Joe Carey
Ceist:51. Deputy Joe Carey asked the Minister for Health the status of the provision of the proposed 60-bed modular unit at University Hospital Limerick; and if he will make a statement on the matter. [50606/18]
Amharc ar fhreagraHospital Accommodation Provision
Ceisteanna (51)
Freagraí scríofa
To support demographic projections and the increase in demand for services, the Health Service Capacity Review 2018 and the Slaintecare Implementation Strategy recommends, in addition to major reform of the health system, an increase in acute hospitals beds of over 2,600 by 2031.
The National Development Plan provides capital funding to support this increase in acute hospital beds, over the next 10 years.
Accordingly, health care reform and addressing the health system's capacity challenges, including acute hospital bed capacity, will remain a priority for the Government in 2019.
The HSE is currently developing its National Service Plan and Capital Plan for 2019.
The proposed modular 60 bed ward block at University Hospital Limerick is being considered as part of this process.
Health Services Staff Data
Ceisteanna (52)
Stephen Donnelly
Ceist:52. Deputy Stephen S. Donnelly asked the Minister for Health the number of sanctioned consultant posts; the number of sanctioned whole-time equivalent posts if different; the number of consultants on the specialist register with permanent contracts; the gap between sanctioned whole-time equivalents and employed whole-time equivalents who are on the specialist register and have permanent contracts; and if he will make a statement on the matter. [50799/18]
Amharc ar fhreagraFreagraí scríofa
The HSE has responsibility for consultant posts which previously came under the remit of Comhairle na nOspidéal. The HSE has advised that at the 30th November 2018, there were 3,215 approved consultant posts and 199 unapproved posts. This gives a total of 3,414 consultant posts. Unapproved posts are those that never went through Comhairle na nOspidéal or, more recently, the HSE's Consultant Applications Advisory Committee. The number of approved posts converts to 3172.4 whole-time equivalents.
The HSE has advised that the number of consultants on the specialist register with permanent contracts stands at 2,516. However, this number excludes over 500 posts that are filled through alternative arrangements including Fixed Term Contracts, Specified Purpose Contracts, Contracts of Indefinite Duration and Agency.
Census data to the end of October 2018 identifies 3,088.48 whole-time equivalent consultants working in the public health services, excluding those on career breaks. This number is higher than at any time in the past.
It is recognised that the recruitment of consultants, as identified by the Public Service Pay Commission, is a significant challenge, particularly in certain specialties and in certain locations. I and the Government recognise the importance of continuing to recruit and retain consultants and to move to a consultant delivered service.
Patient Data
Ceisteanna (53)
Dara Calleary
Ceist:53. Deputy Dara Calleary asked the Minister for Health the estimated number of persons with Alzheimer's disease or dementia in County Mayo; the projection for same in 2030; the additional supports that will be provided in the coming years to adapt to the upturn in incidence; and if he will make a statement on the matter. [50727/18]
Amharc ar fhreagraFreagraí scríofa
Based on the 2016 census and dementia prevalence data published by the European Collaboration on Dementia, it is estimated that approximately 51,000 (8%) of the 637,567 people nationally aged 65 or older and 4,000 (0.18%) of the approximately 2.2 million people aged 30-64 has dementia. Based on these prevalence rates, and the proportion of its population in these age cohorts, it can be calculated that an approximate total of 1,940 people in Mayo have dementia.
Applying the European Collaboration on Dementia’s age and gender-specific dementia prevalence rates, an anticipated increase in the number of people living longer lives, and using a mid-range projection from the CSO, an estimated 99,000 people in Ireland will have dementia by 2030. It is not possible to say with certainty how many people in Mayo will have dementia, as the CSO does not have population projections broken down by county.
The National Dementia Strategy aims to improve dementia care to allow people with dementia to live well for as long as possible. The National Dementia Office (NDO) has worked to develop evidence-based care pathways for people with dementia and in the areas of diagnosis, post-diagnostic supports, and the prescribing of anti-psychotic medications. The HSE provides standard and dementia-specific Homecare Packages to people with dementia to enable them to continue living with assistance at home. Funding has been secured through the Dormant Accounts Fund for additional projects.
A recently completed mapping exercise provides a useful snapshot and baseline study into what, where and when dementia-specific community-based services and supports are being offered. The study has also been used to inform a service finder hosted on the NDO's website. This allows people to search for dementia-specific community services in their area.
In terms of plans to further expand support levels for people with dementia, the quantum of services to be provided by the HSE is being considered as part of the HSE's 2019 National Service Planning.
Hospital Admissions
Ceisteanna (54)
Jack Chambers
Ceist:54. Deputy Jack Chambers asked the Minister for Health his views on the finding in the patient experience survey that just 15% of respondents in Connolly Hospital said they were admitted to a ward within six hours of their arrival at the emergency department; and if he will make a statement on the matter. [50708/18]
Amharc ar fhreagraFreagraí scríofa
The National Patient Experience Survey provides an invaluable insight into the care patients receive in our hospitals and is an essential service for policy makers, service providers, and regulators. It is encouraging that 84% of participants nationally reported a positive overall experience in our hospitals. This year's survey also showed improvement in the dignity and respect patients reported experiencing while in hospital compared to the previous year.
In relation to Connolly Hospital, 83% of participants said they had ‘good’ or ‘very good’ overall experiences.
It is a matter of concern, however, that just 15% of participants from Connolly Hospital said they were admitted to a ward within six hours of arriving at the emergency department (ED). As of the end of September 2018, the HSE reported that 49% of people attending at Connolly Hospital ED were discharged or admitted within six hours of registration. This compares to 65% nationally and falls short of the target of 75% in the HSE's National Service Plan.
While hospitals are increasingly operating at or above capacity, with year-round demand pressures that are further challenged over the winter months, it is regrettable that any patient, and especially older patients, should have to wait for admission to a hospital ward.
The 2018/19 Winter Plan, which runs from 1 December 2018 to 31 March 2019, is now in place and is due to be launched by the HSE on the 6th of December. The Plan includes a period of focused action from 17 December 2018 to 13 January 2019 targeting nine key hospital sites of concern identified on the basis of pressures experienced in previous winters. A priority of the Plan is ensuring that the values of Patient Dignity and Respect are upheld at all times, especially at times of overcrowding.
Hospital Staff Recruitment
Ceisteanna (55)
Charlie McConalogue
Ceist:55. Deputy Charlie McConalogue asked the Minister for Health if recruitment has commenced to staff the short stay ward at Letterkenny University Hospital; if so, the number of staff and the relevant grades that have been advertised for the ward; and if he will make a statement on the matter. [50538/18]
Amharc ar fhreagraFreagraí scríofa
Increasing capacity is a priority for this Government. €10 million in funding is being made available in 2019 to increase acute bed capacity in line with the recommendations of the Health Care Capacity Review.
My Department is currently in discussions 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.
The selection and opening of beds on specific sites in 2019 and future years will be considered as part of the annual Estimates and Service Planning process, and subject to financial, operational, human resource and policy considerations and priorities.
Mental Health Services Staff
Ceisteanna (56)
Kevin O'Keeffe
Ceist:56. Deputy Kevin O'Keeffe asked the Minister for Health the action being taken to address the large number of psychiatrist vacancies in County Cork; and if he will make a statement on the matter. [50704/18]
Amharc ar fhreagraFreagraí scríofa
As is widely acknowledged, there is currently an international shortage of Consultant Psychiatrists, particularly for the HSE Child and Adolescent Mental Health service (CAMHS). CHO4, which covers the Cork and Kerry areas, indicates that there are currently 7.25 Whole Time Equivalent (WTE) vacancies at Consultant level in mental health there.
Cork/Kerry Community Healthcare have established a CAMHS Medical Recruitment Taskforce to review efforts to recruit and retain medical staff, led by the Head of Service for Human Resources. Every possible option is being pursued in order to recruit Consultant Psychiatrists for that area. Acknowledging the critical impact medical vacancies have on service provision, a dedicated Medical Manpower Officer has also been appointed.
Local HSE management are working with eleven national and international agencies to source suitably qualified candidates. All options are being explored, including the provision of out-of-hours, or weekend clinics by Consultants from other HSE areas, along with the potential use of new e-mental solutions currently being developed by the Executive.
The recent Budget saw the HSE mental health allocation increase to nearly €1 billion, which is a clear indication of the importance placed on this key care programme by Government. This represents an increase of over €245 million in the HSE mental health budget since 2012. This has facilitated an increase in the number of WTE Consultant Psychiatrists in the Cork/Kerry mental health area from 46.6 to 51.39 in the last two years.
On the broader front, additional funding has also facilitated initiatives aimed at reducing demand on the specialist mental health services by developing Prevention and Early Intervention services at Primary Care, Disability or other service links. It has, for example, provided an extra 130 Psychiatric Nurse Undergraduates places each year, to fully come on-stream in 2020-21. In addition, 40 Post-Graduate places have been funded for Nurse training. Along with the recent appointment by the HSE of around 114 Assistant Psychologists and 20 Psychologists into Primary Care, and 10 Advanced Nurse Practitioners directly ear-marked for CAMHS, it is anticipated that these new posts will help improve mental health provision overall. Further emphasis to improve mental health services in Cork, and all areas nationally, will be a core objective of the HSE Service plan 2019, which is at present in the process of being finalised.
I have had several meeting over recent times with the HSE, at both national and local level, to improve mental health services in the CHO 4 region and the Deputy can rest assured that I will continue to closely monitor the situation to bring about realistic change on this complex issue as quickly as possible.
Medical Products
Ceisteanna (57)
Bobby Aylward
Ceist:57. Deputy Bobby Aylward asked the Minister for Health the position regarding the use of a device (details supplied) in the treatment of children with scoliosis; the steps he has taken to satisfy himself that there are no health and safety risks to children with scoliosis being treated with the device; the steps he has taken to ensure that parents are informed regarding potential health and safety risks in the use of the device and ensure informed consent guidelines are abided by in all such instances; and if he will make a statement on the matter. [50873/18]
Amharc ar fhreagraFreagraí scríofa
The NuVasive MAGEC Spinal Bracing and Distraction System is a CE-marked medical device and, as such, it has been assessed by an EU-based notified body as complying with the safety and performance requirements of the EU medical device Directives. Certification requires that any clinical risks associated with a device are mitigated and reduced as far as possible, and that all risks cumulatively are weighed against the clinical benefits. It is important to note that the MAGEC system has also been assessed by the National Institute for Health and Care Excellence (NICE) in the UK as an effective surgical treatment option for scoliosis, where other treatments such as casting or bracing have failed or are not suitable.
Our Lady's Children’s Hospital, Crumlin (OLCHC) has confirmed that these devices are only used in children with progressive scoliosis who are too young to undergo a full spinal fusion and who need a growing system to help straighten the spine but still allow growth. When a child receives their MAGEC Rods, they continue to attend a dedicated OLCHC outpatient clinic, which ensures monitoring and adjustments to the rods while the child continues to grow.
The Health Products Regulatory Authority (HPRA) is the competent authority for the regulation of medicines and medical devices in Ireland. The Agency has confirmed that it has not received any reported safety incidents from the Irish market in relation to the MAGEC system. However, the HPRA is aware of concerns raised in relation to this device and is currently conducting a market surveillance review in relation to the product. The outcome of this market surveillance will be communicated when available.
The HPRA's primary function with regard to the regulation of devices is in post-market surveillance. The HPRA does not maintain a register of devices implanted in people in Ireland. However, orthopaedic surgeons at OLCHC have advocated for the development of a national Spinal Register, and the Children’s Hospital Group has undertaken to progress such a Register and to ensure that it is adequately resourced. While this is happening, the hospital will continue to monitor patients and audit their ongoing care, documenting any problems that arise. OLCHC also has a dedicated telephone line in place for parents or guardians who have queries in relation to their child regarding scoliosis-related surgery.
Medical device legislation requires that information is made available with the device relating to its intended purpose, and that as far as practicable and appropriate, the information needed to use the device safely must be provided on the packaging or by a leaflet setting out use instructions and possible side-effects.
New EU Medical Device Regulation will be implemented over the coming years and will enhance and reinforce the existing regulatory system.
Addiction Treatment Services
Ceisteanna (58)
Maureen O'Sullivan
Ceist:58. Deputy Maureen O'Sullivan asked the Minister for Health the waiting lists and options open to those wanting to detox from benzodiazepines and similar substances. [50827/18]
Amharc ar fhreagraFreagraí scríofa
The Health Service Executive has overall responsibility for the provision of addiction treatment services. The Executive has advised that the vast majority of people who wish to detoxify off tablets such as benzodiazepines or similar substances are appropriate to treat in a community setting.
The Department of Health and Children published Benzodiazepine Best Practice Guidelines in 2002. Detoxification in the community can be achieved either by a gradual dose reduction of the drug or by converting to an equivalent dose of diazepam and providing a tapered dose reduction over a period of time, in conjunction with psychosocial support. There are no data on waiting lists for this type of intervention.
Residential detoxification off benzodiazepines is occasionally required in the case of polysubstance misuse where the individual is using tablets in conjunction with other substances. All the tier 4 services can provide a detoxification off heroin and tablets concurrently if the clinical assessment indicates that this is necessary. In instances where the assessment has indicated that tablets alone are the problem it is advised that at least 2 community-based detoxification programmes are attempted before a residential detoxification would be considered.
As part of a comprehensive care plan, an inpatient detoxification can be offered by tier 4 services if clinically appropriate and if the person is engaged in an addiction counselling process with a structured rehabilitation plan in place for the post detoxification phase of their treatment.
A summary of residential detoxification places by service provider follows, along with average waiting times, as of October 2018.
Detoxification beds by type and location
|
Medical Detoxification Units[1] Location |
Number of Beds |
Current Average Waiting Time |
|
2018 |
||
|
Cuan Dara - Cherry Orchard Hospital |
9 |
6 weeks |
|
St. Michael's Ward, Beaumont Hospital |
10 |
Male 8–10 weeks |
|
Female 4-6 weeks |
||
|
Community Based Residential Detoxification Location |
Number of Beds |
Current Average Waiting Time |
|
2018 |
||
|
Cuan Mhuire, Athy (Drugs) |
6 |
Up to 4 weeks (opiates) |
|
Cuan Mhuire ,Farnanes, Co. Cork (Drugs and Alcohol) |
8 |
7-14 days (opiates & polysubstance), |
|
1-7 days Alcohol |
||
|
Cuan Mhuire, Bruree, Limerick (6 male Drugs, 21 male Alcohol & 3 female drugs/alcohol) |
30[2] |
8 - 12 weeks (opiates & polysubstance), |
|
1-3 days Alcohol |
||
|
St. Francis Farm Merchant's Quay Ireland, Tullow, Co. Carlow |
10 |
2 weeks[3] |
|
Adolescent Residential Detoxification Location |
Number of Beds |
Current Average Waiting Time |
|
2018 |
||
|
Aislinn, Ballyragget, Co. Kilkenny (Drugs and Alcohol) |
4 |
2 weeks |
[1] Note there are an additional 6.5 Stabilisation beds that can be used interchangeably depending on need for detoxification within the Medical Detoxification Units.
[2] In addition, there are 2 emergency beds that are used for observation (medical concern). These additional beds have been used for people in detox.
[3] Data from June 2018
Disease Management
Ceisteanna (59)
Catherine Connolly
Ceist:59. Deputy Catherine Connolly asked the Minister for Health the information he received about the implementation of the guidelines on the prevention and control of tuberculosis in Ireland 2010, amended in 2014, pursuant to an outbreak of tuberculosis, a notifiable disease, in Galway University Hospital; if he is satisfied that the procedures were appropriately rolled out and are sufficiently robust in view of the substantial number of persons, including staff, who contracted latent tuberculosis; and if he will make a statement on the matter. [50611/18]
Amharc ar fhreagraFreagraí scríofa
Since 2004, it is mandatory for clinical directors of laboratories to notify a case of TB to the regional director of public health (DPH) under their role as medical officer of health (MOH). This relates to cases of TB disease only and not to cases of latent TB infection (LTBI). LTBI is not a notifiable disease. The ‘Guidelines on the Prevention and Control of Tuberculosis in Ireland 2010’ were produced by the National TB Advisory Committee in 2010 and amended in 2014. These guidelines deal with many aspects of prevention, diagnosis and control of TB in Ireland and are intended to act as a source of expert advice on tuberculosis. The guidelines provide that once a diagnosis of TB is confirmed, it is communicated to the MOH. The MOH is required to report possible, probable and confirmed cases of TB to the HSE's Health Protection Surveillance Centre (HPSC). This information is published as part of the HPSC's Weekly Infectious Diseases Report and is available on the HSE's website. In relation to the specific case at Galway University Hospital referred to by the Deputy, my Department sought an update from the HSE. The HSE has assured me that once the case of infectious TB was confirmed, it was managed in accordance with the 'Guidelines on the Prevention and Control of Tuberculosis in Ireland, 2010' referred to above. The HSE has also confirmed that this incident has been logged as part of their Quality and Incidents Management system.
HIQA Remit
Ceisteanna (60)
Stephen Donnelly
Ceist:60. Deputy Stephen S. Donnelly asked the Minister for Health his plans to expand the remit and powers of the Health Information and Quality Authority; and if he will make a statement on the matter. [50798/18]
Amharc ar fhreagraFreagraí scríofa
Health Information and Quality Authority
Background
The Health Information and Quality Authority (HIQA) was established in 2007. HIQA is an independent authority established to drive high-quality and safe care for health and social care services in Ireland. HIQA’s mandate extends across a range of public, private and voluntary sector services. Reporting to the Minister for Health and the Minister for Children and Youth Affairs, HIQA’s role is to develop standards, inspect and review health and social care services and support informed decisions on how services are delivered.
HIQA operates under the Health Act 2007, which sets out the functions which the Authority is to carry out. HIQA has responsibility for setting standards for healthcare services, and monitoring compliance with those standards. It also regulates facilities providing care for the elderly and those with disabilities, and has a role with regard to inspecting some of the social care services which are accessed by children to determine if they are meeting the relevant National Standards. In addition, it undertakes functions in relation to Health Information and Health Technology Assessment.
Section 9 of the Act sets out the grounds under which HIQA may undertake an investigation into a particular service, or may be requested to undertake such an investigation by the Minister for Health.
The Act provides HIQA with the power to set standards for the healthcare services delivered by the HSE, and then to undertake monitoring programmes to assess compliance with these standards. In this regard, HIQA published the National Standards for Safer Better Healthcare in 2012; they represent the overarching standard which public health services are expected to meet. Flowing from these themes, HIQA have also developed standards for particular services, e.g. National Standards for the prevention and control of healthcare-associated infections in acute healthcare services. HIQA has in turn conducted a thematic inspection programme against these standards since 2012, which has resulted in the publication of over 300 reports of inspection visits to date. In addition, HIQA has also undertaken thematic inspection programmes in relation to nutrition and hydration in acute hospitals, and in relation to medication safety.
In such cases, HIQA typically undertakes both announced and unannounced inspection of healthcare facilities in order to ascertain the degree of adherence to expected standards. A report of the inspection visit will subsequently be published on HIQA’s website, and frequently attracts media attention. In cases where remedial action is required, depending on the severity of the risk identified, HIQA may draw the matter to the attention of hospital management during the inspection and request an immediate response, or in less severe cases, will raise the issue in writing. In either case, an appropriate management response would be expected.
Further standards also continue to be developed i.e. most recently National Standards for Safer Better Maternity Services and National Standards for the Review of Patient Safety Incidents.
Extension of HIQA's Remit
Patient Safety Licensing Bill
The Patient Safety Licensing Bill, in line with the Slaintecare Implementation Strategy, will see HIQA become the licensing authority for all hospitals and certain designated activities. The Bill will, for the first time, introduce a licensing requirement for all hospitals, public and private, and certain designated high risk activities in the community. It was approved by Government in December 2017 and underwent pre-legislative scrutiny at the Joint Oireachtas Committee on Health on 13 June 2018.
HIQA will be the licensing body, with statutory powers to require hospitals to undertake improvements and the authority to remove a licence from a service which is failing to meet required standards.
Patient Safety Bill
In advance of a formal licensing regime for public and private hospitals it is proposed that the Patient Safety Bill will bring the private/independent healthcare sector within the remit of the Health Act 2007. The proposed bill will extend HIQA’s powers to set and monitor standards, and undertake investigations, where necessary, to the private acute hospital sector. The Patient Safety Bill underwent Pre-Legislative Scrutiny at the Oireachtas Health Committee on 26 September 2018.
Competent Authority for Medical Ionizing Radiation
HIQA has been designated to take on the responsibilities of the “Competent Authority” for Medical Ionizing Radiation, as is required by European Directive 2013/59/Euratom. HIQA will assume regulatory responsibility for Medical Ionising Radiation Protection, e.g. the use of x-ray machines in clinical settings. These functions currently reside with the HSE, however the transfer of responsibility is required in order to ensure Ireland complies with the incoming European regulations. Such a move was also recommended by the International Atomic Agency in its review of Irish regulatory practice in this area. The legislation to transpose the European Directive is almost complete. As such, HIQA has been taking preparations to assume these new responsibilities.
I have set out above the current responsibilities of HIQA, and the additional roles it is expected to acquire in the coming period. However, I can also assure the Deputy that HIQA's role and remit will continue to be kept under review by my Department.
Services for People with Disabilities
Ceisteanna (61, 136)
Richard Boyd Barrett
Ceist:61. Deputy Richard Boyd Barrett asked the Minister for Health if a centre (details supplied) will remain open with all the services and staff available to the blind community of CHO area 6; and if he will make a statement on the matter. [50804/18]
Amharc ar fhreagraRichard Boyd Barrett
Ceist:136. Deputy Richard Boyd Barrett asked the Minister for Health his views on whether it is reasonable that the blind community of CHO 6 would have to travel from County Wicklow to Tallaght for services that have always been available in Dún Laoghaire in view of reports of the possible transfer of a centre (details supplied) to Tallaght; and if he will make a statement on the matter. [50805/18]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 61 and 136 together.
The National Council for the Blind of Ireland (NCBI) is a non-statutory organisation that works with people across the country who are experiencing sight loss. It is funded by the Health Service Executive (HSE), under Section 39 of the Health Act, to provide a range of centre, domiciliary and community based services to people who are blind or vision impaired. The NCBI currently runs an office in Dun Laoghaire, Co. Dublin (HSE Community Healthcare Organisation Area 6).
The NCBI will be opening a new purpose-built and fully accessible centre in Tallaght Cross in January 2019. This €800,00 investment has been funded by the NCBI through fundraising income and will see the NCBI provide a greater level of service to people with sight loss across South Dublin and in neighbouring counties. The new Tallaght centre will serve as the NCBI’s centre of excellence on the southside for all its staff and service users.
HSE CHO 6 has been in recent discussions with the NCBI to discuss the future of the NCBI Dun Laoghaire Office. Both parties are in agreement that the NCBI’s service is much valued locally and that every effort should be made to continue with a local service to local people with sight loss. The NCBI Board agreed at its meeting on 28 November 2018 that there will be no cessation of any services currently provided out of Dun Laoghaire. The HSE will continue to review this situation on an ongoing basis with the NCBI.
Hospital Services
Ceisteanna (62)
Robert Troy
Ceist:62. Deputy Robert Troy asked the Minister for Health when capital works will commence to facilitate the new MRI scanner at the Midland Regional Hospital, Mullingar. [50737/18]
Amharc ar fhreagraFreagraí scríofa
The provision of a new MRI at Mullingar Regional Hospital is included in the proposed new extension of the radiology department at the Hospital. The project team are currently at an advanced stage in the pre-planning process with a view to lodging a full planning application in the first quarter of 2019.
The Health Service Executive is developing its Capital Plan for 2019 which will determine the projects that can progress in 2019 having regard to the limited available capital funding, the number of large national capital projects currently underway and the relevant priority of each project.
Question No. 63 answered with Question No. 41.
Hospital Services
Ceisteanna (64)
Louise O'Reilly
Ceist:64. Deputy Louise O'Reilly asked the Minister for Health if resources will be forthcoming for the breast multidisciplinary team and for the diabetes and endocrine diseases clinic at Cork University Hospital to increase staff, tackle delays, allow for referral pathways and other associated issues; and if he will make a statement on the matter. [50778/18]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter, I have asked the Health Service Executive to respond to you directly as soon as possible.
Occupational Therapy Waiting Lists
Ceisteanna (65)
Barry Cowen
Ceist:65. Deputy Barry Cowen asked the Minister for Health the way in which it is proposed to reduce the long waiting times in counties Laois and Offaly for under 18 year olds in need of a first assessment for occupational therapy; and if he will make a statement on the matter. [50786/18]
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.
Medicinal Products Reimbursement
Ceisteanna (66, 105)
Clare Daly
Ceist:66. Deputy Clare Daly asked the Minister for Health if access to experimental drugs such as Pembrolizumab will be provided to all women with cervical cancer in view of the decision to make such drugs available to women whose false negative screening results were uncovered during the audit of the CervicalCheck screening programme. [50596/18]
Amharc ar fhreagra
Alan Kelly
Ceist:105. Deputy Alan Kelly asked the Minister for Health when Pembrolizumab will be made available free of charge to all cervical cancer patients whose clinicians are of the view they require same. [50824/18]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 66 and 105 together.
The HSE has statutory responsibility for medicine pricing and reimbursement decisions, in accordance with the 2013 Act. The Act specifies the criteria for decisions on the reimbursement of medicines.
In line with the 2013 Act and the national framework agreed with industry, if a company would like a medicine to be reimbursed by the HSE, it must apply to have the new medicine added to the reimbursement list.
Reimbursement is for licensed indications which have been granted market authorisation by the European Medicines Agency (EMA) or the Health Products Regulatory Authority (HPRA).
HSE decisions on which medicines are reimbursed by the taxpayer are made on objective, scientific and economic grounds, on the advice of the National Centre for Pharmacoeconomics (NCPE).
Pembrolizumab has market authorisation in Ireland/the EU for a number of indications.
The HSE has approved the reimbursement of pembrolizumab for the following indications:
- as monotherapy for the treatment of advanced (unresectable or metastatic) melanoma in adults;
- as monotherapy for the first-line treatment of metastatic non-small cell lung carcinoma (NSCLC) in adults whose tumours express PD-L1 with a 50% tumour proportion score (TPS) with no EGFR or ALK positive tumour mutations; and
- as monotherapy for the treatment of adult patients with relapsed or refractory classical Hodgkin lymphoma (cHL) who have failed autologous stem cell transplant (ASCT) and brentuximab vedotin (BV), or who are transplant-ineligible and have failed BV.
It should be noted that the first part of the last indication is not reimbursed because the HSE is already reimbursing another immunotherapy with similar efficacy (nivolumab) at lower cost. Patients who are transplant-ineligible and have failed BV can receive reimbursement support for pembrolizumab, as nivolumab does not have market authorisation for this sub-group of patients.
The HSE Drugs Group are reviewing the indication below:
- as monotherapy for the treatment of locally advanced or metastatic urothelial carcinoma in adults who are not eligible for cisplatin-containing chemotherapy and whose tumours express PD-L1 with a combined positive score (CPS) 10.
The following indications are currently under health technology assessment with the NCPE:
- in combination with pemetrexed and platinum chemotherapy, for the first-line treatment of metastatic non-squamous NSCLC in adults whose tumours have no EGFR or ALK positive mutations; and
- as monotherapy for the treatment of locally advanced or metastatic urothelial carcinoma in adults who have received prior platinum-containing chemotherapy.
No reimbursement application has been received to date for the following indication:
- as monotherapy for the treatment of recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) in adults whose tumours express PD-L1 with a 50% TPS and progressing on or after platinum-containing chemotherapy.
However, the HSE has approved reimbursement of nivolumab for the treatment of recurrent or metastatic squamous cell cancer of the head and neck in adults progressing on or after platinum-based therapy.
A reimbursement application for the following indication has been withdrawn by the applicant:
- as monotherapy for the treatment of locally advanced or metastatic NSCLC in adults whose tumours express PD-L1 with a 1% TPS and who have received at least one prior chemotherapy regimen. Patients with EGFR or ALK positive tumour mutations should also have received targeted therapy before receiving pembrolizumab.
However, the HSE has approved reimbursement of nivolumab, which could also be used in this cohort of patients at a lower cost.
In October 2018, the Committee for Medicinal Products for Human Use (CHMP), which is the European Medicines Agency's committee responsible for human medicines, adopted a positive opinion recommending a change to the terms of the marketing authorisation for pembrolizumab to include a new indication as follows:
- as monotherapy for the adjuvant treatment of adults with stage III melanoma and lymph node involvement who have undergone complete resection.
The HSE has commissioned a rapid review assessment for this indication.
There are no other indications for pembrolizumab approved in the European Union at this time. Clinical trials for various immunotherapies, including pembrolizumab, are ongoing globally for a range of other possible indications, which may receive marketing authorisation in the EU over the next number of years. Each of those indications will be considered for reimbursement as market authorisations are granted and applications received.
A Government decision put in place a package of support measures for the women and families affected by the issues related to CervicalCheck. As part of this package, all out of pocket medical costs incurred by the women affected will be met to the extent that they are not already covered either under existing public schemes or any private health insurance policy that an individual might hold. This commitment includes medicines which might not be approved for reimbursement, once they are prescribed by the treating clinician. Although not specifically referenced, pembrolizumab would be encompassed under this aspect of the support package.
The statutory responsibility of the HSE for medicine pricing and reimbursement decisions, in accordance with the Health (Pricing and Supply of Medical Goods) Act 2013, remains unchanged regardless of this support package.
I am aware of the concerns raised in the Dáil and elsewhere regarding the question of providing medication to other cervical cancer patients on the same basis as encompassed by the Government decision of 11 May 2018. At my request, the HSE Medicines Management Programme is examining ways in which other woman with cervical cancer could be afforded access to pembrolizumab if prescribed by their treating clinician. I have asked the HSE to revert to me as soon as possible in this regard.
Hospital Appointments Delays
Ceisteanna (67)
Aindrias Moynihan
Ceist:67. Deputy Aindrias Moynihan asked the Minister for Health the steps he is taking to address the delay experienced by children awaiting services at the paediatric diabetes clinic at Cork University Hospital; and if he will make a statement on the matter. [50836/18]
Amharc ar fhreagraFreagraí scríofa
In relation to the particular query raised, as this is a service matter, I have asked the HSE to respond to the Deputy directly.
Disability Support Services Provision
Ceisteanna (68)
Margaret Murphy O'Mahony
Ceist:68. Deputy Margaret Murphy O'Mahony asked the Minister for Health if there will be an increase in personal assistance hours in 2019; and if he will make a statement on the matter. [50722/18]
Amharc ar fhreagraFreagraí scríofa
As the HSE's National Service Plan for 2019 has not yet been finalised, a final decision with regard to the quantum of personal assistance hours to be delivered has not yet concluded, but will be agreed shortly.
It is the policy of the HSE to provide Personal Assistant services that are person-centred, equitable and transparent to people with a physical and/or sensory disability. The HSE is committed to protecting the level of Personal Assistant services and Home Support services available to persons with disabilities.
In 2018 the HSE's priority is to provide 1.46 million hours of personal assistance to almost 2,500 people, representing an increase of 60,000 hours over the 2017 target, and having regard to Home Support services will provide 2.93 million hours to both adults and children with a disability this year, an increase of 180,000 hours over the target for 2017, and since 2013 the number personal assistance hours has increased by 17% to the end of 2017.
HSE Staff
Ceisteanna (69)
Thomas Pringle
Ceist:69. Deputy Thomas Pringle asked the Minister for Health the efforts made to date to resolve matters between the HSE and a union (details supplied); and if he will make a statement on the matter. [50834/18]
Amharc ar fhreagraFreagraí scríofa
The union which is recognised by the HSE as representing ambulance grades is SIPTU. The Psychiatric Nurses' Association (PNA), which is a non ICTU affiliated union, have negotiating rights for nurses working in psychiatry and intellectual disability sectors. The National Ambulance Service Representative Association (NASRA), which is affiliated with the PNA is not recognised by the HSE and, therefore, does not have negotiating rights for HSE ambulance staff. The HSE can only engage with recognised unions with negotiation rights. This approach is in keeping with Government policy. Indeed, the principle of engaging only with recognised trade unions has been acknowledged previously by the Labour Court in a dispute involving the PNA but with a different public sector employer.
Whilst individuals have a right to membership of any trade union, HSE ambulance staff who choose to join an association which is not recognised by their employer should be aware that such membership is not facilitated by their employer.
Maternity Services
Ceisteanna (70)
Clare Daly
Ceist:70. Deputy Clare Daly asked the Minister for Health if he will halt the handover of the new national maternity hospital to a private entity and ensure that this institution is in full public ownership in order to protect women’s lives, health and choices. [50595/18]
Amharc ar fhreagraFreagraí scríofa
I am committed to the development of the new maternity hospital on the St Vincent's campus. This is a vital project for women and babies in Ireland, representing the flagship project of the National Maternity Strategy and the largest single investment ever made in maternity services in Ireland.
Considerable work has been undertaken to develop a legal framework to protect the State's significant investment in the new hospital and to ensure that the new hospital building will remain in State ownership. The proposals will require consideration by Government, the National Maternity Hospital and the St Vincent’s Healthcare Group before they are finalised. This legal framework will underpin the operational and clinical independence of the new hospital, ensuring care in the new maternity hospital will be delivered without religious, ethnic or other distinction and any medical procedure which is in accordance with the laws of the land will be carried out there.
Mental Health Services Provision
Ceisteanna (71)
James Browne
Ceist:71. Deputy James Browne asked the Minister for Health the plans in place to increase bed capacity in acute mental health units; and if he will make a statement on the matter. [50702/18]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter I have asked the Health Service Executive to respond directly as soon as possible.
Hospital Admissions
Ceisteanna (72)
James Lawless
Ceist:72. Deputy James Lawless asked the Minister for Health his views on the finding in the patient experience survey that just 18% of respondents in Naas Hospital said they were admitted to a ward within six hours of arriving at the emergency department; and if he will make a statement on the matter. [50719/18]
Amharc ar fhreagraFreagraí scríofa
According to the National Patient Experience Survey which was published recently, 84% of respondents said they had a very good or good experience in our hospitals. The results regarding the confidence and trust, as well as the dignity and respect patients experience while in hospital were also encouraging.
It is a matter of concern, however, that in the case of Naas Hospital, just 18% of respondents said they were admitted to a ward within six hours of arriving at the emergency department (ED). Moreover, as of the end of September 2018, 51.8% of people attending at Naas General Hospital ED were discharged or admitted within six hours of registration. This compares to 64.6% nationally and falls short of the target of 75% in the HSE's National Service Plan.
While hospitals are increasingly operating at or above capacity, with year-round demand pressures that are further challenged over the winter months, it is regrettable that any patient, and especially older patients, should have to wait for admission to a hospital ward
The 2018/19 Winter Plan, which runs from 1 December 2018 to 31 March 2019, is now in place and is due to be launched by the HSE on the 6th of December. The Plan includes a period of focused action from 17 December 2018 to 13 January 2019 targeting nine key hospital sites of concern, including Naas General Hospital, identified on the basis of pressures experienced in previous winters. A priority of the Plan is ensuring that the values of Patient Dignity and Respect are upheld at all times, especially at times of overcrowding
Hospitals Discharges
Ceisteanna (73, 80)
Anne Rabbitte
Ceist:73. Deputy Anne Rabbitte asked the Minister for Health the measures that will be taken to reduce the number of bed days lost owing to delayed discharges in hospitals in County Galway; and if he will make a statement on the matter. [50728/18]
Amharc ar fhreagra
Declan Breathnach
Ceist:80. Deputy Declan Breathnach asked the Minister for Health the measures that will be taken to reduce the number of bed days lost owing to delayed discharges in Our Lady of Lourdes Hospital, Drogheda; and if he will make a statement on the matter. [50733/18]
Amharc ar fhreagraFreagraí scríofa
I propose to take Questions Nos. 73 and 80 together.
The recently published report of a Working Group set up to carry out an independent expert review of delayed discharges recognised that delayed discharges or transfers of care are caused by a multitude of factors. The report made nine recommendations which include the development of a national policy to provide for a more consistent approach to recording delayed discharges, strengthening data collection, standardising definitions and ensuring consistent discharge guidelines.
Following its publication, I stressed that my immediate focus was on reducing delayed patient discharges and transfers of care as we come into winter through mobilising the additional resources being made available through the Winter Plan and ensuring that social care measures are effectively deployed to enable older people leave hospital and return to a more appropriate care setting, including their own home, as quickly as possible, with the supports they need.
As part of Budget 2019, €10 million has been made available to the HSE for the winter period for home supports and other measures to minimise delays in people getting home from hospital, with a focus on those in the over 75 age group. The Department of Health sanctioned the release of €5m of this additional funding to support the deployment of social and primary care measures to enable patients to return from hospital to their home or community with the supports they need.
This will provide 300 additional home support packages, additional transitional care and additional aids and appliances. These measures are currently being put into operation. A further 250 home support packages will be provided in the New Year. I will be monitoring progress on these actions over the winter months and I am considering, with my officials, an appropriate approach to progressing the longer term recommendations of the recent Review.
Hospital Overcrowding
Ceisteanna (74)
Willie O'Dea
Ceist:74. Deputy Willie O'Dea asked the Minister for Health the initiatives being taken to alleviate overcrowding in University Hospital Limerick; and if he will make a statement on the matter. [50713/18]
Amharc ar fhreagraFreagraí scríofa
I acknowledge the distress overcrowded EDs cause to patients, their families, and frontline staff working in very challenging working conditions in hospitals throughout the country. This year has been characterised by high demand for unscheduled care, particularly among the over-75 age group, which was further exacerbated by Storm Emma and the extended influenza season earlier this year.
My Department has been working with the HSE throughout the year to ensure the most effective response to the pressures on our hospital system associated with the winter period. As part of this process, integrated Winter Preparedness Plans have been developed by Hospital Groups and Community Healthcare Organisations to meet the anticipated surge in demand for healthcare services during the winter months. The Plans are designed to optimise existing resources and encompass:
planning and escalation;
operational management of patient flow; and
maintaining public health.
The Winter Plan, which was endorsed by the Emergency Department Task Force at its meeting on 26 November, is now in place and is due to be launched on the 6th of December. The Plan runs from 1 December 2018 until 31 March 2019 and includes a period of focused action from 17 December to 13 January targeting 9 sites of concern.
These sites have been identified on the basis of pressures experienced in previous winters and include University Hospital Limerick.
A key component of the Plan, which is already underway, is the provision of an additional 550 home care packages over the winter period to help patients return home from hospital with the supports they need.
The Winter Plan will also seek to increase capacity and the Department of Health is currently in discussions 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.
Island Communities
Ceisteanna (75)
Éamon Ó Cuív
Ceist:75. Deputy Éamon Ó Cuív asked the Minister for Health if the resources will be provided to the HSE to fully implement the recent report published on island health provision; and if he will make a statement on the matter. [50866/18]
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.