Bernard Durkan
Ceist:291. Deputy Bernard J. Durkan asked the Minister for Health the progress in respect of the new national children's hospital project; and if he will make a statement on the matter. [4917/17]
Amharc ar fhreagraNational Children's Hospital
Ceisteanna (291)
Freagraí scríofa
The previous Government's decision to locate the new children's hospital at the St James's campus was based on the over-riding priority of best clinical outcomes for our children and, in particular, the sickest of these. That decision is unequivocally supported by this Government and by me as Minister. The planned new facilities will provide us with the means to deliver on improved health outcomes for children, especially the sickest children in Ireland.
As announced in June 2015, the Coombe Women and Infants University Hospital will relocate in time to the St James's campus, achieving tri-location of adult, paediatric and maternity services. The National Maternity Strategy, published in January 2016, reaffirms the delivery of tri-located maternity services on the campus with the new children's hospital and St James's Hospital. A site for the proposed maternity hospital is identified in the Site Master Plan for the St James's campus, and the new children's hospital design has incorporated the required operational links with both maternity and adult hospitals.
The National Paediatric Hospital Development Board (NPHDB) is the statutory body responsible for planning, designing, building and equipping the new children's hospital. The granting of planning permission in April 2016 for the hospital, satellite centres and related buildings was a huge and very welcome milestone for the project. Enabling works (site clearance and demolition), which began this summer on the campus of St. James's, are advancing well.
The Children's Hospital Group Board is bringing together the three existing children's hospitals, with a focus on integrating into one organisation well before transitioning to the new children's hospital. A General Scheme of a Bill is at an advanced stated to merge the three existing children's hospitals into a single hospital body in advance of the move to the new facilities, which will plan for the transition of services, integrate the existing services, and in due course run the new unified hospital.
The NPHDB has recently completed evaluation of the tenders, received at the end of October 2016, for the main and specialist contractors for the new children's hospital and for the two Paediatric OPD and Urgent Care Satellite Centres at Tallaght and Connolly Hospitals. My priority is to make progress on the new hospital as soon as possible this year so we can ensure children, young people and their families have the facilities they need and deserve.
Primary Care Centres
Ceisteanna (292)
Bernard Durkan
Ceist:292. Deputy Bernard J. Durkan asked the Minister for Health the number of primary care centres which are fully staffed and operational; the extent to which evidence exists of the alleviation of overcrowding in hospital accident and emergency departments as a result; and if he will make a statement on the matter. [4918/17]
Amharc ar fhreagraFreagraí scríofa
The Programme for a Partnership Government commits to a decisive shift towards primary care so that better care close to home can be provided for communities around the country.
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 do not need to be in an acute setting out of hospital.
As the provision of Primary Care Centres and related staffing and service matters are the responsibility of the Health Service Executive (HSE), I have arranged for the question to be referred to the HSE for direct reply to the Deputy.
Medicinal Products Prices
Ceisteanna (293)
Bernard Durkan
Ceist:293. Deputy Bernard J. Durkan asked the Minister for Health the procedures in place to encourage manufacturers of medicines to make their product available for sale to the health services at a manageable cost, with particular reference to top of the range new products with an expensive price tag; and if he will make a statement on the matter. [4919/17]
Amharc ar fhreagraFreagraí scríofa
The 2016 Framework Agreement on the Supply and Pricing of Medicines provides for a new and more robust process for the reimbursement of medicines offering greater certainty to manufacturers regarding the reimbursement process.
The revised process now requires that each product seeking reimbursement under the Community Drugs Schemes will undergo an assessment process by the National Centre for Pharmacoeconomics (NCPE). As part of this process the manufacturer must submit the price at which it is seeking reimbursement for its product.
Under Clause 6.2.1 of the Framework Agreement the maximum supplier proposed price shall be no greater than the average of the currency-adjusted relevant price (being the ex- factory price or equivalent thereof and using the applicable exchange rate) applicable in such of the nominated states in which the medicine is available on the date of application. Under Clause 6.2.3 medicines are also subject to an annual price realignment so as to ensure that prices in Ireland fall in line with prices in other basket countries.
Once submitted to the NCPE the product will then be assessed in terms of its safety, clinical effectiveness and cost-effectiveness at the price submitted. The cost-effectiveness of the drug at the price submitted is factored into the NCPE's recommendation on whether or not the product should be reimbursed.
Following a recommendation from the NCPE the HSE enters into negotiations with manufacturers often seeking price reductions. The HSE frequently seeks to address what it may regard as excessive pricing demands around new medicines so as to bring those medicines within the range of affordability.
It is important to point out however that the HSE does not select the prices of patented medicines, that is determined by the pharmaceutical industry. Therefore I would urge all pharmaceutical companies to submit pricing proposals which are affordable and sustainable and which represent value for money for the Irish health service, patients and the taxpayer.
Last December I also used the opportunity of the second Round Table meeting for European Health Ministers and CEOs/Heads of Europe-based pharmaceutical companies in Portugal to engage directly with the industry on drug pricing. I stated the need for the pricing model adopted by industry to be both sustainable and affordable and noted that many companies need to fundamentally reassess their pricing model so that innovative medicines are available to patients with unmet needs.
Hospital Services
Ceisteanna (294)
Bernard Durkan
Ceist:294. Deputy Bernard J. Durkan asked the Minister for Health if he will ensure the retention and expansion of facilities at a hospital (details supplied) having particular regard to the need for such facilities in the public sector and a lack of adequate facilities to facilitate the discharge of patients from acute hospitals; and if he will make a statement on the matter. [4920/17]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter it has been referred to the Health Service Executive for direct reply.
Emergency Services Provision
Ceisteanna (295)
Bernard Durkan
Ceist:295. Deputy Bernard J. Durkan asked the Minister for Health the extent to which his Department has been in a position to identify precisely the full extent of resources needed to meet eventualities such as flu epidemics or a major disaster, with particular reference to the capability of general hospitals to meet the challenge without causing difficulties at accident and emergency departments; and if he will make a statement on the matter. [4921/17]
Amharc ar fhreagraFreagraí scríofa
The Government Task Force on Emergency Planning is the top-level body which coordinates and oversees the emergency management activities of all Government Departments and Public Authorities. Ireland has adopted the “Lead Department” principle which means that the Government Department having responsibility for a particular area of public life (transport, energy, health etc.) takes the lead when an emergency occurs in that area. When an emergency occurs it is the responsibility of the relevant Lead Government Department (LGD) to chair the National Emergency Co-ordination Group (NECG) which deals with the relevant emergency. The Department of Health is currently LGD for two emergencies - Pandemic Influenza and Other Infectious Diseases, and Other Biological Incidents.
The National Public Health Emergency Team (NPHET) is the forum for managing the interface between the Department of Health and the Health Service Executive and will manage the planning and response phases of public health response to any influenza pandemic. The management of a pandemic influenza epidemic will be carried out in the context of the existing international framework, including the WHO's International Health Regulations (IHR's) which sets out an international system of preparedness and response for dealing with public health emergencies of international concern. EU Decision No 1082/2013/EU on serious cross-border threats to health also provides a coherent framework for tackling all serious cross-border public health threats at an EU level. The EU Health Security Committee, which includes representatives from all EU Member States, is responsible for coordinating the response at EU level. All responses will take into account the advice of the European Centre for Disease Prevention and Control, which provides rapid risk assessments of infectious disease outbreaks, advises actions to be taken to prevent or control their spread and provides support for dealing with outbreaks.
As part of this process the HSE and hospitals should have their own National Emergency Plans in place to order to ensure a structured and timely response to a major emergency.
Health Services Staff
Ceisteanna (296, 297)
Bernard Durkan
Ceist:296. Deputy Bernard J. Durkan asked the Minister for Health the extent to which plans are in preparation to ensure the retention of adequate health personnel at all levels to meet any eventualities and eliminate overcrowding at acute hospitals; and if he will make a statement on the matter. [4922/17]
Amharc ar fhreagraBernard Durkan
Ceist:297. Deputy Bernard J. Durkan asked the Minister for Health the extent to which an adequate supply of general practitioners, non-consultant hospital doctors, nurses and consultants is likely to become available to the public health service to ensure the elimination of waiting list and overcrowding at accident and emergency departments and the availability of community health services throughout urban and rural areas; and if he will make a statement on the matter. [4923/17]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 296 and 297 together.
The Government is committed to the continued development of GP capacity to ensure that patients across the country continue to have access to GP services. The Programme for Partnership Government commits to increasing the number of GP training places to 259 places annually. In July 2016, the GP training intake increased from 157 to 172 places and the HSE's 2017 National Service Plan envisages a further increase to 187 places this year. I am anxious to achieve further increases in future years in order to ensure that the future manpower needs of general practice can be met. In addition, I am cognisant of the need for a new GP services contract which will help modernise our health service and develop a strengthened primary care sector, and health service management have already progressed a number of significant measures through engagement with GP representatives in recent years. The next phase of engagement on a new GP contract is under way and initial meetings with GP representative bodies have been held in January. The GP contracts review process will, inter alia, seek to introduce further measures aimed at making general practice a fulfilling and rewarding career option into the future.
There are many initiatives currently under way to improve nursing and midwifery staffing levels throughout the country. The number of nursing and midwifery staff increased by 1,650 between December 2013 and December 2016. 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. Its 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. The Acute Hospital Groups have advertised a number of Emergency Department nursing posts and are currently in the recruitment process. The HSE ran a 3 day open recruitment event over the Christmas holiday period in Dr Steevens' Hospital for nurses and midwives from all disciplines who are interested in working in the Irish Public Health Service. 220 attended the event. 115 nursing and midwifery candidates were deemed successful and panelled following interview. The files for successful candidates have passed to the contracting unit within National Recruitment Service, Manorhamilton. This event will be followed by a series of careers events for nurses throughout 2017 with the next one scheduled for 31 March 2017. A relocation package of up to €1,500 continues to be available to nurses who return from overseas.
The report of the Emergency Department Expert Group identified a need to take on additional nurses to care for boarded patients awaiting admission from Emergency Departments. This is particularly where the number of patients awaiting admission occupy over 50% of the Emergency Department cubicle capacity for the hospital concerned. Having regard to the formula set out in the Report for calculating the required nursing compliment an additional 107 nursing and midwifery posts are to be created and filled to look after all admitted patients in Emergency Departments. The Group also recommended that nursing numbers in Emergency Departments are brought to their full agreed staffing levels. Of the 144 related posts that were vacant approximately half have been filled to date. The current recruitment campaigns and others that are in the process of being developed will be used to fill the vacant Emergency Department posts and the additional 107 posts.
It is Government policy to move to a consultant delivered service. While the ratio of consultants to patients is lower in Ireland than in other countries, reflecting a historical low base, significant progress has been achieved. There has been a large increase in the number of consultants since the establishment of the HSE, the number having increased by 956 from December 2004 to the end of 2016 (1,905 to 2,861 - Whole Time Equivalents). There are some specialties in which there are international shortages and which have been traditionally difficult to fill. This means that progress in improving the ratios is more difficult. Shortages in specialties such as emergency medicine, anaesthesia and psychiatry are a worldwide phenomenon and not specific to the Irish health services. The number of NCHDs has also increased significantly in the past decade, reflecting service demands and ongoing efforts to achieve full compliance with the requirements of the European Working Time Directive. From 31 December 2006 to 31 December 2016 the number increased from 4,679 to 6,060 an increase of 1,381.
Health Services Provision
Ceisteanna (298)
Bernard Durkan
Ceist:298. Deputy Bernard J. Durkan asked the Minister for Health the degree to which the delivery of health services here continues to be compared with such services in other jurisdictions with a view to identifying and adapting the most effective, efficient and satisfactory practices and the elimination of the opposite; and if he will make a statement on the matter. [4924/17]
Amharc ar fhreagraFreagraí scríofa
The development of health services in Ireland is subject to on-going enhancement and improvement processes and initiatives to ensure the delivery of high quality care in the most effective and efficient manner. As a general principle, these processes and initiatives are informed by national and international best practice.
As the Deputy will appreciate, there are a range of initiatives under way across the health service in this regard. I have sought to highlight some of these in this response.
My Department publishes the National Healthcare Quality Reporting System annually on its website. This reports on the performance indicators that reflect on the quality of the healthcare provided at national, regional and hospital level, and allows for the comparison of the quality of healthcare and variation across our country and at international level.
As part of our suite of clinical effectiveness processes, National Clinical Guidelines, National Clinical Audit and Standards for Clinical Practice Guidance provide a robust evidence-based framework for improving and standardising service design and delivery. These processes are informed by and benchmarked against international standards. To date, 14 National Clinical Guidelines in the areas of clinical deterioration, cancer and palliative care, hospital acquired infections and chronic diseases have been published by the National Clinical Effectiveness Committee (NCEC). These are evidence based guidelines developed to international standards.
The Health Information and Quality Authority (HIQA) undertakes health technology assessments which evaluates the clinical and cost effectiveness of health technologies such as drugs, equipment, diagnostic techniques and health promotion activities. These assessments take account of international best practice and provide the basis for informing national policy, service decisions and National Clinical Guidelines.
There are a number of other efficiency and effectiveness tools in use, for example Activity Based Funding, and Value for Money reviews.
Activity Based Funding (ABF) is a new model for funding public hospital care. It involves moving away from block grant budgets to a new system where hospitals are paid for the volume and quality of care provided. Key benefits that are expected from the introduction of ABF include increased fairness in resource allocation, improved efficiency and increased transparency.
Under the current public spending code, the Department is required to work with the HSE on the rolling value for money (VFM) assessment of spending programmes. This will be in the form of VFM and Policy Reviews and smaller Focused Policy Assessments. As outlined in the Department's new Statement of Strategy, the next VFM assessment will be a review of the costs of long-term residential facilities for older people within the public sector.
More generally, my Department and its agencies actively collaborate with international organisations conducting work in the area of health including the European Union, the World Health Organisation, the OECD and the National Institute for Health and Care Excellence in the UK. This includes participation in data collection initiatives. International collaboration and engagement presents a useful opportunity for sharing research, best practice and expertise and provides an important input to national policy development.
Commissions of Investigation
Ceisteanna (299)
Robert Troy
Ceist:299. Deputy Robert Troy asked the Minister for Health the final costs to the Exchequer of each commission of investigation that has been completed to date in his Department, in addition to the estimated costs to date of ongoing commissions of investigation. [5307/17]
Amharc ar fhreagraFreagraí scríofa
Under the Commission of Investigation Act 2004, the Commission to examine matters relating to the management, operation and supervision of Leas Cross Nursing Home was established by the Government in April 2007. Final costs were €2,104,749. There have been no further Commissions of Investigation in this Department.
Fisheries Protection
Ceisteanna (300)
John Brassil
Ceist:300. Deputy John Brassil asked the Minister for Agriculture, Food and the Marine his views on the Irish Wildlife Trust's request to ban pair trawler fishing at Kenmare Bay, County Kerry in view of legislation designating Kenmare Bay as a river and its importance as an area of natural conservation; and if he will make a statement on the matter. [4741/17]
Amharc ar fhreagraFreagraí scríofa
I am aware of the Irish Wildlife Trust's calls for the prohibition of pair trawling in coastal areas. I am advised that the practice of pair trawling in inshore waters and estuaries around Ireland is confined to fishing for sprat. The Irish Wildlife Trust also identifies sprat as the target species for this activity.
Sprat in Irish waters is not a species subject to fishing quotas or Total Allowable Catches established under EU regulation. The International Council of the Exploration of the Seas (ICES) considers sprat to be a data limited stock which means that more detailed data is required in order to form a full understanding of the state of the stock. In order to address that paucity of accurate information in respect of sprat stocks in the waters around Ireland, a three year research project, partially funded by industry, began in October 2014 under the auspices of the Marine Institute in cooperation with Galway-Mayo Institute of Technology.
This project aims to develop an accurate and detailed understanding of the stock structure of sprat around Ireland. It will determine whether the sprat in Irish coastal waters is one stock or several separate stocks and it aims to increase our understanding of their role in the broader marine ecosystem. This data will in turn contribute to the ICES assessment of the vulnerability or otherwise of sprat in the waters around Ireland.
The central objective of the Common Fisheries Policy (CFP) is to ensure that fishing and aquaculture activities are environmentally sustainable in the long term through the conservation and sustainable exploitation of marine biological resources and the management of fisheries and fleets exploiting such resources.
Available scientific information is that sprat in Ireland spawn from January to June with a fishery normally taking place from October to Christmas. This is a fortuitous situation, allowing some degree of reproductive output as the fishery takes place after the fish have been able to spawn. The Marine Institute advise that there is no evidence that spawning sprat are or ever have been targeted in Irish fisheries nor is there evidence that sprat actually spawn inshore. That of course is not to deny that they are easily targeted inshore when they occur there.
I have also been informed that the Marine Institute is actively pursuing the addition of sprat to the species covered under the European Maritime and Fisheries Fund Marine Biodiversity Scheme, in 2017. This would allow for more intensive data collection to enhance scientific knowledge and underpin any future efforts at management.