Written Answers Nos. 87-107
87. Deputy John McGuinness asked the Minister for Health the reason for the substantial increase in overcrowding in the emergency department in St. Luke's Hospital, Kilkenny over the first four months of 2018 relative to the same period in 2017. [23539/18]
Amharc ar fhreagraUnder the Winter Initiative, over 200 additional beds opened this winter across a range of sites, including 14 additional beds in St. Luke's General Hospital Kilkenny. In addition, St. Luke's General Hospital Kilkenny was supported over the recent winter months with additional home support packages and transitional care beds in order to reduce delayed discharges, which can impact on patient flow and contribute to Emergency Department (ED) congestion.
In the context of a difficult winter for our health services, further compounded by Storm Emma, the first 4 months of the year saw a rise of 13.9% of patients on trolleys nationally, as compared to the same period in 2017. This increase reflects a rise in demand for unscheduled care across the hospital system, characterised by increased attendances and admissions, in particular, of those in the over 75 age group.
In relation St Luke’s Hospital Kilkenny, the first 4 months of the year saw a decrease in trolley number of 16.9%, 301 less trolleys, than the same period last year. This was against a background of:-
- a 2.1% increase in overall ED attendances;
- a 2.7% increase in ED attendances of people over 75 years of age;
- an increase of 11.8% in ED admissions; and
- an increase of 12.2% in ED admissions of those over 75.
Within an overall situation that remains very challenging, I welcome the reduction in trolley numbers achieved by St Luke's General Hospital Kilkenny and that we are beginning to see the impact of winter initiatives to relieve ED congestion.
As Minister for Health, I am committed to continuing the effort to address overcrowding in our Emergency Departments and, in particular, the capacity of the system to respond during periods of peak demand. In this context, I have asked my Department to work with the HSE to identify the location and mix of beds across the hospital system which can be opened and staffed this year and into 2019 in order to improve preparedness for Winter 2018/2019. Proposals received from the HSE in this regard are currently under consideration by my Department.
88. Deputy Catherine Connolly asked the Minister for Health the status of the two orthopaedic theatres which closed in Merlin Park University Hospital, Galway in September 2017; if the theatres have been reopened; if so, the date on which they opened; if not, the date scheduled for their opening; and if he will make a statement on the matter. [23456/18]
Amharc ar fhreagraAs this is a service issue, I have asked the HSE to reply to you directly.
89. Deputy Mick Wallace asked the Minister for Health the actions he plans to take in response to the increase in suicide rates in 2017 among young mothers in Ballyfermot, Clondalkin and Tallaght, which for the first time equalled the rates of suicide among men; the engagement he has had on the issue with his counterparts working in the areas of social protection, mental health and education in order to find practical solutions; and if he will make a statement on the matter. [23491/18]
Amharc ar fhreagraSuicide is a tragedy which has devastating effects for individuals, families and wider society. Addressing suicide and its causes is a priority for myself and for the Government.
The HSE has advised me that the 3-year moving average rate of suicide in South Dublin is recorded as 6.8 per 100,000 population for the period 2013-2015 and 5.0 per 100,000 for the period 2014-2016. The Deputy will be aware that final figures 2017 are not yet available however, recent reports indicate a possible increase in the number of suicides in Dublin South-Central in 2017. Further indications are that women may account for up to 50% of such suicides.
A number of responses have been developed and implemented in relation to individual suicides in terms of supports to families in the aftermath of suicide and also at community level. These responses include:
- Individual support through the Primary Care Psychology service to children bereaved by suicide;
- Support to community members given by Primary Care Psychology services;
- Linking in appropriate services to support individual families and the community in the aftermath of suicide;
- Working with agencies who have contacted the HSE with concerns around family members bereaved by suicide and ensuring a timely access into appropriate services including Mental Health Services;
- Working with agencies concerned with substance misuse to identify trends in relation to poly-drug use and suicide; and
- Supporting local community initiatives to respond to suicide at a local level through training and developing a local resource for residents in relation to agencies available to support them around the issue of suicide.
Our response involves suicide prevention and the building of resilience for individuals and communities. Significant engagement has taken place with stakeholders across a variety of areas to ensure that this issue is being addressed in the most appropriate manner. One example of our engagement can be seen in the February 2018 launch of ‘Connecting for Life Dublin South; Suicide Prevention Action Plan 2018-2020’.
In 2017 an extensive consultation took place to develop this plan. This consultation process helped to identify key risks in relation to suicide in the Dublin South area and associated service challenges. In response to these identified risks and in line with the national Connecting for Life framework, the action plan was developed.
Implementation of the plan is being driven by one of three Resource Officers for Suicide Prevention across Dublin South, Kildare and West Wicklow. ‘Connecting for Life Dublin South’ details 64 actions that are currently being implemented in the area with the aim of reducing the rate of suicide in South Dublin in line with national targets.
Throughout Dublin South there are a number of services targeted at the promotion of positive mental health and at addressing the needs of those experiencing mental health difficulties. These services include adult, adolescent and child specialist mental health services, suicide prevention supports and services and primary care and network services including counselling in Primary Care.
In addition, the HSE funds a number of Dublin South partner agencies with the aim of providing support and building resilience. These include Candle Community Trust; AWARE; Belong To; Mental Health Ireland; Pieta House; Samaritans Ireland; and Suicide or Survive Ltd amongst others.
The Resource Officer for Suicide Prevention in the area is also involved with mental health promotion and training at local level. In 2017, over 1,000 individuals, working or living in the Dublin South area, were trained through programmes to enhance the community’s capacity to respond to suicide and self-harm.
90. Deputy Stephen S. Donnelly asked the Minister for Health if he will be reviewing governance structures in public hospitals; and if he will make a statement on the matter. [23502/18]
Amharc ar fhreagraCurrently, there are seven hospital groups which have responsibility for planning and managing acute hospital services within a specified area. The Groups are presently established on a non-statutory administrative basis. Each Group has an Administrative Board that has a mandate to assist and advise in respect of acute hospital services in the Hospital Group. Management teams are in place for all Hospital Groups. The sole line of executive accountability for the Group CEO is to the National Director for Acute Hospital Services, and they are accountable for their Hospital Groups’ planning and performance under the HSE Accountability Framework. It is also important to note that the majority of Hospital Groups contain a number of voluntary hospitals, which have their origins in varying forms of legal establishment with differing legal corporate governance structures. The relationship between the Group CEO and the voluntary hospitals under their remit is governed exclusively through the Service Level Arrangement entered into between the HSE and each voluntary hospital.
As the Deputy will be aware, the Sláintecare report made a series of important recommendations in relation to health service structures, governance and accountability. This includes the establishment of a governing board for the HSE, the creation of regional bodies to support the delivery of integrated care and enhanced clinical governance and patient safety and quality measures.
I have already signalled my support for the Committee's recommendations in this area and work is already underway that will bring improvements in governance and accountability. Legislation is being drafted to establish a board for the HSE and I hope that this will be enacted this year. An extensive programme of work is underway to embed clinical governance and patient safety in healthcare delivery. This includes the Patient Safety Licensing Bill which is due to go to pre-legislative scrutiny shortly. A public consultation on the geographical alignment of hospital groups and community healthcare organisations has been undertaken as a first step to inform considerations in relation to future health service structures.
Ultimately, the task of identifying the optimal set of health structures and the most appropriate governance, accountability and performance framework for the future health system will be an important stream of work under the Sláintecare programme of reforms. To this end, work on a Sláintecare Implementation plan is advancing in my Department. I expect bring to these proposals to Government in the coming weeks.
91. Deputy Clare Daly asked the Minister for Health the progress of proposals to improve the legal approach to managing clinical negligence cases. [23434/18]
Amharc ar fhreagraSince the publication of the recommendations of the Working Group on Medical Negligence and Periodic Payments, which was chaired by former High Court Judge John Quirke, significant legal reforms have been introduced or are on the way in order to deal more effectively with clinical negligence claims.
These include the enacting of The Mediation Act, 2017 and The Civil Liability Amendment Act 2017. Work is also underway within the Department of Justice and Equality on framing regulations for Pre-Action Protocols under the Legal Services Regulation Act 2015, which are aimed at encouraging timely communications between parties and the early resolution of such actions. Other important measures include the establishment of the National Patient Safety Office in my Department and the launch of the HSE’s Incident Management Framework in January 2018.
Nevertheless, I believe we must go further in addressing the difficulties which our current system presents for those who have experienced harm. I have informed Government that, building on recent legal reforms, I will engage with Minister Flanagan on the options to further improve the legal approach to managing clinical negligence cases. For this purpose my officials met Department of Justice and Equality officials recently to examine the key issues involved and to examine all options available.
This action will be progressed in the coming weeks in order to bring further proposals to Government. I expect that all potential options to improve the current system will be considered in the process.
92. Deputy Stephen S. Donnelly asked the Minister for Health if he will report on the HSE’s budget; if spending is within profile; if hospitals are in budget; and if he will make a statement on the matter. [23500/18]
Amharc ar fhreagraAt the end of March, the HSE is €116m over profile. While made up of offsetting surpluses and deficits, the main drivers of the overall deficit are Acute Hospitals, Disabilities, Support Services, State Claims Agency, and underachievement on the Value Improvement Programme.
Expenditure in the Acute Hospitals Division is approximately €63m over budget at the end of the first quarter. Two thirds of the variance is a result of expenditure over budget, with one third associated with shortfalls in income. The HSE estimates that approximately a quarter of the variance at the end of the first quarter relates to the influenza surge and the impact of Storm Emma.
In addition to the challenges set out in the National Service Plan, pressures around pay rates, hospital income and regulatory compliance continue to be experienced during 2018. Performance engagement with the Health Service Executive management team has emphasised the importance of financial management and delivery of the National Service Plan savings. Specific emphasis has been placed on acute hospitals performance and pay management with dedicated meetings between the Department and the Health Service Executive to focus on these areas.
The Department and the HSE will, under the general umbrella of the Performance and Accountability Framework continue to seek to mitigate challenges as they arise.
93. Deputy Bernard J. Durkan asked the Minister for Health if, in the context of reorganisation of the health services, consideration will be given to the establishment of regional bodies consisting of public representatives, the professional stakeholders and patient representatives with a view to restoring a demographic structure throughout the country at which the specific issues relative to these particular regions can be discussed in detail, senior representatives of which might then be considered for a national body accountable to him; and if he will make a statement on the matter. [23465/18]
Amharc ar fhreagraThe Sláintecare report makes a number of recommendations in relation to improving health service structures, governance and accountability, including the establishment of a governing board for the HSE and the establishment of regional bodies to support the delivery of integrated care.
A range of actions are already underway in response to the Sláintecare report. Work is at an advanced stage in my Department in developing a Sláintecare Implementation Plan. The plan will translate the Sláintecare Report into a detailed programme of reform over the next 10 years, with a focus on the immediate years ahead. I have already signalled my support for the Committee's recommendations in relation to structures, governance and accountability and these will form an integral component of the Implementation Plan. I expect to bring this Plan to Government shortly.
As part of delivering early on this element of the reform programme, the Government has agreed to the establishment of an independent board for the HSE. The required legislation is being drafted and it is hoped that it can pass through the Houses of the Oireachtas and be enacted quickly.
The task of identifying the optimal set of health structures and the most appropriate governance, accountability and performance framework for the future health system will also be an important stream of work under the Sláintecare programme of reforms. As an initial first step, my Department has undertaken a public consultation regarding the geographical alignment of Hospital Groups and Community Healthcare Organisations. The outputs from this consultation process will inform the development of detailed proposals in this area, including the role and function of regional bodies.
94. Deputy Clare Daly asked the Minister for Health if the HSE is now operating assessment of needs for children with disabilities on a new standard operating procedure; and the organisations which were consulted regarding the new procedures. [23435/18]
Amharc ar fhreagraThe 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 service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
95. Deputy Seán Haughey asked the Minister for Health the action which will be taken to expedite outpatient appointments for the 3,944 children who have been waiting for a consultation in Temple Street Hospital for more than 18 months. [23572/18]
Amharc ar fhreagraImproving waiting times for hospital procedures and outpatient appointments is a key commitment in the programme for Government. It is acknowledged that outpatient waiting lists are a challenge which need to be addressed.
The development of a sustainable and safe paediatric orthopaedic service, including scoliosis services for children and young people has been prioritised in the 2018. An additional €9 million has been provided to the HSE in 2018 specifically to develop paediatric orthopaedic services, including further increasing access to scoliosis services.
The HSE and Children’s Hospital Group developed a Paediatric Scoliosis Waiting List Action Plan for 2018 and this includes actions to address the longest outpatient waiters.
The HSE National Service Plan 2018 sets out a target that 80% of patients waiting for a first outpatient appointment will be seen within a 52 week wait timeframe. HSE figures for March 2018 show that Children's University Hospital, Temple Street are seeing 61-63% outpatients within 52 weeks.
The HSE advise that in 2017, Children's University Hospital, Temple Street, had 60,534 outpatient attendances. It is worth noting that in the same year, 8,678 (14%) of patients did not attend their hospital appointment.
The most recent NTPF figures for April 2018 show that there was a total of 17,030 patients on the outpatient waiting list for Children's University Hospital, Temple Street. 77% of these patients are waiting 18 months or less.
A key component of the management of waiting lists by hospitals is the categorisation of patients by clinical priority to ensure that all patients receive care in timely and clinically appropriate matter.
The HSE is working with the NTPF and my Department to finalise a joint plan focused on improving overall use of resources to tackle long patient waiting times and ensuring timely access to treatment and care for our patients. I hope to publish this Plan shortly. As part of this process, the NTPF and the HSE are currently reviewing proposals from hospitals for outpatient initiatives.
96. Deputy Fiona O'Loughlin asked the Minister for Health the timeframe for bringing the child and adolescent mental health services in CHO7 to the level envisaged in A Vision for Change. [23558/18]
Amharc ar fhreagraAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
97. Deputy Thomas Pringle asked the Minister for Health the reason there has been little progress to date on the appointment of consultants to Letterkenny University Hospital, including a consultant paediatric post vacated in County Sligo over a year ago still not approved by CAC with the incorrect calibre level of consultant being advertised; if the crisis in diabetes care in County Donegal will be addressed; and if he will make a statement on the matter. [23488/18]
Amharc ar fhreagraAs this is a service issue, I have asked the HSE to reply to you directly.
98. Deputy Shane Cassells asked the Minister for Health the reason for the four-fold increase since April 2016 in the number of outpatients waiting more than a year for a consultation in Our Lady’s Hospital, Navan. [23564/18]
Amharc ar fhreagraI acknowledge that Outpatient waiting times are often unacceptably long and I am conscious of the burden that this places on patients and their families.
The HSE service plan 2018 sets out a target that 80% of patients waiting for a first outpatient appointment will be seen within a 52 week wait timeframe. HSE figures for March 2018 show that Our Lady's Hospital, Navan is seeing over between 79-83% of outpatients within 52 weeks.
Each year 3.3 million patients attend Hospital Outpatient clinics for appointments, with demand for services growing year-on-year. A key component of the management of waiting lists by hospitals is the categorisation of patients by clinical priority to ensure that all patients receive care in timely and clinically appropriate matter.
In 2017, Our Lady’s Hospital, Navan had over 29,000 (29,836) Outpatient Department attendances.
Our Lady's Hospital Navan has advised that a number of steps are underway to reduce current OPD waiting lists. These include the appointment of a scheduled care lead to oversee scheduling of patients and an Out-patient Manager who will support validation of OPD lists and other measures to improve OPD waiting times. In addition, Our Lady's Hospital is seeking to fill a number of vacant posts, including positions in orthopaedics, rheumatology and gynaecology.
The HSE is working with the NTPF and my Department to finalise a joint plan focused on improving overall use of resources to tackle long patient waiting times and ensure timely access to treatment and care for our patients. I hope to publish this Plan shortly. As part of this process the NTPF and the HSE are currently reviewing proposals from hospitals for outpatient initiatives.
99. Deputy Louise O'Reilly asked the Minister for Health his plans to update the living kidney donor reimbursement scheme to provide for the reimbursement of stay-at-home parents who donate a kidney; and if he will make a statement on the matter. [23452/18]
Amharc ar fhreagraThe Minister of Health approved a policy for the reimbursement of the expenses of living donors in November 2014. The scheme provides for the reimbursement of accommodation and travel expenses incurred by living kidney donors up to a maximum of €6,000. In addition, the scheme reimburses loss of earnings incurred by salaried/waged donors and self-employed donors for up to 12 weeks after the donation, up to a maximum of €10,000. This maximum figure for loss of earnings was increased from €6,000 in 2016.
A review of the policy is being initiated in my Department and it is hoped that this will be completed around the end of June. Some reimbursement of the child care expenses incurred by stay at home parents will be considered as part of the review.
100. Deputy Stephen S. Donnelly asked the Minister for Health when a plan to tackle outpatient waiting lists will be published; and if he will make a statement on the matter. [23503/18]
Amharc ar fhreagraImproving waiting times for hospital procedures and outpatient appointments is a key commitment in the Programme for Government. The Outpatient waiting list remains a significant challenge to be addressed in 2018.
The HSE service plan 2018 sets out a target that 80% of patients waiting for a first outpatient appointment will be seen within a 52 week wait timeframe. HSE figures for March 2018 show that nationally hospitals are seeing over 71% of outpatients within 52 weeks, with 19 of the 45 hospitals reaching the target of 80%.
Each year, 3.3 million patients attend Hospital Outpatient clinics for appointments. A number of steps, including a national waiting list validation project by the HSE, are being taken to ensure the lists are accurate and these efforts will intensify in the coming months.
The HSE is working with the NTPF and my Department to finalise a joint plan focused on improving overall use of resources to tackle long patient waiting times and ensuring timely access to treatment and care for our patients. I hope to publish this Plan shortly. As part of this process the NTPF and the HSE are currently reviewing proposals from hospitals for outpatient initiatives.
101. Deputy Maureen O'Sullivan asked the Minister for Health if services provided by a service (details supplied) will be guaranteed to have a location in Dublin 1. [18609/18]
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.
102. Deputy Eamon Scanlon asked the Minister for Health when there will be a permanent cath lab at Sligo University Hospital. [23516/18]
Amharc ar fhreagraSpecialist cardiac catheterisation lab services are provided in a small number of hospitals in order to ensure that the services provided achieve the required standards of safety, quality and sustainability in the interests of patients.
The Deputy may wish to note that I have established a Steering Group, chaired by Professor Philip Nolan, President of Maynooth University to undertake a National Review of Specialist Cardiac Services. The National Review aims to achieve optimal patient outcomes at population level with particular emphasis on the safety, quality and sustainability of the service. In that regard, consideration will be given to the optimal configuration of a national adult cardiac service. In terms of scope, the National Review will cover scheduled and unscheduled hospital-based services for the diagnosis and treatment of cardiac disease in adults. The question of the provision of a permanent cath lab at Sligo University Hospital will be informed by the National Review.
The Steering Group began its work on 31st January 2018 and the Chair anticipates that it will take approximately 18 months to produce a comprehensive and robust final report. However, the Deputy can be assured that all efforts will be made to conclude the Review at an earlier date, if feasible.
103. Deputy Thomas Pringle asked the Minister for Health further to Parliamentary Question No. 156 of 28 February 2018, the reason the HSE has not issued a reply to date; when the renal dialysis unit will open in Letterkenny University Hospital; the reason for the delays to date; and if he will make a statement on the matter. [23489/18]
Amharc ar fhreagraAs this is a service issue, I have asked the HSE to reply to you directly.
104. Deputy John Curran asked the Minister for Health his plans for drug task forces to provide community responses to problem alcohol consumption and promote community awareness of alcohol-related harm; and if he will make a statement on the matter. [23460/18]
Amharc ar fhreagra109. Deputy John Curran asked the Minister for Health his plans to increase the funding to local and regional drug task forces in view of the extreme difficulties they are experiencing in maintaining programmes and projects with funding allocations remaining at 2014 levels; and if he will make a statement on the matter. [23461/18]
Amharc ar fhreagraI propose to take Questions Nos. 104 and 109 together.
Drug and Alcohol Task Forces play a key role in assessing the extent and nature of the drug problem and in initiating appropriate responses, so that there is a coordinated approach involving all sectors to the problem of substance misuse in local communities.
I secured additional funding of €250,000 in Budget 2018 to improve the organisational effectiveness of the task forces in implementing the national drugs strategy, Reducing Harm, Supporting Recovery. It is intended that task forces can apply for up to €10,000 in additional funding, on a once-off basis, in 2018 under this scheme. Task forces must submit applications for this additional funding by 11 June 2018.
The Department is developing a new programme to promote community awareness of alcohol-related harm. An additional €0.25m is available in Budget 2018 to fund phase 1 of the scheme, with the expectation that this will increase to €1m in 2019. It is anticipated that the scheme will commence in the last quarter of 2018.
I strongly believe that resources should be directed towards interventions that are most effective in reducing problem substance use. Measuring the effectiveness of responses to the drug problem is therefore an important objective of public policy. Towards this end, my Department will develop a performance measurement system by 2020 which will improve accountability across all sectors, including the task forces.
105. Deputy Jackie Cahill asked the Minister for Health when he will bring forward proposals to reform the nursing home support scheme in relation to farming families. [23554/18]
Amharc ar fhreagraThe Department of Health has been examining the potential for changes to the treatment of business and farm assets under the Nursing Homes Support Scheme. Any changes to the scheme, if approved by Government, will require amendment of the Nursing Homes Support Scheme Act 2009.
A Memorandum for Government setting out the details of the proposed policy change and seeking Government approval to draft the General Scheme of a bill to amend the Nursing Homes Support Scheme Act 2009 has been prepared and will shortly be circulated to other Government Departments for observations.
106. Deputy John Brady asked the Minister for Health the status of plans to deliver a general practitioner out of hours service for north County Wicklow; and if he will make a statement on the matter. [23493/18]
Amharc ar fhreagraI am committed to the development of an improved GP out of hours service for North Wicklow which can provide the appropriate level of cover for the population of the area. The development of such a service will allow GPs to participate fully in the provision of an integrated healthcare system providing medical services that are appropriate, timely and effective, easily accessible and responsive to the needs of patients. There is funding provision for the introduction of a structured GP out of hours service for the South Dublin / North Wicklow areas in the HSE 2018 National Service Plan. This service is intended to cover the night time hours from Monday to Friday and 24 hour cover at weekends and public holidays, providing urgent general practitioner services to patients outside of normal surgery hours. The service will include initial triage and GP consultation at treatment centres or home visits as appropriate, in accordance with HIQA standards for Safer Better Healthcare. The procurement process to identify a service provider has commenced and the tender was published on the eTenders website earlier this month. Subject to successful selection of a suitable service provider, the service is scheduled to be operational later this year.
107. Deputy Maureen O'Sullivan asked the Minister for Health the way in which he is addressing the lengthy waiting time for student appointments with CAMHS; and his role in ensuring children have prompt access to services. [22383/18]
Amharc ar fhreagraAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
