Martin Heydon
Ceist:426. Deputy Martin Heydon asked the Minister for Health the status of the recruitment of a sarcoma specialist for a hospital (details supplied); and if he will make a statement on the matter. [49289/18]
Amharc ar fhreagraHospital Staff Recruitment
Ceisteanna (426)
Freagraí scríofa
Following the advertisement of a post of Consultant Oncologist with a special interest in Sarcoma, a successful candidate was identified and an offer of appointment was made. However, the hospital has been advised that the person involved is not in a position to take up the post until summer 2019.
Meanwhile, specialist care of patients with sarcoma will continue to be provided through a multi-disciplinary team approach.
Hospital Waiting Lists
Ceisteanna (427)
Robert Troy
Ceist:427. Deputy Robert Troy asked the Minister for Health when a person (details supplied) will be called for surgery in Cappagh Hospital. [49296/18]
Amharc ar fhreagraFreagraí scríofa
Under 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.
The National Waiting List Management Policy, a standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, since January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
Hospital Procedures
Ceisteanna (428)
John Brassil
Ceist:428. Deputy John Brassil asked the Minister for Health if he is satisfied the necessary provisions are available here, including doctors who have undergone specialist training, to allow full removal for all women affected by transvaginal mesh complications within a reasonable timeframe; when the chief medical officer's report will be available; if he will consider making the treatment abroad scheme available for this treatment; and if he will make a statement on the matter. [49300/18]
Amharc ar fhreagraFreagraí scríofa
In late 2017, concerns were brought to my attention about the frequency and severity of complications associated with the use of mesh devices in the surgical treatment of Stress Urinary Incontinence (SUI) and Pelvic Organ Prolapse (POP) in women in Ireland; the regulation and audit of their use; the extent of use of these devices in Ireland and the availability of services for women affected by mesh-associated complications, including through the tabling of several Parliamentary Questions.
In responding to these questions and in recognition of the complexity of the matters arising, I requested the Chief Medical Officer (CMO) to prepare a report for me on the clinical and technical issues involved in ensuring both:
a) the safe and effective provision of mesh procedures in urogynaecology and
b) an appropriate response to women who suffer complications as a result of undergoing such procedures.
The Report, entitled The Use of Uro-gynaecological Mesh in Surgical Procedures, has now been presented to me and was published on the 21 November 2018 on the Department of Health website.
The report provides a brief background description of mesh implant devices, including the complications associated with their use; and summarises international best practice in the use of mesh procedures in the clinical management of SUI and POP. A range of recommendations for action by the HSE in collaboration with other stakeholders is identified, to provide assurance that the use of mesh implants and the care of women requiring aftercare in Irish hospitals is in line with emerging evidence and best practice internationally, based on expert advice received and review of international experience.
Methodology
Preparation of the report has involved consultation and engagement with national and international bodies, including the Health Products Regulatory Agency (HPRA); the relevant professional training bodies, the Institute of Obstetricians and Gynaecology (IOG) and the Royal College of Surgeons in Ireland (RCSI); the Continence Foundation of Ireland (CFI) and the Health Service Executive (HSE), as well as colleagues in other jurisdictions. The report has been informed by review of international reports and safety reviews of mesh surgery which have been published in recent years. The report has also been informed by the personal experiences of women who have suffered complications following mesh surgery.
I wish to acknowledge the bravery, commitment and dignity shown, by the women that met with me and by those women who have written to me concerning this issue, in sharing what were harrowing, deeply personal experiences.
It is important to note that the views of the many women who have undergone mesh procedures and have had satisfactory outcomes, with minor or no complications, have not been formally sought and so are not reflected in this report. Also, following the implementation of a pause in mesh procedures by the HSE in July 2018, as described in Section 2, a number of women whose procedures were postponed made representations to the Department expressing concern at the impact that this has on them personally as they await treatment for the distressing symptoms of SUI, reflecting another important group of women affected directly by this issue.
Report Findings
The report makes a number of overall findings, in addition findings are presented which relate to informed consent, aftercare of women with complications, clinical and professional issues and information issues. The findings are:
Overall Findings
- Mesh implant devices are certified as compliant with relevant European Union (EU) legislation and no market action against mesh devices for the treatment of SUI or POP has been taken by any of the European device regulatory competent authorities.
- There is an extensive evidence base supporting (i) the use of the mid-urethral sling (MUS) devices in the treatment of SUI and (ii) the use of abdominally placed mesh in the management of POP. A significant majority of patients benefit greatly from these procedures, with reduced long-term complications and improved functional outcomes compared to non-mesh procedures.
- Mesh procedures should be performed by trained personnel, in patients who are appropriately selected and counselled and when appropriate multidisciplinary expertise and clinical governance mechanisms are in place.
- Transvaginal placement of mesh for the treatment of POP is no longer regarded as appropriate first line treatment. Its use is restricted by clinical guidance in some jurisdictions. Regulatory restrictions on its use are in place in Australia and New Zealand.
- Mesh devices are associated with significant and severe complications in a minority of women, which are of concern given the difficulties of mesh implant removal.
- Many other health systems, including the United Kingdom (UK), Australia and the Netherlands have implemented specific measures in recent years to ensure appropriate use of mesh procedures in the treatment of SUI and POP and to ensure appropriate aftercare for women suffering mesh complications.
Informed Consent
- As would be usual with many surgical conditions, standardised information resources were not available at national level to ensure that all patients receive consistent information about the benefits and risks of mesh devices, to advise of other treatment options and to support informed consent processes.
- Many women reported that they were not informed of other treatment options; they had not been informed that their surgeries involved the use of mesh; they were not informed of mesh complications; and they were not made aware of the difficulties associated with mesh removal or with the treatment of long-term mesh complications.
Aftercare of Women with Complications
- Structured treatment or referral pathways were not evidently in place for the minority of women requiring specialist, multidisciplinary care for serious complications following mesh surgery.
- Some women reported considerable difficulty in accessing timely, compassionate and appropriate specialist aftercare for complications.
- Some women reported that individual clinicians responded to their personal concerns in an inappropriate manner which greatly added to their distress. Women also reported feeling that they were not believed, or that their clinicians minimised or did not understand the severity of their complications.
Clinical and Professional Issues
- Governance mechanisms are not in place at national level to provide assurance that mesh surgeries are carried out in accordance with agreed international best practice and clinical guidance.
- There is no mandated professional clinical guidance at national level to guide the use of mesh implants in the management of SUI or POP or to guide the management of women with complications.
- Communication mechanisms currently in place at national level between the HPRA, healthcare providers and professional bodies do not provide assurance that the findings and recommendations of safety reviews such as those circulated by the HPRA in recent years regarding mesh implants are systematically analysed and acted upon where appropriate.
Information
- There are significant gaps in knowledge about current practice in Ireland regarding the use of urogynaecological mesh implants.
- Routinely collected clinical information at national level does not provide the capacity for monitoring or audit of mesh surgeries for the treatment of SUI and POP.
- Based on international experience, there is under-reporting of adverse events relating to mesh surgeries by clinicians to both the HPRA and to the National Incident Management System (NIMS) operated by the State Claims Agency (SCA).
Recommendations
Nineteen recommendations in total are identified throughout the report in response to the findings above:
- Patient Information and Consent - 2 recommendations;
- Aftercare for Women Suffering Complications - 5 recommendations;
- Clinical and Professional Recommendations - 8 recommendations;
- Information Recommendations - 5 recommendations.
These include recommendations about the development of patient information and informed consent materials to ensure appropriate patient selection and counselling, ensuring clinical and professional standards of practice are met by ensuring that all surgeons have undergone appropriate surgical professional training and ensuring that appropriate multidisciplinary expertise is available in units carrying out mesh procedures, the development of clinical guidance for the management of SUI and POP, the development of information resources to monitor the ongoing use of mesh devices and to permit long-term research and audit of practice, ensuring the reporting of mesh related complications, and ensuring timely, appropriate and accessible care pathways for the management of women with complications.
Full implementation of the report’s recommendations will provide significant assurance that all patients presenting for treatment for SUI and POP and all women who develop mesh-related complications receive high quality, patient centred care in accordance with accepted evidence and supported by robust clinical governance mechanisms.
Actions to date
A number of important interim system actions to address the safety and effectiveness of mesh implant use have been progressed in advance of completion of the report.
1. Pause on all uro-gynaecological mesh procedures
On 24 July 2018, the HSE was requested by the CMO to pause all uro-gynaecological mesh procedures, in cases where it is clinically appropriate and safe to do so, pending confirmation by the HSE of the implementation of recommendations relating to (i) professional training requirements, (ii) patient information and consent and (iii) the development and maintenance of a national data set for all mesh procedures carried out in HSE funded hospitals. The request to institute a pause in vaginal mesh procedures was considered proportionate and necessary to address public and patient concern about the ongoing safety of mesh devices as comprehensively as possible.
2. Development of patient information and consent materials
Prior to this request, in May 2018, the HSE had been requested to begin work immediately on the development of national standardised patient information and informed consent materials and the clarification and development of treatment pathways and appropriate referral services for women suffering serious complications.
3. Learning Notice on mesh devices
A Learning Notice concerning mesh devices in uro-gynaecological procedures was circulated by the National Women and Infants’ Health Programme (NWIHP) on 26 June 2018 to all maternity hospitals and acute hospitals with gynaecological services to highlight the importance of appropriate patient selection, adequate information and consent and also to inform the service providers that a Response Group has been convened to propose remedies for and address the provision of aftercare for complications. This learning notice has been posted on the NWIHP website. https://www.hse.ie/eng/about/who/acute-hospitals-division/woman-infants/quality-and-safety/learning-notice-0518-transvaginal-mesh.pdf
3. Synthetic Mesh Devices Group
A Synthetic Mesh Devices Advisory Group has been convened by the NWIHP which includes three patient representatives, as well as representatives of the HPRA, the IOG, the RCSI, the CFI and all Hospital Groups, to advise on and progress all the interim recommendations as advised to the HSE in May 2018 and in July 2018. To ensure that the spectrum of views of women affected by mesh safety concerns is represented, the three patient representatives include Ms Melanie Power, representative of Mesh Survivors Ireland; as well as a woman who has had a successful outcome of mesh surgery for the treatment of SUI and a woman who is on the waiting list for surgery (currently paused).
I am informed that a work programme for the development of appropriate patient information resources and consent materials, the clarification and development of treatment pathways and appropriate referral services for women suffering from mesh-related complications including access to specialist diagnostic facilities such as translabial scanning is being progressed through this Group. The work being progressed by the HSE will include identifying the appropriate specialist clinical expertise and facilities required at hospital group level and nationally to provide comprehensive aftercare services. Pending the completion of this, the HSE will also examine the need to look at sourcing services from abroad to address any immediate shortfalls identified, either through utilisation of the treatment abroad scheme or by commissioning services from abroad.
Next Steps
As requested by the CMO in July 2018, the pause in the use of mesh procedures for the management of SUI and POP in HSE-funded hospitals is ongoing, in cases where it is clinically appropriate and safe to do so, pending confirmation by the HSE of the implementation of recommendations.
The Department will be writing to the HSE to request that it prepare a detailed Implementation Plan for the complete set of recommendations set out in the CMO’s Report, working in conjunction with other stakeholders.
As promised at my meeting with Mesh Survivors Ireland on 14 June 2018, I provided the group with a copy of the CMO’s Report on the date of publication and a date has been arranged for a further meeting with the group in coming weeks.
Hospital Appointments Status
Ceisteanna (429)
Barry Cowen
Ceist:429. Deputy Barry Cowen asked the Minister for Health when a person (details supplied) will receive a hospital appointment. [49302/18]
Amharc ar fhreagraFreagraí scríofa
Under 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.
The National Waiting List Management Policy, a standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, since January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
Cross-Border Health Services Provision
Ceisteanna (430)
Thomas Byrne
Ceist:430. Deputy Thomas Byrne asked the Minister for Health when a payment under the cross-border health care directive will issue to a person (details supplied). [49308/18]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter, it has been referred to the Health Service Executive for attention and direct reply to the Deputy.
Hospitals Building Programme
Ceisteanna (431, 432)
Maurice Quinlivan
Ceist:431. Deputy Maurice Quinlivan asked the Minister for Health the commencement date for the construction of the 60 bed block at University Hospital Limerick; and if he will make a statement on the matter. [49312/18]
Amharc ar fhreagraMaurice Quinlivan
Ceist:432. Deputy Maurice Quinlivan asked the Minister for Health when the funding for the construction of the 60 bed block in University Hospital Limerick will be allocated; and if he will make a statement on the matter. [49313/18]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 431 and 432 together.
The Health Service Executive is currently developing its National Service Plan and Capital Plan for 2019. The HSE will consider this development in the context of planning for 2019 within available funding and the process in place for the agreement and prioritisation of projects in the Capital Plan. All projects including the new block at University Hospital Limerick must comply with national and EU spending and procurement requirements and require time to complete the various development stages, including appraisal, design, planning, tender, construction, commissioning.
As the Health Service Executive is responsible for the delivery of healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to this project.
Hospital Accommodation Provision
Ceisteanna (433)
Catherine Murphy
Ceist:433. Deputy Catherine Murphy asked the Minister for Health if there is a management plan for persons waiting on hospital trolleys at Naas General Hospital; the per day trolley numbers for Naas General Hospital from 1 October 2017 to 1 March 2018 and 1 October 2018 to 21 November 2018; and if he will make a statement on the matter. [49320/18]
Amharc ar fhreagraFreagraí scríofa
My Department is working with the HSE to ensure the most effective response to the winter challenges to unscheduled care provision. Within this context, the HSE requested singular integrated winter plans from Hospital Groups and Community Health Organisations in June 2018. Subsequently in September and October 2018, I met with Hospital Groups and Community Health Care Organisations to discuss their plans for winter preparedness.
The HSE Winter Plan 2018/19, which is currently under consideration by my Department, provides for a 4-week enhanced focus period from 17 December 2018 to 13 January 2019, targeting 9 key sites of concern. Naas General Hospital has been identified as one of these 9 sites, based on performance in previous winters.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
Nursing Homes Support Scheme
Ceisteanna (434)
Denis Naughten
Ceist:434. Deputy Denis Naughten asked the Minister for Health if the cost of a specialised item of furniture recommended to a person residing in a private nursing home under the fair deal scheme is met by the HSE or the private nursing home or must it be funded by the person; and if he will make a statement on the matter. [49329/18]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter it has been referred to the HSE for attention and direct reply to the Deputy.
Hospital Overcrowding
Ceisteanna (435)
Brendan Ryan
Ceist:435. Deputy Brendan Ryan asked the Minister for Health the actions that have been taken to relieve overcrowding pressure at Naas General Hospital over the coming months under the winter plan, with particular reference to reducing the number of persons on trolleys in the accident and emergency department; and if he will make a statement on the matter. [49335/18]
Amharc ar fhreagraFreagraí scríofa
My Department is working with the HSE to ensure the most effective response to the winter challenges to unscheduled care provision. Within this context, the HSE requested singular integrated winter plans from Hospital Groups and Community Health Organisations in June 2018. Subsequently in September and October 2018, I met with Hospital Groups and Community Health Care Organisations to discuss their plans for winter preparedness.
The HSE Winter Plan 2018/19, which is currently under consideration by my Department, provides for a 4-week enhanced focus period from 17 December 2018 to 13 January 2019, targeting 9 key sites of concern. Naas General Hospital has been identified as one of these 9 sites, based on performance in previous winters.
As part of Budget 2019, an additional €10m in funding is being provided in 2018 for social care measures to enable older people to leave hospital and return to a more appropriate care setting, including their own home, as quickly as possible with the supports they need. My Department has sanctioned the release of €5 million of this additional funding to enable the deployment of social and primary care measures to support this transition.
Increasing bed capacity is a Government priority. Over the past 12 months an additional 240 beds have been opened, including 11 additional beds in Naas General Hospital and a further 78 additional beds are due to come on stream nationally in 2019.
My Department is currently in discussion with the HSE, in the context of the National Service Plan 2019, to identify the sites for investment and the associated number of beds, as part of an agreed capacity programme for 2019.
Physiotherapy Provision
Ceisteanna (436)
Frank O'Rourke
Ceist:436. Deputy Frank O'Rourke asked the Minister for Health when a primary care physiotherapy service will be put in place for a person (details supplied); and if he will make a statement on the matter. [49339/18]
Amharc ar fhreagraFreagraí scríofa
As this question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply.
Hospital Waiting Lists
Ceisteanna (437)
Thomas Byrne
Ceist:437. Deputy Thomas Byrne asked the Minister for Health when a person (details supplied) will have surgery in Our Lady of Lourdes Hospital in Drogheda. [49342/18]
Amharc ar fhreagraFreagraí scríofa
Under 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.
The National Waiting List Management Policy, a standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, since January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
Hospital Waiting Lists
Ceisteanna (438)
Peter Burke
Ceist:438. Deputy Peter Burke asked the Minister for Health if an emergency procedure for a person (details supplied) will be expedited; and if he will make a statement on the matter. [49348/18]
Amharc ar fhreagraFreagraí scríofa
Under 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.
The National Waiting List Management Policy, a standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, since January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
Primary Care Centres Provision
Ceisteanna (439)
Fiona O'Loughlin
Ceist:439. Deputy Fiona O'Loughlin asked the Minister for Health the position regarding the provision of a facility (details supplied) in County Kildare. [49356/18]
Amharc ar fhreagraFreagraí scríofa
As the HSE has responsibility for the provision, along with the maintenance and operation of Primary Care Centres and other Primary Care facilities, the Executive has been asked to reply directly to the Deputy.
Mental Health Services Provision
Ceisteanna (440)
Fiona O'Loughlin
Ceist:440. Deputy Fiona O'Loughlin asked the Minister for Health the progress of plans for the development of a new mental health unit at Naas General Hospital included as part of the health priorities of the National Development Plan 2018-2027; and if he will make a statement on the matter. [49360/18]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
General Medical Services Scheme
Ceisteanna (441)
Brendan Griffin
Ceist:441. Deputy Brendan Griffin asked the Minister for Health if dental treatment will be covered under the general medical services scheme for a person (details supplied) in County Kerry; and if he will make a statement on the matter. [49367/18]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter it has been referred to the HSE for direct reply to the Deputy.
Hospital Appointments Status
Ceisteanna (442)
Michael Healy-Rae
Ceist:442. Deputy Michael Healy-Rae asked the Minister for Health the status of an assessment for a person (details supplied); and if he will make a statement on the matter. [49370/18]
Amharc ar fhreagraFreagraí scríofa
Under 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.
The National Waiting List Management Policy, a standardised approach to managing scheduled care treatment for in-patient, day case and planned procedures, since January 2014, has been developed to ensure that all administrative, managerial and clinical staff follow an agreed national minimum standard for the management and administration of waiting lists for scheduled care. This policy, which has been adopted by the HSE, sets out the processes that hospitals are to implement to manage waiting lists.
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
Air Ambulance Service Provision
Ceisteanna (443)
Michael Healy-Rae
Ceist:443. Deputy Michael Healy-Rae asked the Minister for Health if he will address a matter (details supplied) regarding an air ambulance; and if he will make a statement on the matter. [49372/18]
Amharc ar fhreagraFreagraí scríofa
The Deputy will be aware that the Programme for a Partnership Government commits to exploring the feasibility of the expansion of air ambulance services, including the possibility of a second base. In that context, I met with the Irish Community Rapid Response (ICRR) last year to discuss their proposal to establish a charitably funded Helicopter Emergency Medical Service in the South. At that meeting it was agreed that the ICRR would work with the National Ambulance Service (NAS) with a view to reverting to me with an agreed proposal.
I am advised that the ICRR and the NAS are currently finalising the details of a proposed service arrangement which will be submitted to me for decision. The Deputy will appreciate that I will need to be fully satisfied that the necessary clinical and corporate governance arrangements are such that the new service will be safe, robust and sustainable. I expect that the proposal will be submitted to me without undue delay.