Written Answers Nos. 49-59
49. Deputy Louise O'Reilly asked the Minister for Health his views on the lack of neuro-rehabilitation services as a critical factor in the current trolley crisis, leading to delayed discharges and unnecessary admissions; the immediate steps he is taking to address this issue; and if he will make a statement on the matter. [4548/17]
Amharc ar fhreagraIncreased demand on hospital Emergency Departments can be caused by a range of factors. To deal with this increased demand, the Health Service Executive (HSE) launched the "Winter Initiative Plan 2016 - 2017", in September 2016, which provided €40 million of additional funding for winter preparedness. On 5th of January, in response to significant pressures in our EDs in the New Year, a series of enhanced measures were added to this initiative.
A key target of this Initiative is to reduce delayed discharges nationally in order to ensure that patients who have been waiting in acute hospitals, including those people who require neuro-rehabilitation services, are getting the support they need to go home or to an alternative suitable community setting which meets their needs. Since the start of the Initiative, delayed discharges have reduced nationally from a high of 659 earlier in 2016 to 469, as of 24th of January. The data available would indicate that cases relating to neuro-rehabilitation services are a relatively small proportion of the overall total.
In addition, the Initiative has delivered 75 additional acute beds opened in the Mercy Hospital Cork, Galway, the Mater, Beaumont and Mullingar. Over 3,900 patients have availed of aids and appliances, over 780 additional homecare packages have been made available and 410 additional transitional care beds have been approved since early October, enabling patients to be discharged from hospital sooner.
I wish to assure the Deputy that my colleague, Minister Harris, and my Department, meet every week with senior officials from the HSE, including the Director General, to monitor progress on the Winter Initiative and ED Performance.
With regard to neuro-rehabilitation services, the Programme for Partnership Government includes a commitment to publish a "plan for advancing neuro-rehabilitation services in the community." The HSE's National Service Plan 2017 contains a priority to finalise and progress implementation of the framework for the Neuro-rehabilitation Strategy. A National Steering Group, chaired by the Head of the Health Service Executive's (HSE's) Disability Reform Team, has completed an implementation framework in respect of the recommendations from the "National Policy and Strategy for the Provision of Neuro-rehabilitation Services in Ireland 2011 - 2011" . The Group is currently considering feedback on the framework, which was circulated to wider stakeholder interest groups. The National Service Plan also contains a priority action to establish an innovative pilot day service aimed at supporting people with severe acquired brain injuries, which is being explored by the HSE.
The Deputy may be aware of the new development of the National Rehabilitation Hospital, which will deliver a 120 bed ward block, including support therapies to paediatrics, acquired brain injury wards, a hydrotherapy unit and a sports hall. Planning permission is already in place and it is expected that tenders from contractors for the main works will be returned in February, 2017.
50. Deputy Mary Lou McDonald asked the Minister for Health the status of the establishment of the clinical stream within the HSE tasked with the issue of interacting mental illness and addiction which leaves many persons in severe mental health distress struggling to find adequate treatment. [4633/17]
Amharc ar fhreagraThe HSE Mental Health Division, along with the Clinical Strategy and Programmes Division and the College of Psychiatrists of Ireland, have recognised the need for a Clinical Programme for Dual Diagnosis to respond to people with substance misuse, both alcohol and/or drugs, together with mental illness. A Programme Manager has been appointed to oversee the Clinical Programme. In addition, a Clinical Lead has been identified at interview and will be seconded pending discussions with the local Addictions Service.
The Primary Care Division has already appointed a National Clinical Lead for the Addiction Services to improve its response to drug and alcohol abuse at primary care level and this Clinical Lead will work with the Mental Health Clinical Lead to develop a programme for those with a dual diagnosis.
The aim of this Programme is to develop a standardised evidence-based approach to the identification, assessment and treatment of comorbid mental illness and substance misuse. These include increasing awareness of the frequent coexistence of mental illness and substance misuse; ensuring there is a clear clinical pathway for management of people with such a dual diagnosis including when they present to Emergency Departments; ensuring a standardised service is provided throughout the country; and ensuring adolescents are also included within the scope of this Clinical Programme.
An integral part of the Dual Diagnosis Programme will be to devise a model of care that will ensure that all adolescents and adults suspected of having a moderate to severe mental illness coexisting with significant substance misuse have access to a timely mental health service delivered on a regional basis. The service will be provided in an integrated manner across the Primary Care Division and the Mental Health Service. There will also be close working relationships with the relevant specialities in Acute Hospitals to deal with any medical comorbidities that may occur, particularly in those with alcohol misuse.
51. Deputy Mick Wallace asked the Minister for Health further to Parliamentary Question No. 104 of 1 December 2016, the timeframe for evaluating the pilot peer support initiative; and if he will make a statement on the matter. [4503/17]
Amharc ar fhreagraAs you will be aware, the 2016 National Mental Health Division’s Operational Plan outlined an objective to introduce Peer Support Workers in Mental Health Services. Peer Support Workers are people who have lived experience of mental distress and recovery. The Peer Support Worker role will use expertise gained through lived experience to promote recovery, share information to promote choice, self-determination and opportunities for connection with local communities. In addition to working with other mental health multidisciplinary professionals, it is envisaged that the Peer Support Worker will work alongside an agreed number of service users on a one to one and/or group basis.
Following a national competitive process for all HSE Mental Health Service areas, an initial funding allocation to develop the national Peer Support Initiative was allocated as part of a pilot initiative to a small number of Multidisciplinary Teams in the Carlow/Kilkenny/South Tipperary area. The pilot initiative is set to commence in early 2017. The pilot sites will be evaluated after a defined period of time and following this, it is anticipated that the Peer Support Worker will be developed (subject to additional resources) across the extended catchment area.
As yet, Peer Support Workers are not in place. They have been selected, with training due to start on 20th February 2017. Plans for evaluations are in process but not yet completed. The Mental Health Engagement Office for the Division is leading on this initiative and is collaborating with all stakeholders to progress plans for this evaluation.
Additionally, a commitment to Peer Support is outlined in the 2017 HSE National Service Plan, with a stated aim of recruitment and training of 20 whole time equivalent (WTE) peer support workers.
52. Deputy Niamh Smyth asked the Minister for Health when the anomaly scan will be made available on site at Cavan General Hospital. [4263/17]
Amharc ar fhreagraI am advised that the provision of routine foetal anomaly scanning for all pregnant women has been a key target for Cavan General Hospital; however, despite every effort having been made, the hospital has not been successful to date in recruiting the necessary specialists required to provide a routine 20 week anomaly scanning service.
The Deputy will be aware that 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, and this work will be led by the HSE National Women and Infants Health Programme. In this regard, the newly-appointed Programme Director has advised that clinical guidance on routine 20 week anomaly scans will be developed as a priority.
In the interim, the Programme will continue to work with the six hospital groups to assist in increasing access to anomaly scans for those units with limited availability. It is expected that the establishment of maternity networks across hospital groups will assist in developing a sustainable service model that ensures that all women within each hospital group can access anomaly scans.
53. Deputy Marc MacSharry asked the Minister for Health the reason for the 139% increase in the numbers on trolleys in Sligo University Hospital between 2013 and 2016; and if he will make a statement on the matter. [4673/17]
Amharc ar fhreagra63. Deputy Sean Fleming asked the Minister for Health the reason for the 308% increase in the numbers on trolleys in the Midland Regional Hospital, Portlaoise, between 2013 and 2016; and if he will make a statement on the matter. [4669/17]
Amharc ar fhreagra67. Deputy John Brassil asked the Minister for Health the reason for the 138% increase in the numbers on trolleys in Kerry General Hospital between 2013 and 2016; and if he will make a statement on the matter. [4670/17]
Amharc ar fhreagra68. Deputy Barry Cowen asked the Minister for Health the reason for the 310.7% increase in the numbers on trolleys in the Midland Regional Hospital, Tullamore, between 2013 and 2016; and if he will make a statement on the matter. [4667/17]
Amharc ar fhreagra72. Deputy Michael Moynihan asked the Minister for Health the reason for the increase in the numbers of patients on trolleys in Cork city hospitals in 2016. [4657/17]
Amharc ar fhreagra90. Deputy Lisa Chambers asked the Minister for Health the reason for the 95.7% increase in the numbers on trolleys in Mayo University Hospital between 2013 and 2016; and if he will make a statement on the matter. [4665/17]
Amharc ar fhreagra106. Deputy Jonathan O'Brien asked the Minister for Health the special steps or initiatives taken during the period November 2016 to date in 2017 in response to the deteriorating overcrowding situation; the status of these initiatives or steps that were announced; and if he will make a statement on the matter. [4565/17]
Amharc ar fhreagra129. Deputy Mary Butler asked the Minister for Health the reason for the 57% increase in the numbers on trolleys in Waterford hospital in 2016; and if he will make a statement on the matter. [4659/17]
Amharc ar fhreagraI propose to take Questions Nos. 53, 63, 67, 68, 72, 90, 106 and 129 together.
Recent data from the HSE indicates that in 2016 there was a circa 5% increase in Emergency Department attendances nationally. In addition, early January 2017 saw continued significant pressure on our EDs due to high demand, increased incidence of flu mainly affecting older people, as well as on-going bed capacity constraints due to staff shortages.
In September 2016, the HSE launched the ‘Winter Initiative Plan 2016-2017’ which provided €40 million of additional funding for winter preparedness and to assist hospitals to deal with increased demand. In January 2017, in response to significant pressures in our EDs in the early New Year, a series of enhanced measures were added to this Initiative.
So far, the Initiative has delivered 75 newly-opened additional beds. Also, as of 24 January, delayed discharges have reduced nationally to 469, freeing up hospitals beds to alleviate ED pressures. In addition under the Initiative, since October: over 3,900 patients have availed of aids and appliances; over 780 additional homecare packages and 410 additional transitional care beds have been provided, enabling patients to be discharged from hospital sooner. Along with my Department, every week, I meet with senior officials from the HSE, including the Director General, to monitor progress on the Winter Initiative and ED Performance.
In relation to the specific sites identified in this composite PQ response, I can confirm that both Cork University Hospital and the Midland Regional Hospital Tullamore have been identified as focus sites under the Winter Initiative experiencing the greatest challenges in terms of ED pressures, and consequently needing specific support measures in order to be able to respond more effectively to expected surges in demand for emergency care over the busy winter period. Under the Initiative, 18 new step-down beds have opened in the Mercy University Hospital Cork, and the Midland Regional Hospital Tullamore will also receive 12 new acute beds, which are expected to open by mid-February.
While all hospitals have experienced ED pressures this winter and increased demand for ED services, Sligo University Hospital, Kerry General Hospital and Mayo University Hospital have been performing better than the national average in terms of patient experience times and trolley numbers. Under the current HSE Service Plan 2017, additional funding is provided to facilitate the opening of the new medical assessment unit at the the Midlands Regional Hospital in Portlaoise. The performance of all of these hospitals is monitored on a daily basis by the HSE’s Special Delivery Unit and support is given as needed to facilitate alleviating ED pressures.
54. Deputy Aengus Ó Snodaigh asked the Minister for Health the number of persons whose elective surgery was cancelled or rescheduled more than once in 2016 and to date in 2017; and if he will make a statement on the matter. [4568/17]
Amharc ar fhreagraThe National ED Escalation Framework sets out procedures to be followed in hospitals during periods of high demand for emergency care, to ensure that safe care is provided to all patients. In order to respond to surges in ED demand, under the Framework, hospital managers may, in consultation with the relevant clinical leads, review and cancel non-urgent planned electives, where appropriate. This allows both beds and staff to be redeployed to alleviate pressure in the ED.
The HSE intends to undertake a review of the Escalation Framework in the coming months to ensure its effectiveness. It is essential that hospitals continue to improve how they manage and balance the demand for emergency care with the planning of elective procedures, to minimise the impact on patients.
In addition, it is important that the HSE continues to improve its processes to minimise the number of sessions lost when patients cancel or do not attend for their procedures.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to you directly.
55. Deputy Maureen O'Sullivan asked the Minister for Health if there has been engagement with the Department of Justice and Equality regarding those issues that are delaying the commencement date of tablet legislation; and if he will make a statement on the matter. [4526/17]
Amharc ar fhreagraThe Misuse of Drugs (Amendment) Act 2016 was passed by the Oireachtas on the 27th July 2016. Controlling the substances in the Act was part one of a two-step process and Regulations and various Orders are also required to allow legitimate users (e.g. patients with a prescription, health professionals) to possess the substances.
Drafting of the Misuse of Drugs Regulations and Orders is complex and technical in nature and involved consultation with a number of State Agencies. However, since Autumn 2016 significant resources in the Medicines, Controlled Drugs and Pharmacy Unit within the Department have had to be allocated to drafting of the Misuse of Drugs (Supervised Injecting Facilities) Bill and also dealing with various issues in relation to the use of cannabis for medicinal purposes.
In December 2016, the Early Warning Emerging Trends Group, of which the Department of Justice and Equality is a member, were updated on the progress in relation to the Regulations.
Once the Regulations are finalised, under the Technical Standards Directive, Member States are required to inform the Commission of any new regulations or standards which may create a barrier to the free movement of goods. Since these draft Regulations have the potential to affect trade, in particular because of the introduction of a requirement for import licences, they must be notified to the EU whilst they are in draft and before they are adopted in national law.
Notified regulations are usually subject to a 3-month standstill period - to enable the Commission and the other Member States to examine the notified text and to respond appropriately. The Department intends to invoke an urgency procedure which can shorten the notification period to 10 days as the matter is considered to be related to the protection of public health or safety. If the Commission does not raise any objections the Regulations will be in order to be signed.
56. Deputy Niamh Smyth asked the Minister for Health the status of the regional maternal foetal medicine service for the RCSI hospital group. [4264/17]
Amharc ar fhreagraIn relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to you directly.
57. Deputy Bobby Aylward asked the Minister for Health if he will instigate an independent clinical review of children's scoliosis surgery services in order to develop current services to an adequate level to reduce surgery waiting lists; and if he will make a statement on the matter. [4256/17]
Amharc ar fhreagraLong waiting times for scoliosis surgery are not acceptable, and my Department has been working closely with the HSE to address this service pressure.
Additional funding of €1.042m was allocated under the 2015 Service Plan to increase capacity at Crumlin, and further resources of €0.987m were allocated under the 2016 Service Plan for Orthopaedics and Trauma to address service needs in Crumlin which will have a positive effect on access for scoliosis patients. In order to improve access in the short term the HSE Winter Initative 2016/2017 includes €2m provided specifically for surgery for scoliosis patients. To date under this initiative 78 patients have been reviewed, 54 have been treated, and 4 have received appointments for treatment in February.
The construction of a new orthopaedic theatre in Crumlin is complete and will provide capacity for additional scoliosis activity in 2017. However, the use of this theatre is dependent on the recruitment of additional theatre nurses. The Children's Hospital Group is exhausting every recruitment and retention avenue available to them, including international recruitment, to support the opening of the new theatre.
I have met with a number of scoliosis advocacy groups to discuss their concerns and the Children’s Hospital Group has begun a process of engagement with advocacy groups on developing a partnership approach to the design and planning of services for children with scoliosis. Therefore, an independent clinical review of scoliosis services is not required at this time.
The HSE is currently developing a 2017 Waiting List Action Plan for inpatient/daycase procedures to ensure that no patient is waiting more than 15 months by the end of October. My Department will continue to work with the HSE and the relevant hospitals in this context to ensure improvements in access to spinal surgery.
58. Deputy Jackie Cahill asked the Minister for Health his and the HSE's position regarding the use of Our Lady's Hospital, Cashel, County Tipperary, as part of the solution to the continuing overcrowding at South Tipperary General Hospital; and if he will make a statement on the matter. [4506/17]
Amharc ar fhreagraCashel Health Campus, Co. Tipperary, which includes Our Lady’s Hospital, provides mainly primary care services. There is a small residential facility on the site, together with other services including day and outreach services. The residential unit, which includes elderly, mental health and intellectual disability beds, is currently fully occupied.
The development of the campus as a centre for non-acute healthcare services arose from the decision by the former South Eastern Health Board to centralise acute hospital services for the South Tipperary area on one site in Clonmel. This took place in 2007.
I have been assured by the HSE that the Executive will continue to explore and maximise the on-going and future use of the Cashel campus, and services provided will continue to play a significant role in the provision of overall health services within the South Tipperary area.
Minister Harris has requested that the HSE explore what additional supports Our Lady's Hospital, Cashel can provide in alleviating pressure in South Tipperary General Hospital, including on the Emergency Department. This work is on-going.
59. Deputy Imelda Munster asked the Minister for Health his plans to instruct the HSE to draw up national guidance on the provision of routine detailed scans at 20 weeks; the progress to date on this; and if he will make a statement on the matter. [4556/17]
Amharc ar fhreagra81. Deputy Louise O'Reilly asked the Minister for Health if he will ring-fence funds specifically for the necessary investment in equipment and personnel for providing 20-week routine scans for pregnant women; and if he will make a statement on the matter. [4547/17]
Amharc ar fhreagra100. Deputy Denise Mitchell asked the Minister for Health the number of pregnant women offered or given 20-week routine scans as a percentage of total pregnancies in each of the six maternity units in which these scans are available; and if he will make a statement on the matter. [4559/17]
Amharc ar fhreagra130. Deputy Donnchadh Ó Laoghaire asked the Minister for Health the reason detailed 20-week routine scans for pregnant women are not provided routinely or offered to all patients; his plans to extend this facility from the current six maternity units to all 19 maternity units here; and if he will make a statement on the matter. [4558/17]
Amharc ar fhreagraI propose to take Questions Nos. 59, 81, 100 and 130 together.
An anomaly scan is a full detailed anatomical survey of pregnant women that takes place between 20 and 22 weeks' gestation. Anomaly scans are currently available in the following Hospital Groups:
- Ireland East Hospital Group - The National Maternity Hospital
- Dublin Midlands Hospital Group - The Coombe Women & Infants University Hospital
- RCSI Hospital Group - The Rotunda Hospital
- Saolta Hospital Group - University Hospital Galway
- South/South West Hospital Group - Cork University Maternity Hospital
University Maternity Hospital Limerick offers two routine scans during pregnancy (at booking and at 31-32 weeks). Additional anomaly scans at 20-22 weeks are offered if clinically indicated.
The hospitals/maternity units currently providing anomaly scans accept referrals from other maternity units, if requested. This occurs where the medical team in the referring maternity unit consider that an anomaly scan is clinically indicated.
The issue of anomaly scanning is a priority issue for the newly established HSE National Women and Infant’s Health Programme (NWIHP). A Programme Director was seconded into position on the 3rd January last. A Clinical Director has recently been appointed and takes up position on the 1st March 2017. An early priority for the Programme will be to develop clinical guidance regarding routine detailed scans at 20 weeks. In the meantime, the NWIHP will continue to work with the six Hospital Groups to assist in increasing access to anomaly scans for those units with limited availability.
One of the current challenges to increase access to anomaly scans is the recruitment of ultra-sonographers. In this context it is expected that the establishment of maternity networks across hospital groups will assist in developing a sustainable model that ensures that all women within each hospital group can access anomaly scans.
In relation to the query concerning the number of pregnant women who have been offered or provided with an anomaly scan, as this is an operational matter, I have asked the HSE to reply to you directly.
