Written Answers Nos. 42-73
54. Deputy Pat Buckley asked the Minister for Health if his attention has been drawn to the fact that in January 2019, 39 out of 72 CAMHS beds were operational and the HSE has listed staffing as a major cause of this problem; his plans to resolve the issue; and if he will make a statement on the matter. [5127/19]
Amharc ar fhreagraThe Government is committed to providing the best possible mental health services to children. This commitment is reflected in Budget 2019 which gave an additional €55 million to progress new developments in mental health this year. This brings overall HSE mental health funding to €987 million, an increase of €276 million since 2012.
This funding has facilitated an increase in the number of CAMHS inpatient beds. In 2011 there were 52 beds; today there are 74 beds, including two high observation beds. However, bed capacity in the past twelve months has been reduced due to a number of factors, including but not limited to, difficulty in sourcing required staffing levels. Complexity of presenting cases is also a significant factor that affects bed capacity. Bed capacity in CAMHS In-Patient Units is currently operating at 44 of 74 in-patient beds nationally as of 28 of January 2019.
Difficulties in recruiting mental health staff are well-documented but significant efforts are underway to increase staffing. We have provided funding for an extra 130 Psychiatric Nurse Undergraduate places each year. We will see the benefits of this initiative in 2020/21.
The recent appointment by the HSE of 114 Assistant Psychologists and 20 Psychologists in Primary Care and 10 Advanced Nurse Practitioners directly into CAMHS, will help to reduce demand on the CAMHS service.
There are also plans for an additional 10 CAMHS Forensic Beds in the New Forensic Hospital due to open in 2020 bringing the total number of inpatient beds for CAMHS to 82.
I have worked with the HSE to introduce a number of new measures in the HSE Service Plan 2019. These will help to change the way we promote youth mental health and deliver services, with a particular focus on prevention and early intervention thus helping reduce pressures on the specialist CAMHS service. These initiatives include introducing new digital mental health services, improving supports for relevant sports, community and voluntary groups active in this area, and expanding out-of-hours CAMHS provision.
55. Deputy Aindrias Moynihan asked the Minister for Health his plans to lower the number of persons on the waiting list for orthopaedic treatment in County Cork; and if he will make a statement on the matter. [5387/19]
Amharc ar fhreagraImproving access to hospital appointments and procedures is a key commitment of Government.
I hope to publish the Scheduled Care Access Plan 2019 shortly. This plan which is a joint collaboration between my Department, the HSE and the NTPF, will set out commitments aimed at improving access for patients waiting for hospital operations or procedures, as well as patients waiting for a first Outpatient appointment.
The Plan will reflect HSE activity levels, in keeping with the National Service Plan, to reduce waiting times across specialties and improve access to appointments and treatment. It will also set out activity levels for the NTPF in line with their increased allocation of funding totalling €75 million in 2019.
South/South West Hospital Group advise that they continue to work with the hospitals in their group in improving patient access. At the end of December 2018, 81% of orthopaedic patients (381 patients) were waiting less than 9 months for their procedures, while 98% (462 patients) were waiting less than 18 months.
As a result of the continued engagement between South/South West Hospital Group and the NPTF, 250 Orthopaedic patients will be seen in extra Outpatient sessions in 2019. This is a pathway that proved very successful in 2018 where similar additional clinics were used to provide outpatient appointments to 170 of the longest waiting patients.
South/South West have also worked with the NTPF to outsource operations for orthopaedic patients to private providers, and 100 orthopaedic patients were treated through this pathway in 2018.
Other pathways to increase capacity include the use of a musculoskeletal (MSK) physiotherapist. This model of care functions to create more capacity for the Consultants to see the more clinically urgent patients.
Furthermore, the hospitals of South/South West continue to work with the NTPF National Validation office in ensuring that their waiting lists are correct with only patients still requiring their appointments being reported.
56. Deputy Michael Moynihan asked the Minister for Health the action being taken to address and reduce the number of persons under 18 years of age enduring long waits for occupational therapy in counties Cork and Kerry; and if he will make a statement on the matter. [5260/19]
Amharc ar fhreagraI acknowledge that the current time to access occupational therapy services can be too long and that this may cause anxiety for parents and patients who are currently waiting to access services.
That is why the HSE will be prioritising investment in OT in 2019 to reduce waiting times and improve access to services. Across the country, 40 additional OT posts will be recruited by the end of the year, and there will be a focus on addressing those individuals who have been waiting over 52 weeks. In total, HSE’s National Service Plan estimates that over 350,000 primary care occupational therapy patients will be seen in 2019.
It is also anticipated that investment being undertaken locally will significantly improve access for occupational therapy first time assessment for young people in counties Cork and Kerry.
I understand that Cork Kerry Community Healthcare has put in place a Paediatric OT project in line with a National Occupational Therapy Review. This will focus on those waiting over one year for assessment or intervention. Six OTs and one administrative staff member have recently been recruited to support this process. Further, I am informed by the HSE that appointments for those children and young people who are have been waiting for a long period in the region have now commenced on a phased basis and that activity levels are projected to increase significantly by end Quarter 1 2019.
57. Deputy Dara Calleary asked the Minister for Health the initiatives being taken to improve dental and orthodontic services in County Mayo; and if he will make a statement on the matter. [5402/19]
Amharc ar fhreagraDental treatment for medical card holders is provided under the Dental Treatment Services Scheme (DTSS). Services available annually include an examination, two fillings and emergency extractions. More complex care and a broader range of treatments for patients with special needs and high risk patients is also provided, some of which requires prior approval.
Preventive care, screening and necessary interventions for permanent teeth including fillings and extractions as well as referral for orthodontics and other secondary care, where appropriate, are provided for school children mainly in 2nd , 4th and 6th class. Emergency treatment is provided to children up to 16 years of age. Services are also provided for people with special needs and other vulnerable groups.
The provision of services by the HSE Public Dental Service for school children in Mayo is prioritised based on age cohorts. Children in 6th class are the first priority, followed by 2nd and 4th class. The services for some schools are outsourced to private dentists if a HSE service is not available.
The HSE provides orthodontic treatment to children who have the greatest level of need once assessed and referred for treatment before their 16th birthday. The HSE aims to commence treatment for the majority within two years of assessment with priority accorded to cases of greatest clinical need.
The HSE is up to date with 6th class assessments for orthodontics in Mayo. Initiatives planned or in place to improve orthodontic services include:
A designated orthodontic clinic in the new primary care centre in Claremorris since February 2018 providing a 2-day-per-week service.
A new orthodontic consultant and an orthodontic therapist will provide 2 extra clinical days service per week in Claremorris from June 2019.
Services are also provided in Castlebar on 2 days per week and patients from Mayo avail of services in Tuam and Merlin Park, Galway.
58. Deputy Thomas Byrne asked the Minister for Health the steps he is taking to reduce waiting times for speech and language, psychology and occupational therapy services in County Meath. [5404/19]
Amharc ar fhreagraI accept that the current time to access primary care therapy services can be too long and that this may cause anxiety for individuals who are currently waiting to access services.
It is for this reason that the expansion of primary care was prioritised as part of the National Service Planning process for 2019. Overall funding for primary care increased by more than €50m or 6.1%, and this additional resourcing will enable a range of measures to be advanced, including the recruitment of additional nursing and therapy staff. The exact profile of the additional investment at county level is currently being determined in consultation with Community Healthcare Organisations.
In County Meath, there have been a number of initiatives to ensure timely access to primary care services. For example, an additional six SLTs were recruited under a waiting list initiative in 2016, while the county also benefitted from the assignment of five posts under the roll-out of the new Assistant Psychology grade. This will enhance the provision of counselling services to young people, and the HSE has advised that it has already resulted in an increase in referrals screened and the number of interventions offered to families.
Similarly, County Meath has benefitted from additional investment in OT. The OT staffing complement was increased to 2.5 WTE in 2017 and this was supplemented by an interim allocation of a further 3 WTE in 2018. In addition, a service improvement plan has been initiated and has achieved its target of reducing waiting times to maximum of 52 weeks.
59. Deputy Sean Fleming asked the Minister for Health the status of the consultation process on the future of the Midland Regional Hospital, Portlaoise; and if he will make a statement on the matter. [5405/19]
Amharc ar fhreagraI am committed to securing and further developing the role of the Midland Regional Hospital Portlaoise as a constituent hospital within the Dublin Midlands Hospital Group. Since 2014, the focus has been on supporting the hospital to develop and enhance management capability, implementing changes required to address clinical service deficiencies, and incorporating the hospital into the governance structures within the Dublin Midlands Hospital Group.
Significant work has been undertaken to strengthen and stabilise current arrangements for services at the hospital to ensure that services that are not sustainable are discontinued and those that are, are safety assured and adequately resourced. Funding has increased by 35% relative to the 2012 budget and staffing levels have risen by 32% from the 2014 base. Governance and management arrangements in Portlaoise Hospital have been strengthened, additional clinical staff have been appointed and staff training, hospital culture and communications have improved.
As I have outlined previously, no decision has been made yet on the draft Action Plan for Portlaoise Hospital. I committed to ensuring that local clinicians and the community would be consulted with before a decision is made. I have decided that a comprehensive consultation exercise should be undertaken by the HSE, with an external facilitator, with the key stakeholder groups involved in the Portlaoise Hospital. The consultation will involve key stakeholders and local community representatives and provide an opportunity to listen to and address the issues and concerns the stakeholders have highlighted. The consultation will also provide an opportunity to set out clearly the immediate priorities for service development and improvement in the hospital.
I intend to appoint an independent external facilitator for the consultation process in the coming weeks. The outcome of the consultation process will be a submission from my Department, setting out the key findings from the consultation process and recommended response to inform me in making a final decision on the draft Action Plan.
60. Deputy Mick Wallace asked the Minister for Health his views on a possible overmedicalisation of the mental health services; and if he will make a statement on the matter. [5380/19]
Amharc ar fhreagraMental Health is a complex matter requiring a broad range of interests depending on individual patient need. In many cases, medication plays an important part in helping the patient to deal with mental health issues. At the same time, it is necessary to ensure that alternatives, such as talk therapies, are available where needed.
The Government’s commitment to mental health is well documented. Budget 2019 increased mental health funding to €987 million, an increase of €276 since 2012. That is nearly 40% over the period. This additional funding has helped us to develop the range of services available to a person with mental health issues.
The HSE provides a comprehensive range of community-based mental health services. It is committed to the provision of a person-centred approach to the care for each patient. It provides evidence-based psychological interventions that are delivered through Primary Care and where necessary through specialist mental health services. Interventions are tailored to each patient’s individual needs and can include a broad range of interventions that may include psychopharmacological treatments, various forms of psychotherapy including those which have their roots in cognitive behavioural therapies, systemic therapies, psychodynamic therapies etc.
The Government has committed €55 million to Mental Health new developments in 2019, a total of €105 million over the last three years. This will facilitate in providing increased access to talk therapies to improve treatment outcomes for service users. For Children and Adolescents, significant additional funding has been allocated to NGOs, for example Jigsaw, to improve access and early intervention to young people seeking assistance.
In addition, I have worked closely, over the past few years, with the HSE, to introduce new initiatives and ways of working, including digital technologies and early intervention services. These include a dedicated 24-hour signposting telephone line, a crisis text line and tele-psych facilities, which will provide increased talk therapies to patients within the primary care setting and directly to their digital device as is proven to be the preference of many teens and adolescents. I am very focused on building up therapeutic services in the community and trying to get service users to engage with the services at the earliest possible stage of intervention. That is why we have recruited 114 Assistant Psychologists, 20 Psychologists and 10 Assistant Nurse Practitioners to Primary Care services last year.
I have also committed up to €3 million of the new development funding to develop resilience and early intervention programmes. The HSE will work with sports, community and voluntary groups to ensure that services are delivered at community level, where required.
61. Deputy Martin Kenny asked the Minister for Health the number of children waiting to see the school age psychologist in counties Sligo and Leitrim; when the school age psychologist will be in place; and if he will make a statement on the matter. [5173/19]
Amharc ar fhreagraIn Sligo / Leitrim children over the age of six are assessed by HSE School Aged Teams. At present there are 71 children aged between 6 and 17 years on the waiting list to see a psychologist and be assessed for Autism Spectrum Disorder.
In relation to Sligo / Leitrim, plans are currently underway to have assessments for Autism Spectrum Disorder completed by private assessors. With regard to the recruitment of a full time Senior Psychologist for the School Age Team, the HSE has advised that the successful candidate has accepted the post and it is hoped that they will be in place in Q2 2019.
The HSE recognises, that in many parts of the country, the waiting times for access to psychology assessment and therapy services are too long. This can be a source of distress for many parents and families. Several initiatives have been undertaken to address these waiting times.
Funding for an additional 100 therapy posts for children’s disability services was secured as part of Budget 2019. Detailed planning in relation to the location and breakdown of the posts is underway and is expected to be completed shortly.
As the Deputy may be aware, the HSE is actively progressing its reconfiguration of children’s disability services into geographically based teams under the Progressing Disability Services for Children and Young People programme . The objective of this programme is to provide one clear referral pathway for all children irrespective of their disability, where they live or the school they attend.
The additional therapy posts, along with the reconfiguration of services and other innovative approaches will have a significant positive impact on waiting times for therapy services for children.
62. Deputy Thomas P. Broughan asked the Minister for Health the number of reviews requested during January 2019 by persons refused abortion services; the outcome of these reviews; and if he will make a statement on the matter. [4713/19]
Amharc ar fhreagraUnder section 18 of the Health (Regulation of Termination of Pregnancy) Act 2018, the HSE is required to submit a report to the Minister each year on the operation of reviews in the immediately preceding year. The Minister must, as soon as possible after receiving the report, cause copies of the report to be laid before each House of the Oireachtas. The HSE shall then arrange for the report to be published.
No information on reviews carried out under the Act will therefore be released until after the annual report for 2019 has been laid before the Houses of the Oireachtas on or before 30 June 2020.
63. Deputy Kevin O'Keeffe asked the Minister for Health the progress being made to reduce waiting times for orthodontic services in CHO 4. [5410/19]
Amharc ar fhreagraThe HSE provides orthodontic treatment to children who have the greatest level of need and who have been assessed and referred for treatment before their 16th birthday. The HSE aims to commence treatment for the majority of patients within two years of assessment with patients with greatest clinical need being prioritised for treatment.
In Cork Kerry Community Healthcare area (CHO 4) children who are assessed as meeting the criteria to be prioritised for treatment, for example, cleft palate or impacted teeth, commence treatment within one month to a year. Other priority cases commence treatment within 18 to 24 months with routine cases usually commencing treatment within 4 years.
In order to help address long waiting times, in 2016, the HSE procured orthodontic services in primary care from a number of private service providers. Under this initiative, 142 patients in Cork/ Kerry were treated and are coming to the end of their treatment.
Cork Kerry Community Healthcare is working to further improve equity of access to its orthodontic service and reduce waiting lists across Cork and Kerry by the introduction of a centralised waiting list, a new IT system, better patient flow processes and, where appropriate, resource realignment.
64. Deputy John Brady asked the Minister for Health if screening for severe combined immunodeficiency at birth will be introduced similar to that introduced in the United States, Canada and New Zealand with pilot studies being carried out in the Netherlands, the UK and Australia on the same; and if he will make a statement on the matter. [5371/19]
Amharc ar fhreagraSevere combined immunodeficiency (SCID- pronounced “skid”) is a rare but treatable genetic disorder that affects the immune cells in infants. Infants with SCID appear healthy at birth but are highly susceptible to severe infections.
All babies (between 3 and 5 days old) born in Ireland are currently screened for 8 rare but serious medical conditions as part of the National Newborn Bloodspot Screening Programme. However, SCID is not currently screened for as part of this screening programme in Ireland.
As recommended in the Scally Review (2019), a National Screening Committee will be established and become operational before the end of 2019. Similar, to the UK National Screening Committee, their role will be to undertake an independent assessment of the evidence for screening for a particular condition against internationally accepted criteria. Any potential changes to the National Newborn Bloodspot Screening Programme will be incorporated as part of the Committee's work programme.
65. Deputy Brendan Smith asked the Minister for Health the steps being taken to reduce the waiting times for assessments of need under the Disability Act 2005 in counties Cavan and Monaghan; and if he will make a statement on the matter. [5395/19]
Amharc ar fhreagraThe HSE recognises that the waiting times for completing Assessments of Need are excessive in many parts of the country and this is can be a source of distress for many parents and families. Several initiatives have been undertaken to address these waiting times. The HSE has advised that in the case of Cavan and Monaghan a number of Assessments of Need are currently being outsourced to private assessors and this has led to a significant improvement in addressing the backlog.
As the Deputy may be aware, the HSE is actively progressing its reconfiguration of children’s disability services into geographically based teams under the Progressing Disability Services for Children and Young People programme . The objective of this programme is to provide one clear referral pathway for all children irrespective of their disability, where they live or the school they attend.
Children’s Disability Network Managers, who will lead these teams, are central to this successful reconfiguration of services. A large number of these managers are currently in post and the remaining vacancies were advertised late last year. Interviews for these posts were held recently and it is hoped that all of these Network Managers will be in post shortly.
In addition, the HSE are also working actively to reduce waiting times through the development of a standardised assessment process.
Funding for an additional 100 therapy posts for children’s disability services was secured as part of Budget 2019. Detailed planning in relation to the location and breakdown of the posts is underway and is expected to be completed shortly. These additional posts, along with the reconfiguration of services and other innovative approaches will have a significant positive impact on waiting times for Assessment of Need and therapy service delivery.
66. Deputy Eamon Scanlon asked the Minister for Health when a permanent general practitioner service for Carrigallen, County Leitrim, will be in place; and if he will make a statement on the matter. [5254/19]
Amharc ar fhreagraI have been advised by the HSE that the GP post in Carrigallen, Co. Leitrim was offered to the successful candidate and that the candidate has accepted the post. A tentative start date of early May has been agreed.
In line with the HSE protocol for filling such vacancies, the HSE and the candidate must now complete the contractual paperwork, vetting and references. As the candidate is returning from abroad this provides added complexities to progressing these requirements. However at this time the HSE is confident that a permanent GP service will be restored to Carrigallen to fill the current vacancy.
In the meantime, a full time locum GP has been in place in Carrigallen since August 2018 and this arrangement will remain in place until the new GP comes into post.
69. Deputy Bríd Smith asked the Minister for Health if he has had discussions with HSE officials or management on a decision not to recognise a trade union that represents ambulance and paramedic workers; the meetings or discussion with a group of unions (details supplied) in relation to the issue; and if he will make a statement on the matter. [5367/19]
Amharc ar fhreagra88. Deputy Peadar Tóibín asked the Minister for Health if he will direct the HSE to recognise a body (details supplied) as a representative body for ambulance staff. [5130/19]
Amharc ar fhreagra104. Deputy Thomas Pringle asked the Minister for Health his views on recent announcements of strikes by ambulance staff members of unions (details supplied) over the refusal by the HSE to recognise the right of the branch of the unions to represent members and the deduction of union subscriptions at source from their pay; his plans to engage with members of the union in an effort to resolve the impasse; and if he will make a statement on the matter. [5275/19]
Amharc ar fhreagra387. Deputy Maureen O'Sullivan asked the Minister for Health his views on whether he can have a positive role with the HSE in engaging with a union (details supplied); and if he will make a statement on the matter. [5303/19]
Amharc ar fhreagra402. Deputy Joan Collins asked the Minister for Health the reason why the HSE is not recognising a union (details supplied). [5441/19]
Amharc ar fhreagraI propose to take Questions Nos. 69, 88, 104, 387 and 402 together.
SIPTU is the main union recognised by the HSE and has negotiating rights for front-line ambulance grades employed by the Executive. Unite and FORSA also represent some ambulance grades. As a result, the HSE deducts subscriptions at source for those ambulance staff that are members of those unions. However, the National Ambulance Service Representative Association (NASRA) is not recognised by the HSE and, therefore, does not have negotiating rights.
Whilst individuals have a right to membership of any trade union, if they choose to join an association which is not recognised by their employer, such membership is not facilitated by their employer. This means that the HSE does not facilitate the deduction of union subscriptions for this particular Association.
While it is regrettable that the PNA has taken industrial action, it is not possible to negotiate with a union which is not recognised as having negotiating rights for ambulance grades. In terms of the Deputy's query in relation to discussions, I can advise that Department officials have been in regular contact with their HSE counterparts. My Department is aware of the situation and supports the HSE's position. My Department has not been involved in meetings with ICTU in relation to this matter.
70. Deputy Marc MacSharry asked the Minister for Health if health capital projects in County Sligo will be delayed by the overrun in the costs of the new children’s hospital. [5399/19]
Amharc ar fhreagraThe Health Service Executive is currently developing its Capital Plan for 2019. The HSE Capital Plan will determine the projects that can progress in 2019 and beyond having regard to the available capital funding, the number of large national capital projects currently underway and the relevant priority of each project. The requirements of the new children's hospital and other health capital projects, currently at various stages of development, are being considered as part of this process. Once the HSE has finalised its Capital Plan for 2019, it will then be submitted to me for consideration.
71. Deputy Brendan Smith asked the Minister for Health the action being taken to address waiting times for orthopaedic procedures in the north east; and if he will make a statement on the matter. [5396/19]
Amharc ar fhreagraImproving waiting times for hospital procedures is a key commitment in the Programme for Government and €75 million was allocated to the National Treatment Purchase Fund (NTPF) in Budget 2019 to provide treatment for patients.
I hope to publish the joint Department of Health/HSE/NTPF Scheduled Care Access Plan 2019 for inpatient, day case and outpatients shortly. The plan will ensure an appropriate balance between high volume activities and offering treatment to complex long-waiting patients. It will reflect activity targets from the HSE, in line with the National Service Plan, to reduce waiting times across specialties and improve access to appointments and procedures. The plan will also set out activity levels for the NTPF in line with their increased allocation of funding in 2019.
The NTPF will deliver this activity through working with hospital groups and individual hospitals as well as private health providers to maximise the number of patients treated in both public and private capacity. Under the Plan the NTPF has committed to make offers of treatment to patients waiting for one of 75 hospital procedures, which will include orthopaedics. The longest waiting patients who are clinically suitable for outsourcing for one of these targeted procedures will be offered treatment in 2019.
72. Deputy Jack Chambers asked the Minister for Health if he will report on the relocation of the Rotunda Hospital to Connolly Hospital. [5249/19]
Amharc ar fhreagraThe model of stand-alone maternity hospitals is not the norm internationally. In line with the National Maternity Strategy, Government policy is to co-locate all remaining maternity hospitals with adult acute services in order to provide optimal clinical outcomes. Co-location of maternity services with adult services provides mothers with access to a full range of medical and support services should the need arise. The availability of these services helps ensure the delivery of an optimum, safe service, particularly for high risk mothers and babies.
Project Ireland 2040 and the National Development Plan 2018-2027 support the implementation of the National Maternity Strategy, including the relocation of the Rotunda. I have been advised that the Rotunda hospital has prepared a Design Brief for the new facility. In addition, a Development Control Plan for the Connolly campus has been drafted to support the orderly development of future capital projects on that campus, including the Maternity Hospital. As the Rotunda relocation proposal is at an early development stage, I am not in a position to provide any indicative time frames for completion at this time.
73. Deputy Bobby Aylward asked the Minister for Health his plans to improve and enhance cardiac care services for those living in the south east; if he believes there is an equal provision of cardiac services in the region in comparison to the rest of the country; and if he will make a statement on the matter. [5378/19]
Amharc ar fhreagraIn 2016, the Herity Report concluded that the needs of the effective catchment population of University Hospital Waterford (UHW) could be accommodated from a single cath lab and recommended that the operating hours of the existing cath lab should be extended. Approval and funding has been provided for the additional staff required to facilitate this service expansion and five staff (Grade IV Admin, Porter, Senior Cardiac Physiologist, Senior Radiographer and Staff Nurse) have now been recruited on an 8am to 8pm working day basis. Furthermore, the recruitment of a cardiologist to facilitate an increase in the operating hours of the existing cath lab is also being progressed by the HSE.
A mobile cath lab has also been deployed at UHW since October 2017 to conduct diagnostic cardiac procedures.
I remain committed to the provision of a second cath lab in University Hospital Waterford. The cost of progressing the project to design, planning and construction stages will be addressed in the context of the HSE’s Capital Plan for 2019, which is currently being finalised.
The Herity Report also recommended that the current 9 to 5 provision of emergency pPCI services should cease to allow the hospital focus on the much larger volume of planned work. I asked my Department to address the implications of this recommendation by arranging for a National Review of Specialist Cardiac Services. The aim of this Review is to achieve optimal patient outcomes at population level with particular emphasis on the safety, quality and sustainability of the services that patients receive by establishing the need for an optimal configuration of a national adult cardiac service.
