Tuesday, 18 Oct 2016

Mental Health Services

Ceisteanna (535)

Anne Rabbitte

Ceist:

535. Deputy Anne Rabbitte asked the Minister for Health his plans to prioritise child and adolescent mental health services, CAMHS, for children in care; and the way in which he will achieve this [30911/16]

Amharc ar fhreagra

Freagraí scríofa

Minister of State at the Department of Health

Additional funding provided for mental health services in the recent Budget accords with our Programme for Government commitments to improve all aspects of mental health services, including Child and Adolescent Mental Health services. The allocation for mental health in 2017 will total around €851 million thereby giving an increase of €24.7 million, or approximately 3%, over 2016.

In line with the recommendations of A Vision for Change, the HSE has prioritised the mental health needs of those under age 18 by developing services in accordance with the HSE National Service Plan, and Operational Plans for 2016. Child and Adolescent Mental Health services fall within the secondary and tertiary levels of specialist care. A young person therefore must have a moderate to severe mental illness in order to access specialist services, based on professional assessed need.

The publication of new Standard Operating Procedures in June 2015 has provided greater clarity and consistency on how this specialist mental health service for children should be delivered nationally. The HSE works closely with TULSA to provide specialist services to children in care. Improvements on this specific issue are subject to regular review, and operational improvements, given evolving service pressures and availability of resources. It is important to note that, despite increasing demands overall on the Child and Adolescent Mental Health system, irrespective of the source of referrals, individual cases assessed as requiring urgent access to such services receive priority.

The HSE is also improving collaboration between the Mental Health and Primary Care Divisions of the Executive in the areas of Preventative, Early Intervention and Counselling services for young people. Depending on the level of acuity presenting, in the vast majority of cases young people will be assessed and treated at Primary Care level, or in Social Care or Disability services, without needing specialist clinical input. The latter is only one element of an overall care approach that can be provided to young people to promote positive mental health.

Mental Health Services Provision

Ceisteanna (536)

Anne Rabbitte

Ceist:

536. Deputy Anne Rabbitte asked the Minister for Health when the policy and strategy will be developed in relation to the recommendations in the Children’s Mental Health Coalition Someone to Care report to develop a policy statement and national strategy to address the mental health needs of children and young persons in care and detention. [30912/16]

Amharc ar fhreagra

Freagraí scríofa

Minister of State at the Department of Health

The Minister has no official responsibility to the Dáil in relation to this matter. The Report referred to in the Question was launched by the Minister for Children. The PQ was offered to that Department on Transfer but they have refused. We also offered it to Department of Justice who were of the opinion that the responsibility for the Report lies with Department of Children and Youth Affairs.

Palliative Care for Children

Ceisteanna (537)

Louise O'Reilly

Ceist:

537. Deputy Louise O'Reilly asked the Minister for Health the actions that have been taken to date to ensure appropriate care pathways are in place in end-of-life care, including the provision of respite, hospice and end of life care during the perinatal period, infancy, childhood and adulthood; his plans to do this, particularly for children. and to ensure geographic equality of services; the investment planned for this; and if he will make a statement on the matter. [30923/16]

Amharc ar fhreagra

Freagraí scríofa

Minister of State at the Department of Health

In December 2009 the Department of Health published Palliative Care for Children with Life Limiting Conditions: a National Policy. The Policy provides clear direction for the development of an integrated palliative care service for children and their families, across all care settings. It aims to address the deficits identified in a national needs assessment undertaken in 2005. Following the publication of the Policy, the National Development Committee for Children’s Palliative Care (NDC) was established by the HSE to oversee the implementation of its recommendations. The emphasis on partnership is reflected in the committee membership comprising statutory, voluntary, professional, and parent representation. The Committee is currently co-chaired by the HSE National Lead for Palliative Care and the CEO of LauraLynn Hospice. The Policy contains 31 recommendations under 19 headings and places significant emphasis on supporting families and health care professionals to care for children in their own homes. With regard to perinatal services, the evidence available suggests that the best location of care is within the maternity or paediatric setting.

To support the implementation of the children's palliative care policy, a programme of care for children with life-limiting conditions has been established including the appointment of a Paediatric Consultant with a Special Interest in Palliative Care, based in Crumlin. As well as supporting other paediatricians, the Consultant also provides clinical support and advice to maternity hospitals and neonatologists. The programme also included the appointment of eight Children’s Outreach Nurses (CONs) whose role is to ensure that children being cared for at home by their families have access to co-ordinated and supportive services. The nurses liaise closely with statutory and voluntary service providers including local GPs, PHNs, Disability Services, the Jack and Jill Foundation and LauraLynn etc. A further two nurses are being recruited under the Programme, one in Letterkenny and the other to the Children's Hospital Group. An independent evaluation of the Children's Palliative Care Programme, which will be published shortly, has recommended that the children's outreach nursing service be strengthened, both to meet increased demand and to address geographical inequities in service provision. The Irish Hospice Foundation has also agreed to fund a second Consultant post for a one-year period.

A national programme of structured continuing professional education on caring for children with life-limiting conditions has been developed in partnership with Our Lady's Children's Hospital Crumlin. The programme is provided in locations around the country and is available to all health care staff. An integrated website for parents has been developed through the All Island Institute for Hospice and Palliative Care. A national needs assessment on respite care was undertaken and the report Respite Services for Children with Life-limiting Conditions and their Families in Ireland was published in 2013. The National Development Committee is also making progress on other recommendations including the development of the model of care, the development of a model for ‘Hospice at Home’, clinical and governance protocols, standards and pathways, and bereavement care. The HSE's Primary Care Division provides homecare packages to facilitate children with complex care needs to be cared for at home.

Palliative Care for Children

Ceisteanna (538)

Louise O'Reilly

Ceist:

538. Deputy Louise O'Reilly asked the Minister for Health the meetings that have been held to date to ensure appropriate care pathways are in place in end-of-life care, including the provision of respite, hospice and end of life care during the perinatal period, infancy, childhood and adulthood; if his attention has been drawn to an organisation (details supplied) fighting for the provision of hospice and end-of-life care for children, particularly for children in geographically disadvantaged areas; if he has received a request to meet with this group, HSE officials and Members of the Oireachtas; if he will accede to this; and if he will make a statement on the matter. [30924/16]

Amharc ar fhreagra

Freagraí scríofa

Minister of State at the Department of Health

In December 2009 the Department of Health published Palliative Care for Children with Life Limiting Conditions: a National Policy. The Policy provides clear direction for the development of an integrated palliative care service for children and their families, across all care settings. It aims to address the deficits identified in a national needs assessment undertaken in 2005. Following the publication of the Policy, the National Development Committee for Children’s Palliative Care (NDC) was established by the HSE to oversee the implementation of its recommendations. The emphasis on partnership is reflected in the committee membership comprising statutory, voluntary, professional, and parent representation. The Committee is currently co-chaired by the HSE National Lead for Palliative Care and the CEO of LauraLynn Hospice. The Policy contains 31 recommendations under 19 headings and places significant emphasis on supporting families and health care professionals to care for children in their own homes. With regard to perinatal services, the evidence available suggests that the best location of care is within the maternity or paediatric setting.

To support the implementation of the children's palliative care policy, a programme of care for children with life-limiting conditions has been established including the appointment of a Paediatric Consultant with a Special Interest in Palliative Care, based in Crumlin. As well as supporting other paediatricians, the Consultant also provides clinical support and advice to maternity hospitals and neonatologists. The programme also included the appointment of eight Children’s Outreach Nurses (CONs) whose role is to ensure that children being cared for at home by their families have access to co-ordinated and supportive services. The nurses liaise closely with statutory and voluntary service providers including local GPs, Public Health Nurses, Disability Services, the Jack and Jill Foundation and LauraLynn etc. A further two nurses are being recruited under the Programme, one in Letterkenny and the other to the Children's Hospital Group. An independent evaluation of the Children's Palliative Care Programme, which will be published shortly, has recommended that the children's outreach nursing service be strengthened, both to meet increased demand and to address geographical inequities in service provision. The Irish Hospice Foundation has also agreed to fund a second Consultant post for a one-year period.

A national programme of structured continuing professional education on caring for children with life-limiting conditions has been developed in partnership with Our Lady's Children's Hospital Crumlin. The programme is provided in locations around the country and is available to all health care staff. An integrated website for parents has been developed through the All Island Institute for Hospice and Palliative Care. A national needs assessment on respite care was undertaken and the report Respite Services for Children with Life-limiting Conditions and their Families in Ireland was published in 2013. The National Development Committee is also making progress on other recommendations including the development of the model of care, the development of a model for ‘Hospice at Home’, clinical and governance protocols, standards and pathways, and bereavement care. The HSE's Primary Care Division provides homecare packages to facilitate children with complex care needs to be cared for at home.

In February 2015 representatives from Our Children's Voice met with the previous Minister for Health, Mr. Leo Varadkar T.D. My Department has not received any requests for a further meeting. As the issues raised by Our Children's Voice relate to the provision of services they are a matter for the HSE in the first instance. Should the Group so request my Department can arrange a meeting with the appropriate representatives from the HSE at an early date.

Maternity Services

Ceisteanna (539)

Alan Kelly

Ceist:

539. Deputy Alan Kelly asked the Minister for Health the status of the implementation of the national maternity strategy; and if there has been any decision on the capital funding model. [30930/16]

Amharc ar fhreagra

Freagraí scríofa

Minister for Health

The National Women & Infants Health Programme will lead the implementation of Ireland's first National Maternity Strategy - Creating A Better Future Together 2016 - 2026. Work to establish the Programme Leadership Team continues. The Programme will draw up a detailed action plan that will inform the full implementation of the Strategy; this work will include the identification of capital funding requirements. As with all capital projects, the further development of the health care infrastructure, including that relating to the National Maternity Strategy, must be considered and prioritised within the context of the overall capital envelope available to the health service. The HSE will continue to apply the available funding for infrastructure development in the most effective way possible to meet current and future needs.

Mental Health Services Provision

Ceisteanna (540)

Alan Kelly

Ceist:

540. Deputy Alan Kelly asked the Minister for Health the status of the roll-out of A Vision for Change; and if he will make a statement on the matter. [30931/16]

Amharc ar fhreagra

Freagraí scríofa

Minister of State at the Department of Health

'A Vision for Change', published in 2006, sets out a 10-year policy framework for Ireland's mental health services. It recommended that interventions should be aimed at maximising recovery from mental illness, building on service user and social network resources to achieve meaningful integration and participation in community life. In addition, it recommended that mental health services should be organised nationally in catchment areas for populations of between 250,000 and 400,000 and that specialist expertise should be provided by community mental health teams (CMHTs) - expanded multidisciplinary teams of clinicians who work together to fulfil the needs of service users.

Progress, while slower than originally anticipated, continues to be made in implementing the Report’s recommendations. A number of service improvements has been implemented in parallel with the accelerated closure of old psychiatric hospitals and their replacement with bespoke new facilities, better suited to modern mental health care. Service improvements include the development of adult and child & adolescent services, shorter episodes of in-patient care, the adoption of a recovery approach in the delivery of services, and the involvement of service users in service planning and delivery.

Other ongoing developments include the development of counselling services across both primary and secondary care, including early intervention at primary care level; a greater awareness of fostering mental health promotion in society through campaigns like the 'Let's Talk' and 'The Little Things' campaigns; the publication last year of the Expert Review Group Report on the Mental Health Act 2001 and the new Suicide Prevention Strategy 'Connecting for Life'; a reduction in the Child and Adolescent Mental Health Services (CAMHS) waiting lists for those waiting over 12 Months and the commencement of work on the new National Forensic Hospital to replace the Central Mental Hospital in Dundrum.

In addition, funding has been made available to facilitate the transfer of some patients from the Forensic Mental Health Services to the community, investment in high observation in acute mental health units, the improvement of 24/7 services through additional liaison psychiatry services, new clinical programmes and provision of additional clinical space in community services.

'A Vision for Change' has guided national mental health policy for the past 10 years and its term ends this year. The Department will shortly be awarding a tender 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. The outcome of this review will inform the parameters of a review of 'A Vision for Change'.

Health Services Data

Minister of State at the Department of Health

The Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.

As the Deputy's question relates to an individual case, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.

Orthodontic Services Provision

Ceisteanna (552)

Pat Casey

Ceist:

552. Deputy Pat Casey asked the Minister for Health the current waiting times for persons to be referred, assessed and receive orthodontic treatment at St. Colmcille's Hospital, Loughlinstown; if the number of staff engaged to provide the service has increased or decreased each year for the past five years; if the number of staff employed is, in his view, sufficient to provide timely and accessible quality care to persons; and if he will make a statement on the matter. [30723/16]

Amharc ar fhreagra

Freagraí scríofa

Minister for Health

As this is a service matter it has been referred to the HSE for reply to the Deputy.

Medical Card Administration

Ceisteanna (553)

Bernard Durkan

Ceist:

553. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the standardised procedures for processing medical card procedures could be improved with a view to a more expeditious process, with particular reference to patients suffering from a life-threatening or terminal illness; and if he will make a statement on the matter. [30972/16]

Amharc ar fhreagra

Freagraí scríofa

Minister for Health

Under the Health Act, 1970, medical cards are provided to persons who are, in the opinion of the HSE, unable without undue hardship to arrange GP services for themselves and their dependents and every application must be assessed on that basis. In accordance with the Act, the assessment for a medical card is determined primarily by reference to the means, including the income and expenditure, of the applicant and his or her partner and dependents. Where deemed appropriate in particular circumstances, the HSE may exercise discretion and grant a medical card even though an applicant exceeds the income guidelines but where they may face difficult financial circumstances, such as extra costs arising from illness.

It should be noted that every effort is made by the HSE, within the framework of the legislation, to support applicants in applying for a medical card and, in particular, to take full account of the difficult circumstances in the case of applicants who may be in excess of the income guidelines.

Social and medical issues are considered when determining whether undue hardship exists for an individual accessing general practitioner or other medical services. The HSE affords applicants the opportunity to furnish supporting information and documentation to fully take account of all the relevant circumstances that may benefit them in the assessment, including medical evidence of cost and necessary expenses.

It is important that people with medical needs should be able to access necessary assistance in a straight forward manner. It is clear greater discretion is being exercised by the HSE because the number of discretionary medical cards in circulation has increased from about 52,000 in mid-2014 to over 110,453 as of 1st September this year. This followed the measures announced by my predecessor Minister Varadkar, when the "Keane" Report of the Expert Panel on Medical Need for Medical Card Eligibility was published. The "Keane" Report found that it is not feasible, desirable or ethically justifiable to list medical conditions for medical card eligibility. On foot of the publication of the report, 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 and demonstrates the HSE's commitment to the development of a medical system which is responsive and considerate of an applicant's particular circumstances.

The HSE has a system in place for the provision of medical cards in response to an emergency situation for persons with a serious medical condition in need of urgent or on-going medical care that they cannot afford and persons in palliative care, who are terminally ill. With the exception of terminally ill patients, all medical cards, granted on an emergency basis, are issued on the basis that the patient is eligible for a medical card on the basis of means or undue hardship, and will follow up with a full application within a number of weeks of receiving the medical card eligibility. These cards are issued within 24 hours of receipt of the required patient details and a letter which confirms the medical condition from a doctor or consultant. For terminally ill persons, no means test applies.

Accident and Emergency Services Provision

Ceisteanna (554)

Bernard Durkan

Ceist:

554. Deputy Bernard J. Durkan asked the Minister for Health the extent to which primary care centres are capable of alleviating the burden of overcrowding at the accident and emergency facilities in general hospitals by way of dealing with cases which might not require hospital treatment; and if he will make a statement on the matter. [30973/16]

Amharc ar fhreagra

Freagraí scríofa

Minister for Health

The Programme for a Partnership Government commits to a decisive shift towards primary care so that we can provide better care close to home for communities around the country. The Government wants to develop and expand the capacity in primary care in order to encompass health promotion, prevention, early identification, simple and early interventions, and patient empowerment, rather than mainly dealing with acute episodes as they occur. The expansion of the range of services and capacity available within primary and community care can help to keep people well and minimise, as far as possible, the number of patients admitted to hospitals in the first place.

The development of Primary Care Centres to accommodate Primary Care Teams and, where possible, GPs in the one location is a key enabler for the delivery of primary care services. Primary Care Centres facilitate the shift from acute care towards primary care because of the range of multi-disciplinary services they can provide and the role they can play in keeping people who don't need to be in an acute setting out of hospital.

There is a range of initiatives and services provided in a primary care setting and which I hope to see further developed, which are intended to prevent unnecessary hospital admission or attendance and to facilitate early discharge of patients. These initiatives include the implementation of Community Intervention Teams (CITs), Outpatient Parenteral Antimicrobial Therapy (OPAT), Ultrasound Diagnostics and the GP Minor Surgery Pilot Initiative.

The 2016/2017 Winter Initiative provides for the expansion of Community Intervention Team services in four areas (Dublin North, Louth/Meath, Galway/Roscommon and South Tipperary) with potential to support more than 7,500 additional patients through the winter and during 2017.

Primary Care Centres

Ceisteanna (555)

Bernard Durkan

Ceist:

555. Deputy Bernard J. Durkan asked the Minister for Health the extent to which the existence of primary care centres has affected the number of referrals to accident and emergency at general hospitals throughout the country; and if he will make a statement on the matter. [30974/16]

Amharc ar fhreagra

Freagraí scríofa

Minister for Health

To date, the HSE has reported a year-on-year increase of approximately 5% in Emergency Department attendances. Despite increased demand, there has been a decrease of almost 5% in numbers of patients waiting on trolleys.

My Department, working with the HSE, has been driving a range of integrated initiatives to alleviate overcrowding in EDs, including: reducing attendances by expanding primary care services, providing additional home help and homecare packages, increasing hospital capacity and improving how hospitals manage demand for emergency care.

Primary care services are being expanded to alleviate pressures on EDs. 92 Primary Care centres have been opened, with 30 at an advanced stage of construction and a further 39 centres at the preliminary stages of development. A project to increase access to diagnostic services in GP surgeries is currently delivering approximately 1,300 ultrasounds per month, while the GP Minor Surgery pilot has delivered just over 4,200 procedures since commencement. Usage of out-of-hours GP services increased by 14% in the first half of 2016, compared with 2015. Thirteen Community Intervention Teams are in place and have reduced hospital bed requirements by approximately 73 beds per day in the first half of 2016. There were nearly 20,000 referrals to CITs in 2015, whereas there have been over 15,000 between January and July 2016.

Minister for Health

As this is a service matter it has been referred to the HSE for reply to the Deputy.