Written Answers Nos. 137-156
137. Deputy Pearse Doherty asked the Minister for Health his plans for the future of long-term residential care at a facility (details supplied); if bed capacity reductions are being considered as part of these plans; and if he will make a statement on the matter. [51256/17]
Amharc ar fhreagra138. Deputy Pearse Doherty asked the Minister for Health his plans for the future of long-term residential care at a facility (details supplied); if bed capacity reductions are being considered as part of these plans; and if he will make a statement on the matter. [51257/17]
Amharc ar fhreagra139. Deputy Pearse Doherty asked the Minister for Health if reports detailing the investment and service needs of community hospitals in County Donegal (details supplied) will be made available to me; and if he will make a statement on the matter. [51258/17]
Amharc ar fhreagraI propose to take Questions Nos. 137 to 139, inclusive, together.
While the care delivered to residents in our community hospitals is generally of a very high standard, many of theses services are delivered in buildings that are less than ideal in the modern context. It is important therefore that we upgrade our public bed stock and this is the aim of the 5 year Capital Investment Programme for Community Nursing Units which was announced last year. This provides the framework to allow for an enhanced programme to replace, upgrade and refurbish these care facilities, as appropriate. Significant work was undertaken to determine the most optimum scheduling of projects within the phased provision of funding to achieve compliance with National Standards.
This investment programme will see the provision of two new centres in Donegal, namely in Ballyshannon and also a 130 bed centre, centrally located in Letterkenny.
Since the announcement in 2016, and following discussions with public representatives, Health Forum members and local community groups, local HSE management in CHO 1 agreed to review overall requirements for the area. The Terms of Reference for the Rhatigan's review were as follows:
1. Assess current and future needs for short/long term bed capacity taking into account of up to date census data from the Central Statistics Office;
2. Based on current planning norms define scale of public/private provision required to meet this need up to 2026;
3. Assess the adequacy of existing facilities in St Joseph’s Hospital Stranorlar, Ramelton and Lifford, taking account of amended legislation governing residential care standards 2016;
4. Recommend changes to the approved capital programme, if appropriate, taking into account capital and revenue costs, geographical factors, integration of care with acute services and time frames for delivery;
5. Make specific recommendations regarding dementia care provision; and
6. Based on the above to finalise brief and options appraisals for infrastructural developments proposed.
I understand that the report has now been received by Social Care division and will be considered over the coming period.
Any proposals for changes to the approved Capital Investment Programme for Community Nursing Units would have to be considered in the context of capital funding available to Health, potential revenue implications and compliance with the agreed capital approval process.
140. Deputy Niamh Smyth asked the Minister for Health the status of a hospital appointment for a person (details supplied); and if he will make a statement on the matter. [51259/17]
Amharc ar fhreagraUnder the Health Act 2004, the Health Service Executive (HSE) is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Section 6 of the HSE Governance Act 2013 bars the Minister for Health from directing the HSE to provide a treatment or a personal service to any individual or to confer eligibility on any individual.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to you directly.
141. Deputy Brendan Smith asked the Minister for Health further to Parliamentary Question No. 155 of 9 November 2017, the details of the working group set up by the national stroke programme to develop guidelines on the affect that a stroke has on a person's mood; the membership of this group; the timeframe for the completion of the guidelines; the supports that will be put in place to ensure the availability of counselling services to support the consequences of a stroke are enhanced in locations once these guidelines are developed and published; and if he will make a statement on the matter. [51261/17]
Amharc ar fhreagraAs this is a service matter, this question has been referred to the Health Service Executive for direct reply.
142. Deputy Mary Lou McDonald asked the Minister for Health the date on which a person (details supplied) ceased employment as the Health Service Executive's assistant national director for older persons. [51263/17]
Amharc ar fhreagraI have asked the HSE to respond to the Deputy directly on this matter.
143. Deputy Billy Kelleher asked the Minister for Health the details of the working group set up by the national stroke programme to develop guidelines on the affect a stroke has on a person's mood; the timeframe for the completion of the guidelines; and if he will make a statement on the matter. [51264/17]
Amharc ar fhreagra144. Deputy Billy Kelleher asked the Minister for Health the support that will be put in place to ensure that the availability of counselling and psychology services to support the consequences of stroke are enhanced in locations once guidelines are developed and published; if this will be provided for in the HSE's service plan; and if he will make a statement on the matter. [51265/17]
Amharc ar fhreagra148. Deputy Billy Kelleher asked the Minister for Health his plans to increase the number of stroke units; if so, the number and locations; if funding is being made available in the HSE's service plan for same; and if he will make a statement on the matter. [51269/17]
Amharc ar fhreagra149. Deputy Billy Kelleher asked the Minister for Health his plans to increase the number of stroke beds; the number and location; if funding is being made available in the HSE's service plan for same; and if he will make a statement on the matter. [51270/17]
Amharc ar fhreagra151. Deputy Billy Kelleher asked the Minister for Health if the recommendation by the national stroke programme, as part of the phased introduction of early supported discharge for a further nine teams to be established over a three-year period, will be part of the 2018 national service plan; and if he will make a statement on the matter. [51272/17]
Amharc ar fhreagraI propose to take Questions Nos. 143, 144, 148, 149 and 151 together.
In 2016 the National Stroke Programme published an Irish Heart Foundation/HSE National Stroke Audit of Stroke Rehabilitation Units, available at
http://www.hse.ie/eng/services/publications/Clinical-Strategy-and-Programmes/National-Stroke-Audit-Rehabilitation-Units-2016.pdf.
It found that standardised assessment of patients for cognitive difficulties is performed on all patients in 89% (23/26) of sites, with mood being assessed using a standardised tool in 27% (7/26) of services, counselling services are also accessible in 27% of sites and psychology services were available in 31% of sites.
In recognition of the requirement to enhance the availability of counselling services to support the consequences of stroke (e. g. depression, anxiety), this has led The National Stroke Programme to establish a working group to develop guidelines in relation to mood in stroke. This group includes representation from acute, rehabilitation and community services .
The first national stroke care audit report in 2006 reported one stroke unit in the country. In 2016, 65.6% of Stroke patients were admitted to a Stroke Unit. Access to stroke unit care has been shown to improve stroke patient outcomes through reduced mortality rates, reduced dependency and shorter lengths of stay in hospital by patients. Since the commencement of the National Clinical Programme for Stroke (NCPS), nine new stroke units have been opened, bringing the total number of stroke units in acute hospitals to twenty-two. Two further stroke units are currently in development with a third at planning stages. It was recommended in the National Stroke Programme Model of Care 2012 that all hospitals admitting stroke patients should have a Stroke Unit large enough to accommodate all stroke patients.
In relation to early supported discharge it has been recognised internationally that Early Supported Discharge of stroke patients from hospital, improves outcomes, reduces need for long term care and increases acute hospital capacity by freeing up beds. It is estimated that 10-25% of patients could benefit from an ESD service.
The NCPS has helped to establish 3 small but effective ESD teams in Dublin and Galway. In 2016, 137 patients were discharged to ESD services representing 15.6% of total stroke discharges. It is estimated that there was an average reduction in length of stay of 10.4 days per ESD patient.
Funding for increasing capacity in the three operational sites was secured for 2017 with further funding secured to support the establishment of two further teams in University Hospital Limerick and Cork University Hospital. Recruitment of these ESD staff is on-going.
The HSE is currently in the process of preparing its 2018 National Service Plan and discussions are continuing with my Department. The timeframes for submission of the HSE Service Plan for approval are set down in legislation and on receipt of the letter of determination, the HSE has 21 days to prepare and submit its Service Plan for 2018 for my approval. Following this, the National Service Plan will be laid before the Houses of the Oireachtas and then published at the earliest possible time.
145. Deputy Billy Kelleher asked the Minister for Health the research or investigation taking place to identify the reason for the increased incidence rates in stroke among persons of working age; if this research and planning will be part of the health service capacity review; and if he will make a statement on the matter. [51266/17]
Amharc ar fhreagraAs this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
146. Deputy Billy Kelleher asked the Minister for Health the plans in place to introduce a national screening programme for atrial fibrillation; and if he will make a statement on the matter. [51267/17]
Amharc ar fhreagraThe Department of Health’s “Changing Cardiovascular Health: Cardiovascular Health Policy 2010 - 2019” established a framework for the prevention, detection and treatment of cardiovascular diseases.
The National Cardiovascular Health Policy acknowledged that many patients with atrial fibrillation remain undetected or untreated. It also noted that there was evidence that the detection of atrial fibrillation in general practice was improved by opportunistic case finding. Improved detection of atrial fibrillation and anticoagulation can be achieved by developing structured systems between primary care and the hospital setting.
Proposals relating to the GP contract for the structured management and prevention of Non-Communicable Diseases, including cardiovascular disease such as rhythm disorders are under consideration.
147. Deputy Billy Kelleher asked the Minister for Health the status of discussions as part of the negotiation of the new general practitioner contract to introduce opportunistic screening for atrial fibrillation in general practice in view of the fact that a health technology assessment by HIQA has shown that it is likely to be highly cost-effective; and if he will make a statement on the matter. [51268/17]
Amharc ar fhreagraThe development of primary care is central to the Government's objective to deliver a high-quality, integrated and cost effective health service. The Programme for Government commits to a decisive shift within the health service towards primary care in order to deliver better care close to home in communities across the country. The development of a new, modernised contract for the provision of general practitioner services will be a key element in facilitating this process. The aim is to develop a contract which has a population health focus, providing in particular for health promotion and disease prevention and for the structured ongoing care of chronic conditions.
Since 2015, negotiations have resulted in a number of service developments including the provision of free GP care to under 6's and over 70's, the introduction of a Diabetes Cycle of Care for adult GMS patients with Type 2 Diabetes and enhanced supports for rural GPs. The next phase of discussions with GP representatives on a new GP contract is under way. These discussions are wide ranging and ambitious in their scope. Proposals around further structured programmes for the management of chronic diseases are being considered in this context. I think it is important to acknowledge that, as with any negotiation-type process, and given the range and complexity of the issues being discussed, this process will take time. I look forward to constructive and positive engagements with a view to achieving a satisfactory outcome.
150. Deputy Billy Kelleher asked the Minister for Health the progress on recruitment for early supported discharge staff in line with increasing capacity in the three operational locations; the further progression on the establishment of two further teams in University Hospital Limerick and Cork University Hospital; and if he will make a statement on the matter. [51271/17]
Amharc ar fhreagraAs this is a service matter, I have asked the HSE to respond to you directly.
152. Deputy Billy Kelleher asked the Minister for Health the consideration being given to the expansion of thrombectomy in the national service plan; the actions being taken to advance the recommendations of the HIQA health technology assessment of mechanical thrombectomy; and if he will make a statement on the matter. [51273/17]
Amharc ar fhreagra154. Deputy Billy Kelleher asked the Minister for Health the level of additional clinical staffing that is required to sustain the increasing level of service provided by the thrombectomy service annually; if this is being provided for in the HSE national services plan; and if he will make a statement on the matter. [51275/17]
Amharc ar fhreagraI propose to take Questions Nos. 152 and 154 together.
The majority of strokes are caused when blood clots travel to a blood vessel in the brain and block the flow of blood to that area. Clot-dissolving treatment (thrombolysis) can contribute to improved outcomes for treated patients, with one-third experiencing important improvements in their ability to walk or self-care and other possible disabling conditions caused by the stroke with sometimes complete reversal of the effects of the stroke. More recently a new therapy, Thrombectomy, has been developed where people with the most severe strokes can have their strokes treated by skilled interventional neuroradiologists who remove the obstructing clots via their blood vessels. This has been shown to halve the mortality and disability from such strokes in some patients.
HIQA who completed a Health Technology Assessment (HTA) found that this intervention is value for money. Full report of the HIQA HTA can be found at: https://www.hiqa.ie/sites/default/files/2017-02/Mechanical-Thrombectomy-technical-report.pdf .
Provision of emergency endovascular thrombectomy remains highly specialised in Beaumont Hospital and Cork University Hospital and this model has been endorsed by the HSE, Acute Hospital Division with a view to a third centre when numbers increase as expected.
To date, the number of patients undergoing this procedure has risen annually, on average almost 50% increase each year: 2015 - 122 cases; 2016 -172 cases; 2017 (end of August) 154 cases. These patients have been referred from 20 different hospitals around the country.
Emergency thrombolysis is provided to patients in all parts of the country, via improved hospital and ambulance protocols, health professional training and the appointment of new stroke physicians. The national stroke thrombolysis rate has increased from 1% in 2006 to 12% in 2016.
The National Clinical Programme for Stroke (NCPS) has developed a number of initiatives including a telemedicine programme to allow delivery of expert thrombolysis therapy in smaller level three hospitals. It has been involved in the training of over 250 doctors nationally to deliver thrombolysis therapy and has participated in a training programme for Stroke in the Royal College of Physicians of Ireland.
The HSE is currently in the process of preparing its 2018 National Service Plan and discussions are continuing with my Department. The timeframes for submission of the HSE Service Plan for approval are set down in legislation and on receipt of the letter of determination, the HSE has 21 days to prepare and submit its Service Plan for 2018 for my approval. Following this, the National Service Plan will be laid before the Houses of the Oireachtas and then published at the earliest possible time.
153. Deputy Billy Kelleher asked the Minister for Health his plans to address infrastructural and equipment issues in relation to the provision of thrombectomy services in Beaumont Hospital; the level of capital expenditure required to replace the existing angiography suite and to open a second angiography suite; if this is being provided for in the HSE national services plan; and if he will make a statement on the matter. [51274/17]
Amharc ar fhreagraProvision of emergency endovascular thrombectomy is highly specialised and the current and agreed clinical strategy of the national stroke programme is to fully commission the two existing services in Beaumont Hospital and Cork University Hospital on a sustainable 24/7 level of service provision. The HSE have advised that the number of patients undergoing this procedure has risen, on average, 50% each year.
The HSE advise that capital expenditure will be required to replace the existing angiography suite and to open a second angiography suite. Future investment in these services will be considered within the overall acute hospital infrastructure programme, the prioritised needs of the hospital groups and in the most cost effective way possible to meet current and future needs of the health service.
155. Deputy Billy Kelleher asked the Minister for Health his plans to address the geographical gap in heart failure services in the south southwest hospital group area; if a business case has been made for the €750,000 investment that is needed to establish heart failure services in Cork University Hospital and Kerry General Hospital; if this will be provided for as a priority in the HSE service plan; and if he will make a statement on the matter. [51276/17]
Amharc ar fhreagraAs the Deputy's 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.
156. Deputy Billy Kelleher asked the Minister for Health the status of the health service capacity review; the timeframe for publication of the review and its findings; and if he will make a statement on the matter. [51277/17]
Amharc ar fhreagraWork on the Health Service Capacity Review is at an advanced stage. As previously indicated, the review has a wider scope than previous exercises in that it is examining key elements of primary and community care capacity in addition to acute hospital capacity.
Independent external technical, analytical and engagement expertise (PA Consulting Services Ltd.) was commissioned by my Department to assist with the health service capacity review process. The work undertaken has involved a detailed, complex and multi-layered exercise, comprising data gathering, analysis of that data, baseline forecasting of both demand and associated capacity requirements for each area and consideration and modelling of the potential impacts of policy change and productivity improvements.
In addition, the company has consulted widely with stakeholders with a focus on data and modelling validation together with identification, verification and consideration of key policies and initiatives that are likely to have an impact on capacity requirements. Separately, my Department also undertook a public consultation process to facilitate input by members of the public and interested groups into the process.
A steering group comprising senior officials from my Department and the Department of the Taoiseach, the HSE and experts with a clinical and academic background is providing guidance and oversight of the review process. In addition, an international peer review group comprising three international health experts is in place to review and validate the methodology and findings.
The Review will provide a basis for determining both the extent of capacity requirements over the next 15 years and the type of capacity needed. The findings will also inform the development of a new 10 year national capital plan.
I expect to receive the final report by the end of the year and I would hope to be in a position to have the report published as soon as possible thereafter.
