Written Answers Nos. 74-93
74. Deputy Clare Daly asked the Minister for Health when community midwifery support will be rolled out for women giving birth in the days immediately following birth once they are discharged from hospital. [5342/19]
Amharc ar fhreagraThe National Maternity Strategy proposes the development of a community midwifery service where hospital midwives, working as part of a multidisciplinary team, provide antenatal and postnatal care in the community. Implementation of the Strategy is being led by the National Women & Infants Health Programme.
Regarding the Deputy's specific query, I have asked the HSE to reply to you directly.
75. Deputy Niamh Smyth asked the Minister for Health the status of the ongoing respite crisis being experienced by families in counties Cavan and Monaghan; and if he will make a statement on the matter. [5265/19]
Amharc ar fhreagraThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
The Programme for Partnership Government states that the Government wishes to provide more accessible respite care to facilitate full support for people with a disability.
As the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
76. Deputy David Cullinane asked the Minister for Health the status of €4.75 million funding announced in November 2018 for the construction of a second cardiac catheterisation laboratory at University Hospital Waterford; if it will be impacted by the proposed cuts in capital funding by the HSE as a result of the cost overrun in the construction of the new national children’s hospital; and if it is to proceed, the timeline of delivery. [5389/19]
Amharc ar fhreagraFollowing the publication of the Health Service Executive's National Service Plan for 2019, the HSE is currently developing its Capital Plan for 2019. The HSE Capital Plan will determine the projects that can progress in 2019 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 University Hospital Waterford 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.
77. Deputy Louise O'Reilly asked the Minister for Health the status of the negotiations for a new general practitioner contract; the number of meetings held in 2018 regarding the new contract; and if he will make a statement on the matter. [5312/19]
Amharc ar fhreagraThe Government is committed to engaging with GP representatives on the development of modernised GP contractual arrangements.
Talks between the State and the Irish Medical Organisation resumed in October 2018 and there was intensive engagement, particularly in the weeks leading up to Christmas. While some progress was made, there are a number of outstanding issues that need to be progressed before any agreement can be secured.
The State’s negotiating team is keen to bring a renewed focus to the engagement with the IMO and talks are continuing in an effort to bring matters to a conclusion.
I look forward to positive and productive engagement with all parties concerned. Agreement on the delivery of service improvements and contractual reform would facilitate a very substantial increase in the resourcing of general practice on a multi annual basis.
In line with the long-established approach to such processes, and by agreement of the parties concerned, I am not in a position to give further details while engagement between the parties is under way.
78. Deputy Niamh Smyth asked the Minister for Health his plans to address the waiting times under the HSE for assessments of needs for children with disabilities; and if he will make a statement on the matter. [5212/19]
Amharc ar fhreagraThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
As the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
79. Deputy Thomas Pringle asked the Minister for Health the status of the role of a third party due to take over the running of services at a respite home (details supplied) in County Donegal; when the third party will commence managing the services at the home; the level of involvement the HSE will continue to have once the third party takes over; and if he will make a statement on the matter. [5276/19]
Amharc ar fhreagraThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
The Programme for Partnership Government states that the Government wishes to provide more accessible respite care to facilitate full support for people with a disability.
As the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
80. Deputy Eugene Murphy asked the Minister for Health if HSE funding will be ring-fenced for the provision of care for Alzheimer's sufferers in County Roscommon by funding two full days respite in the Sacred Heart Hospital, Roscommon during weekend periods (details supplied); and if he will make a statement on the matter. [4986/19]
Amharc ar fhreagraAs a response to the challenges facing people with dementia and their families and carers, the National Dementia Strategy was launched in December 2014. The Strategy seeks to change the attitudes of wider society towards dementia and ensure that people with dementia can continue to live well and participate in their communities. It recognises that, with the right supports and services, people with dementia can live long, fulfilling lives after a diagnosis.
To support future development of services and supports for people with dementia, the National Dementia Office and the Alzheimer Society of Ireland undertook a joint project in 2016 and 2017 to map dementia-specific community-based services across the country. Information from the project is included in an on-line service finder on the Understand Together website so people can find out what services are available in each county.
Gaps remain in access to services and there is a large variance in what services are provided across the country. The National Dementia Office has met with senior HSE officials in each CHO area to highlight service gaps in each area and to provide guidance and support on dementia service planning and development across the country. In addition a Dementia Needs Analysis Framework was developed to support services.
Officials in the Department of Health have raised the provision of dementia services in Co. Roscommon with the HSE. The HSE has advised that its Head of Finance in Community Healthcare West met a delegation from Western Alzheimer's on 24th January concerning the annual Service Level Agreement between the parties. The proposal for the provision of day respite in the Sacred Heart Hospital will be considered as part of the Service Level Agreement process.
The Department of Health and the HSE are working to ensure that a range of community services and supports are made available for people with dementia across the country, subject to the availability of additional resources, and cognisant of the large number of areas competing for finite resources. The National Dementia Office is also working to ensure that existing community health and social care services are optimised to meet the needs of people with dementia.
81. Deputy Pearse Doherty asked the Minister for Health the progress made to secure a permanent second consultant breast surgeon at Letterkenny University Hospital, County Donegal; and if he will make a statement on the matter. [5125/19]
Amharc ar fhreagraThe requirements of the Symptomatic Breast Disease clinic in Letterkenny University Hospital continue to be kept under review to ensure that arrangements are in place to meet the present and future needs of the service.
I advise that a second breast surgeon post on a locum basis is currently assigned to Letterkenny University Hospital.
82. Deputy Catherine Connolly asked the Minister for Health the outcome of the evaluation of the implementation process for the single assessment tool; if a copy of the report will be provided; the status of the roll-out of the single assessment tool nationally; and if he will make a statement on the matter. [5337/19]
Amharc ar fhreagraThe Single Assessment Tool is a comprehensive IT based standardised assessment used to assess the health and social care needs of people (primarily those over the age of 65 years) who may be looking for home care or long-term care support from the HSE. The SAT uses the interRAI assessment system.
InterRAI is a not-for-profit organisation consisting of a collaborative network of clinicians and researchers in over 30 countries, including Canada, USA, Australia, Belgium, Spain, France, Switzerland, Germany and New Zealand.
The interRAI Home Care assessments which are being implemented in Ireland are designed for use with older people in the home, in acute care, and other community-based settings. The implementation of a standardised assessment which guides and informs care planning also facilitates equity and transparency.
A national pilot of the SAT interRAI project was conducted in three locations from May 2016 to April 2017 Beaumont Hospital; Tallaght Hospital and University Galway Hospital. Multidisciplinary staff in these hospitals were nominated and trained to become SAT assessors. Training for other staff members who required knowledge of the system and would be using the information but not completing assessments was also provided in the three locations. Almost 600 assessments were completed by the assessors with older people in the three locations during the pilot. A pilot report was completed in December 2017. This report is available and I have attached a copy for the Deputy.
The project is being implemented nationally since the conclusion of the pilot. InterRAI assessments are being implemented nationally for older people who are seeking access to Home Support Services and to the Nursing Home Support Scheme, so that care is provided in the most appropriate setting based on the individual’s identified needs.
The current contract with the IT Vendor supporting the system is about to conclude and a new procurement process is already underway to source an IT Vendor for the continued implementation of SAT interRAI assessment system.
To date, the progress on the roll out is as follows:
- SAT Clinical leads have been recruited and are in place in 6 of the 9 CHOs, with the recruitment process almost complete in 2018 in the remaining CHOs. A Train the Trainer approach is in place with Clinical leads providing training to assessors (clinicians) and non- assessors (other healthcare personnel) on the use of the interRAI system in clinical practice;
- Nationally 140 assessors and 602 non-assessors have been trained to use the interRAI SAT system. A further 1402 staff have attended information sessions;
- Over 3,000 older people in both community and hospital locations have received interRAI assessments.
Further information on the programme is contained in the following link:
83. Deputy Stephen S. Donnelly asked the Minister for Health the schedule of all costs, subsequent changes to costs and current projected costs associated with the national children's hospital from initial tenders to date; the details of costs covered by the development board (details supplied) and the Children's hospital group and other associated costs; and if he will make a statement on the matter. [5394/19]
Amharc ar fhreagraFollowing evaluation by the National Paediatric Hospital Development Board (NPHDB) in early 2017 of main construction tenders and the selection of preferred contractors, the final cost of the design, build, and equipment programme for which the NPHDB is responsible was €983m. Following the completion of the second stage of the two-stage tender procurement process in November 2018, the capital project cost is now at €1,433m.
In addition to the capital project, there is a broader programme of activity associated with the integration and transfer of the services of the three children’s hospitals to the new sites under development. This includes a comprehensive Children’s Hospital Integration Programme which is well underway, funded through revenue, to ensure the successful clinical and operational merging of three paediatric hospitals; investment in ICT and the Electronic Health Record roll-out funding through the ICT capital programme; pre-2013 project expenditure relating to the former Mater project, and the planned construction of the Children’s Research and Innovation Centre to be funded through philanthropic funding. Costs relating to decommissioning of the three hospitals are not included. Neither have future uses for the hospital premises at Temple Street and Crumlin or potential revenues for the latter been determined. Adult services will be provided in Tallaght Hospital in the spaces vacated by the paediatric services.
The following table sets out the breakdown of costs from initial tenders and following the completion of the two-stage tender procurement process.
In relation to the reporting of the cost escalation, I was first advised by my officials in September 2017 of a costs estimate increase of €61m associated with additional sprinklers, post tender programme alignment and the cost of the OPD Urgent Care Centre at Tallaght with assurance that developments were being carefully managed. The NPHDB was advised to identify savings within its approved capital budget and seek to offset the potential cost increases through a variety of measures with a view to managing the project within approved parameters. It was the subject of detailed discussion and intensive monitoring.
I was briefed on a potential cost escalation for the project on 27 August 2018 following a meeting of my officials and the Chair and Executive Director of the NPHDB on 24 August 2018.
On completion of the Guaranteed Maximum Price process, the NPHDB informed my officials of the revised cost of €1.433bn on 8 November 2018, and I was subsequently briefed on 9 November on the emerging position.
On 9 November, the cost escalation was highlighted at a meeting with the Taoiseach. It was agreed that further details would be provided in a formal way to the Department of Public Expenditure and Reform and to the Department of the Taoiseach prior to Government consideration. Officials in the Department of the Taoiseach were briefed on 21 November and on 13 December, and the Taoiseach’s adviser was briefed on 26 November.
My Department submitted a report from the National Paediatric Hospital Development Board on the cost overrun and the reasons for it to the Department of Public Expenditure and Reform on the 19th November and met with officials of that Department to discuss it on the 23 November.
The draft Government Memo was shared with the Department of Public Expenditure and Reform and the Department of the Taoiseach in early December and was submitted to Cabinet for its meeting on 18 December 2018.
New Children's Hospital Construction and Non-construction Costs
- 2017 costs as per Government approval of €983m following receipt of tenders
- 2018 costs following completion of GMP process in November 2018
|
Item |
2017 Costs €m |
2018 Costs €m |
|
Decant |
16 |
14.5 |
|
Aspergillus |
6.8 |
5.8 |
|
Main NCH |
637 |
890 |
|
Less VE |
-66 |
|
|
Net Main NCH Construction |
571 |
890 |
|
Outpatient and Urgent Care Centres |
38 |
53.4 |
|
Sub Total |
631.8 |
963.7 |
|
VAT |
85.3 |
130.1 |
|
Gross Construction Costs |
717.1 |
1093.8 |
|
Equipping |
71.6 |
87.9 |
|
Planning |
14.9 |
13.6 |
|
Design Team fees |
43.7 |
71.3 |
|
Risk/Contingency |
39 |
51.3 |
|
NPH Project Costs |
52 |
66.04 |
|
Other Costs Sub Total |
221.1 |
290.1 |
|
VAT (excluding Construction) |
44.7 |
49 |
|
Sub Total Gross Other Costs |
265.9 |
339.1 |
|
Capital Build Sub Total |
983 |
1.433bn |
|
Children's Research and Innovation Centre |
18 |
18 |
|
ICT |
88 |
97 |
|
Children’s Hospital Integration Programme |
86 |
86 |
|
Electronic Healthcare Record |
52 |
52 |
|
Mater Campus |
40 |
40 |
|
Sub Total |
284 |
293 |
|
Grand Total |
1.26bn |
1.7bn |
84. Deputy Brian Stanley asked the Minister for Health the steps taken to address the crisis in recruitment and retention in public hospitals. [5028/19]
Amharc ar fhreagraNotwithstanding significant recruitment and retention challenges, including global shortages, considerable progress has been made in the past five years in growing the numbers of front-line staff working in the public health services, including doctors and nurses, as additional resources have become available.
During 2018, the HSE increased the number of nurses and midwives employed by 867 WTEs (including student nurses) in 2018. Recent pay proposals put forward were a positive step towards making the public health service a more attractive place to work for nurses and midwives.
With regard to consultants, numbers have increased by 125 in the 12 months ending December 2018 to 3,096 whole time equivalents, and by 540 in the 5 years since December 2013. The number of NCHDS has increased by 221 in the 12 months ending December 2018 to 6,552 whole time equivalents, and by 1,544 in the 5 years since December 2013. It is recognised that retention of doctors is critical to the future growth of the medical workforce.
In relation to NCHDs, working is continuing on implementing recommendations made by the MacCraith Group with a focus on certain key recommendations including protected training time, the position of doctors not holding training posts and better coverage of training costs incurred by NCHDs. The HSE's Service Plan for 2019 includes an additional €5 million for meeting training costs incurred by NCHDs in 2019, increasing to €10 million in 2020.
The Public Sector Pay Commission identified difficulties in attracting consultant applications for many posts at present and acknowledged that the pay rates for new entrants had been highlighted as a factor in this. Given its analysis, the Pay Commission proposed that the Parties to the Public Service Stability Agreement jointly consider what further measures could be taken, over time, to address the pay differential between pre-existing consultants and new entrant consultants which has increased following the settlement of the 2008 Consultant Contract claim.
The Department of Public Expenditure and Reform and the Department of Health have noted the Commission's views and consideration will need to be given to potential solutions which are in line with public sector pay policy and available budgets. This will be a significant challenge given the amounts involved.
85. Deputy Mick Wallace asked the Minister for Health his plans to increase the use of talk therapies as part of mental health care; and if he will make a statement on the matter. [5379/19]
Amharc ar fhreagraPsychology services, along with psychotherapy and related talk therapies can play an important role in assisting those presenting with mental health issues, and can work alongside medical intervention, or in some cases can help people to deal with issues without the requirement for medication.
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 a wide range of talking therapies and interventions in both CAMHS and adult mental health services including specialist cognitive behavioural therapy, behavioural family therapy and dialectical behavioural therapy.
The HSE provides talk therapies at primary care level, including Counselling in Primary Care, the National Counselling Service, and primary care psychology services. These services have been enhanced recently through the recruitment of assistant psychologists in primary care. The HSE also employs counsellors/ therapists/ psychologists in primary care addiction services. In addition to HSE services, other agencies are also funded by the HSE to provide talking therapies including Jigsaw, MyMind, Turn2Me and Pieta House.
In order to ensure greater consistency and equity of access to talk therapies, HSE Mental Health commenced a service improvement project in January 2018 with a view to developing a Model of Care for adults who access talk therapies while attending specialist mental health services. While the project focuses specifically on adults attending specialist mental health services, it will also reference other services where talk therapies are currently provided from HSE funding.
Building on a stepped care approach, the Model of Care is expected to involve an assessment of the need for talking therapies taking into account stakeholder perspectives and the prevalence of mental health disorders within the adult population. It will consider evidence-based talking therapies best-suited to meet the identified needs, and outline a recommended operational model for talking therapies provided by General Adult Community Mental Health Teams.
In addition, Minister Daly has prioritised the introduction of new digital talk therapies and has agreed various pilot projects with the HSE. Online counselling, crisis text services and pilot tele-psychiatric services will provide additional services to a wider target audience. Should the pilot projects be evaluated positively, a national roll out will support many more individuals access talk therapies online.
86. Deputy John Lahart asked the Minister for Health the reason 6,251 children have been waiting for an outpatient consultation in the three Dublin children's hospitals since before 1 January 2017. [5248/19]
Amharc ar fhreagraI am conscious that waiting times are often unacceptably long and of the burden that this places on patients and their families. Improving waiting times for hospital appointments and procedures is one of my top priorities and is a key commitment in the Programme for Government.
I hope to publish the joint Department of Health, HSE, NTPF Scheduled Care Access Plan 2019 shortly. This 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.
A key element of this Plan is the stabilisation of the Outpatient Waiting List which remains a significant challenge. The HSE, in line with the National Service Plan 2019 will provide 3.3 million outpatient appointments, more than 1 million of which will be first outpatient appointments.
In 2019, the HSE will focus in particular on specialties with a high volume of referrals and large proportions of long-waiting patients including ENT and Dermatology. In addition, the NTPF, with an increased allocation of €75million in 2019, will fund an additional 40,000 first outpatient appointments through weekend and out of hour’s clinics and ‘see and treat’ clinics.
The NTPF will deliver this additional activity by working with hospital groups and individual hospitals as well as private health providers to maximise the number of patients treated in both a public and private capacity. In this context, in 2018 the NTPF approved 504 Outpatient appointments for Temple Street as part of an initiative to support implementation of an extended working day in the hospital. The NTPF have also met with Children’s Health Ireland (CHI) to review Outpatient proposals covering the specialties of Cardiology, Ophthalmology, and Dental Surgery.
The CHI advises that it has implemented a number of new and innovative initiatives to improve access to outpatient appointments for patients across a range of specialties including cardiology, dermatology, and orthopaedics. This includes additional clinics in ENT and dermatology, the appointment of additional staff in general paediatrics and ophthalmology, and the use of virtual assessment clinics for rheumatology.
In addition, the establishment of the Outpatient and Urgent Care Centre at Connolly Hospital in 2019 will result in 6,350 outpatient appointments being issued for the new facility next year, with projected full year outpatient attendance of 15,240 in subsequent years.
87. Deputy Catherine Connolly asked the Minister for Health the projects that will be delayed or deferred due to overruns on the capital project by the National Children’s Hospital; and if he will make a statement on the matter. [5333/19]
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.
89. Deputy Jackie Cahill asked the Minister for Health when the fair deal changes for farming families will be brought forward; and if he will make a statement on the matter. [5270/19]
Amharc ar fhreagraThe proposed policy change to the Nursing Homes Support Scheme (NHSS), to cap contributions from farm assets at 3 years where a family successor commits to working the productive asset, has been approved by Government. My Department is working on the development of draft Heads of Bill while considering a number of complex ancillary policy and operational matters which may need to be addressed in the proposed legislation.
It is intended that this proposed policy change, the 3 year cap, will be extended to eligible existing participants in long term residential care so that they are not disadvantaged, but that there would be no retrospective recoupment of contributions for those who have paid contributions over and above the 3 year period.
A draft General Scheme of a Bill is currently with legal advisers for advice and legal quality control review. Subject to legal advice, I expect to bring the heads of bill to Government soon. The changes to the Scheme will come into effect in 2019 subject to the legislative process.
90. Deputy Bríd Smith asked the Minister for Health the cost to the HSE of its use of agency staff in all nursing grades since 2010; the projected costs for 2019, if available; the number of vacancies for full-time positions for nurses and midwives in the public hospital system; and if he will make a statement on the matter. [5369/19]
Amharc ar fhreagraI have asked the HSE to respond directly to the Deputy on this.
91. Deputy Gino Kenny asked the Minister for Health his views on the fact that the new standard operating procedure for the assessment of need does not require the HSE to diagnose a child at the assessment of need stage (details supplied); and if he will make a statement on the matter. [52346/18]
Amharc ar fhreagraThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
As the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
92. Deputy Margaret Murphy O'Mahony asked the Minister for Health the action he is taking to address the disparity in the provision of respite care nationwide; and if he will make a statement on the matter. [5246/19]
Amharc ar fhreagraThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
The Programme for Partnership Government states that the Government wishes to provide more accessible respite care to facilitate full support for people with a disability.
As the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
93. Deputy Gino Kenny asked the Minister for Health the steps he will take to ensure that the HSE rectifies the undue and excessive delays in completing proper and lawful assessment of needs for children with disabilities in view of the fact that the ongoing failure to provide these services is perceived to be a failure to respect children’s rights under Article 8 of the European Convention of Human Rights; and if he will make a statement on the matter. [52342/18]
Amharc ar fhreagraThe Government is committed to providing services and supports for people with disabilities which will empower them to live independent lives, provide greater independence in accessing the services they choose, and enhance their ability to tailor the supports required to meet their needs and plan their lives. This commitment is outlined in the Programme for Partnership Government, which is guided by two principles: equality of opportunity and improving the quality of life for people with disabilities.
As the Deputy's question relates to service matters, I have arranged for the question to be referred to the Health Service Executive (HSE) for direct reply to the Deputy.
