The most significant changes relate to part of East and West Clare, essentially affecting Ennistymon, Kilrush, and Killaloe with minor changes in terms of operating hours in two locations in North Tipperary.

The recent changes to the Shannondoc out-of-hours services will be subject to a three-monthly review and their impact will be closely monitored and evaluated by the HSE.

Nursing Staff Recruitment

Ceisteanna (48, 63, 396, 560)

Alan Kelly

Ceist:

48. Deputy Alan Kelly asked the Minister for Health the measures he is taking to ensure there will be an adequate supply of nurses in our health service in the coming years to meet demand. [30696/16]

Amharc ar fhreagra

Mick Barry

Ceist:

63. Deputy Mick Barry asked the Minister for Health the way in which the budget announcement that 1,000 additional nurses will be recruited to the health care system will be achieved in the context that many graduate nurses are leaving the country citing pay and conditions. [30297/16]

Amharc ar fhreagra

John Lahart

Ceist:

396. Deputy John Lahart asked the Minister for Health the steps being taken to ensure that nursing graduates do not emigrate from Ireland following graduation; and if he will make a statement on the matter. [30247/16]

Amharc ar fhreagra

Bernard Durkan

Ceist:

560. Deputy Bernard J. Durkan asked the Minister for Health the extent to which sufficient nursing staff are readily available in line with requirements over the next three years; and if he will make a statement on the matter. [30979/16]

Amharc ar fhreagra

Freagraí scríofa

I propose to take Questions Nos. 48, 63, 396 and 560 together.

Nursing and midwifery recruitment and retention is a priority for the health service. There are many initiatives currently underway to improve staffing levels throughout the country.

The HSE is offering permanent posts to 2016 degree programme graduates, and full time permanent contracts to those in temporary posts. The HSE is also focused on converting agency staffing to permanent posts. The HSE's National Recruitment Service is actively operating rolling nursing recruitment campaigns. The campaigns encompass General, Mental Health, Intellectual Disability and Registered Children's Nurses, and also Midwives. In addition, a relocation package of up to €1,500 is available to nurses who return from overseas.

There has been an increase of over 1,160 nurses employed in the public health service (34,375 to 35,538) from August 2014 to August 2016, numbers having fallen by almost 4,600 from 2007 to 2014. The total budget for the health service in 2017 is €14.6 billion, the highest ever health budget, and this will allow for the filling of an additional 1,000 nursing posts.

A number of specific measures have also been taken in relation to pay that will support the recruitment and retention of Irish nursing and midwifery graduates. Measures to date include the first stage of pay restoration under the Lansdowne Road Agreement, additional pay in return for taking on some duties from doctors and an increase in the rate of pay for the student nursing placement to 70% of the first point of the staff nurse pay scale.

In the past week the Government has approved restoration of incremental credit for all nurses in respect of the 36 week clinical placement undertaken by 4th year student nurses in the context of the 2017 Estimates. This decision means that all nurses and midwives will have incremental credit for the 36 week placement restored from 1 January 2017, restoration of the credit to 2016 and future graduates having been approved earlier this year. It is estimated that the inclusion of 2011 to 2015 graduates will benefit around 4,000 nurses who are currently working within the public health service and potentially another 3,000 who may wish to return to the public system in the future.

Hospital Waiting Lists

Ceisteanna (49, 100)

Seán Crowe

Ceist:

49. Deputy Seán Crowe asked the Minister for Health the funding required as part of the digital package solution to the waiting list crisis that has been presented to him; his views on whether the funding that is earmarked is sufficient; the proposals made and the costs involved as part of the digital package solution; and if he will make a statement on the matter. [30506/16]

Amharc ar fhreagra

Aengus Ó Snodaigh

Ceist:

100. Deputy Aengus Ó Snodaigh asked the Minister for Health the progress being made to date in his Department on investigations into technology being developed in respect of waiting list initiatives; if he has received any proposals on a single integrated waiting list initiative; the meetings or briefings he has had on this; if his attention has been drawn to the success of the Portuguese waiting lists system; and if he will make a statement on the matter. [30507/16]

Amharc ar fhreagra

Freagraí scríofa

I propose to take Questions Nos. 49 and 100 together.

A key challenge for our health system is ensuring that patients have timely access to health services, in light of increasing demand. This Government is committed to a sustained focus on improving wait times, particularly for those patients waiting longest.

In August I tasked the Office of the HSE Chief Information Officer with producing a report into how digital solutions could improve the way in which waiting lists are managed. A detailed set of options has been provided to my Department by the HSE and I have asked that this matter be progressed through 2017. As part of this review, I understand that digital solutions from a number of countries were examined, including the Portuguese model.

In addition, my Department works closely with the HSE and the NTPF to implement a number of measures to reduce waiting times. These include the HSE Action Plan to reduce, by year end, the number of patients currently waiting 18 months or more for an inpatient / daycase procedure, the NTPF Endoscopy Initiative; and targeted Winter Initiative funding for orthopaedic, spinal and scoliosis procedures.

Finally, the Budget 2017 provides for the treatment of our longest-waiting patients. €20m is being allocated to the NTPF, rising to €55m in 2018. Planning of this initiative is at an advanced stage by the NTPF, my Department and the HSE.

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