James Lawless
Ceist:62. Deputy James Lawless asked the Minister for Health the reason for the significant overcrowding in the emergency department in Naas General Hospital during 2019. [20827/19]
Amharc ar fhreagraHospital Overcrowding
Ceisteanna (62)
Freagraí scríofa
The Winter Plan 2018/19, recognising the multiple factors across the health service that impact on Emergency Department performance, included a range of measures to support patients accessing services in the community and in hospitals. Planning for Winter 2019/20 has already commenced, with a review of performance over the Winter Period currently underway to ensure that the lessons learned from this year inform future plans.
With regard to Naas General Hospital, for the first quarter of 2019, in comparison to 2018, the number of patients attending the Emergency Department increased by 4.7% and the number of patients admitted increased by 19.2%. However, the number of patients recorded on trolleys at 8am reduced by 26.2%.
Unfortunately, the improved trolley performance did not continue into April and provisional TrolleyGAR data highlights that the number of patients waiting on trolleys in Naas General Hospital increased from 439 in April 2018 to 478 in April 2019.
Data in relation to attendance and admissions for April is not available at this time. However, the HSE has advised that hospitals are reporting very high levels of demand, high patient acuity and high bed occupancy, especially in the over 75-year old cohort of patients. In addition, delayed discharges are above the expected activity threshold set out in the National Service Plan and Hospitals and Community Health Organisations are reporting constrained options for supported discharges, particularly in relation to home support and long-term care.
Building upon the actions in the Winter Plan, and to meet the ongoing operational challenges, robust planning arrangements were put in place for the Easter and May bank holiday weekends by Hospital Groups and Community Health Organisations, and efforts are continuing to build upon the improved performance achieved nationally and in Naas General Hospital in the first three months of the year.
Maternity Services
Ceisteanna (63)
Clare Daly
Ceist:63. Deputy Clare Daly asked the Minister for Health his views on whether the rate of induction of first-time mothers here is too high; and if he will make a statement on the matter. [20839/19]
Amharc ar fhreagraFreagraí scríofa
It is important to note that there is no defined “correct rate” for the induction of labour, rather the decision to induce is always a clinical decision taken in consultation with the woman. Such decisions would be based on the individual circumstances that have arisen and the decision would be arrived at after careful consideration of the relevant factors.
However, as your query relates to service provision, I have asked the HSE to reply to you directly with any additional information that might be available.
National Children's Hospital Administration
Ceisteanna (64)
Mick Wallace
Ceist:64. Deputy Mick Wallace asked the Minister for Health the governance structure changes he expects to make to the national children's hospital board with regard to the overall oversight of the project; and if he will make a statement on the matter. [20886/19]
Amharc ar fhreagraFreagraí scríofa
An independent review into the cost escalation associated with the new children’s hospital construction project was commissioned to understand the reasons for the cost escalation, with the primary focus of the review being on the governance and management arrangements in place within and between the National Paediatric Hospital Development Board (NPHDB) and Executive, Design Team, relevant consultants, user groups and contractors, and so as to inform any governance or other changes required.
The review report, the "New Children's Hospital Independent Review of escalation in costs", published on 9 April 2019, synthesises the findings of the review into a concise set of recommendations, including recommendations relating to the need for enhanced project processes and governance arrangements to ensure successful project delivery against defined parameters. Any changes to the governance structures in response to the recommendations will take account of the findings of the Report. The Minister for Public Expenditure and I are to revert to Government with a plan for implementing the recommendations, including management and oversight arrangements for the new children's hospital project, and I expect that we will do so shortly. When the Plan is approved by Government, it will be published.
Long-Term Illness Scheme Coverage
Ceisteanna (65)
Thomas P. Broughan
Ceist:65. Deputy Thomas P. Broughan asked the Minister for Health if he will report on the review of the long-term illness scheme; his views on whether the scheme needs to be more inclusive of other disease areas in addition to the current 16 specified long-term illness medical conditions; and if he will make a statement on the matter. [20496/19]
Amharc ar fhreagraFreagraí scríofa
The LTI Scheme was established under Section 59(3) of the Health Act 1970 (as amended). The conditions covered by the LTI are: acute leukaemia; mental handicap; cerebral palsy; mental illness (in a person under 16); cystic fibrosis; multiple sclerosis; diabetes insipidus; muscular dystrophies; diabetes mellitus; parkinsonism; epilepsy; phenylketonuria; haemophilia; spina bifida; hydrocephalus; and conditions arising from the use of thalidomide.
Under the LTI Scheme, patients receive drugs, medicines, and medical and surgical appliances directly related to the treatment of their illness, free of charge.
There are no plans to extend the list of conditions covered by the Scheme at this time. However, I wish to inform the Deputy that the LTI Scheme will be included as part of a review of the current eligibility framework, including the basis for existing hospital and medication charges, to be carried out under commitments given in the Sláintecare Implementation Strategy.
For people who are not eligible for the LTI Scheme, there are other arrangements which protect them from excessive medicine costs.
Under the Drug Payment Scheme, no individual or family pays more than €124 a month towards the cost of approved prescribed medicines. The scheme significantly reduces the cost burden for families and individuals with ongoing expenditure on medicines.
People who cannot, without undue hardship, arrange for the provision of medical services for themselves and their dependants may be entitled to a medical card. In the assessment process, the HSE can take into account medical costs incurred by an individual or a family.
People who are not eligible for a medical card may still be able to avail of a GP visit card, which covers the cost of GP consultations.
National Maternity Strategy Implementation
Ceisteanna (66)
Stephen Donnelly
Ceist:66. Deputy Stephen Donnelly asked the Minister for Health the reason there has been a lack of progress in rolling out the national maternity strategy; and if he will make a statement on the matter. [20746/19]
Amharc ar fhreagraFreagraí scríofa
Ireland’s first National Maternity Strategy was published in 2016 and is currently being implemented on a phased basis by the National Women & Infants Health Programme (NWIHP) in the HSE. Realising the vision articulated in the Strategy requires a fundamental restructuring of maternity service delivery, as well as significant investment over the lifetime of the Strategy. This work is ongoing and considerable progress has been made to date to implement the Strategy’s recommendations.
The significant funding provided to the NWIHP has helped in this regard by increasing capacity through the recruitment of additional midwives, consultants, theatre staff, ultrasonographers and Quality and Safety managers across the service. In 2016, the year the Strategy was launched, development funding of €3m was provided for maternity services. This was followed by increased funding of €6.8m in 2017. In 2018, €4.15m development funding was allocated to the NWIHP to progress the Strategy. Funding of €3.1m is being made available to the NWIHP in 2019 to continue services introduced in 2018, along with an additional €1m funding to further progress the Strategy.
As a result of the investment in maternity services made since the launch of the Strategy, more women and their families are being offered midwifery led care, with many of our maternity hospitals and units now providing home-away-from-home suites and community-based midwifery services. Bereavement teams have been established in all maternity hospitals and units and are providing compassionate care to women and families, in line with the National Standards for Bereavement Care following Pregnancy Loss and Perinatal Death. In addition, the expansion of anomaly scanning services is continuing, and 15 hospitals now offer routine scans to women, up from 7 in 2016. Other significant progress includes the design and roll out of safety frameworks, including the establishment of Serious Incident Management Teams at hospital group level, the design and trial of a Maternity Event Review Tool and the completion of Phase 1 of the Maternal and Newborn Clinical Management System. My Department will continue to work with the NWIHP in 2019 to support the ongoing implementation of the National Maternity Strategy.
Question No. 67 answered with Question No. 60.
Nursing Homes Support Scheme Review
Ceisteanna (68)
Jackie Cahill
Ceist:68. Deputy Jackie Cahill asked the Minister for Health the status of changes to the fair deal scheme as regards farming families; and if he will make a statement on the matter. [20818/19]
Amharc ar fhreagraFreagraí scríofa
The proposed policy change to the Nursing Homes Support Scheme (NHSS), to cap contributions based on farm and business 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.
The General Scheme of a Bill has been drafted and we are currently working closely with legal advisers on advice and legal quality control. The focus on matters relating to Brexit, including planning and preparing in a legal and legislative context, has unfortunately had an impact on progressing the Heads of Bill. However, subject to legal advice, I expect to bring the Heads of Bill to Government this month. The changes to the Scheme will come into effect in 2019 subject to the legislative process.
Abortion Legislation
Ceisteanna (69)
Louise O'Reilly
Ceist:69. Deputy Louise O'Reilly asked the Minister for Health when the legislation for exclusion zones is expected to be ready in order to protect women from harassment, deception and coercion with the aim of obstructing healthcare. [20835/19]
Amharc ar fhreagraFreagraí scríofa
As the Deputy is aware, it is my intention to introduce legislation to ensure safe access to premises in which termination of pregnancy services may be provided.
It was originally intended to provide for safe access in the Health (Regulation of Termination of Pregnancy) Act 2018, but a number of legal issues were identified during the drafting process. In order to allow full consideration of these issues, and so that the publication of the Health (Regulation of Termination of Pregnancy) Bill would not be delayed, last September the Government approved the drafting of a separate legislation on safe access to health services.
Officials in my Department are working with the Office of the Attorney General on this legislation with the intention of having legislative proposals drafted by the summer.
Hospital Overcrowding
Ceisteanna (70)
Maurice Quinlivan
Ceist:70. Deputy Maurice Quinlivan asked the Minister for Health the action he has taken to address the overcrowding situation in University Hospital Limerick further to correspondence he received from seven County Limerick and mid-west Deputies; and if he will make a statement on the matter. [20845/19]
Amharc ar fhreagraFreagraí scríofa
I am committed to tackling the key challenges our health service faces in relation to long waiting times and hospital overcrowding. Improving timely access to care for patients is at the heart of Sláintecare. Building upon the progress made in recent years in this area, the Sláintecare Action Plan 2019 published by my Department, includes a specific work stream on Access and Waiting Lists.
Progress has already been made in implementing the Sláintecare Action Plan Waiting List and Access actions this year.
With regard to unscheduled care, the Winter Plan 2018/19 was designed to ensure that the Health system was well prepared, within existing financial and capacity requirements, to meet the increased demand for services over the Winter period.
University Hospital Limerick is one of the busiest in the country and the hospital and CHO Mid West were identified as one of the 9 focus sites requiring additional investment, focus and support this Winter. This support included additional home support packages and transitional care beds, additional bed capacity and access to diagnostics. At local level the Hospital Group have also taken a range of additional actions and I have referred this question to the HSE for direct reply to you on these actions.
The Health Service Capacity Review published last year, highlighted the need for a major investment in additional capacity. Progress has also been made on increasing capacity in UHL and the average number of open inpatient beds has increased by 4% between 2017 and March 2019 to 438. Significant further investment is planned with a capital budget of €19.5 million approved for the provision of a modular 60-bed inpatient ward block at UHL, with €10 million of this funding allocated in 2019. Enabling works commenced in March 2019, and the HSE advise that the main works are expected to start at the end of May 2019.
In addition, the National Development Plan includes a 96-bed replacement ward block in UHL and capital funding was provided in 2018 to progress the design phase of this project.
With regard to the correspondence referenced by the Deputy, the HSE is currently undertaking a review of performance across all Hospital Groups and CHO's over the winter period. The HSE advise that this process will include an independent expert review of clinical, analytical and management capability in University Hospital Limerick and CHO Mid West and the other focus sites and CHO's. In addition, this correspondence, and related correspondence from the INMO, raises INMO concerns regarding patient safety and other matters at University Hospital Limerick and my Department has requested the HSE to consider the issues raised and revert as a matter of priority.
Medicinal Products Reimbursement
Ceisteanna (71)
John Curran
Ceist:71. Deputy John Curran asked the Minister for Health the progress made to provide Spinraza for children with spinal muscular atrophy; and if he will make a statement on the matter. [20645/19]
Amharc ar fhreagraFreagraí scríofa
As the Deputy is aware, the Oireachtas put in place a strong legal framework, in the Health (Pricing and Supply of Medical Goods) Act 2013, to give full statutory powers to the HSE to assess and make decisions on reimbursement of medicines, taking account of a range of objective factors and expert opinion as appropriate.
In the case of Spinraza, following detailed consideration of an application for reimbursement and lengthy engagement with the company, the HSE decided that it was unable to reimburse Nusinersen (Spinraza). The HSE concluded that the evidence for clinical effectiveness was still quite limited and that the price proposed by the manufacturer was not a cost-effective use of resources.
On 21 February 2019, the HSE wrote to the manufacturer involved and informed them of the proposal to refuse reimbursement at the current price offering. Under the requirements of the Health (Pricing and Supply of Medical Goods) Act 2013 the company had 28 days to respond or make representations to the HSE’s proposed decision.
I am advised by the HSE that the manufacturer submitted additional information and that the matter remains under consideration by the HSE.
Medicinal Products Regulation
Ceisteanna (72)
John Brassil
Ceist:72. Deputy John Brassil asked the Minister for Health when a biosimilars policy will be published; and if he will make a statement on the matter. [20811/19]
Amharc ar fhreagraFreagraí scríofa
My Department and the HSE are engaging in a number of initiatives which will endeavour to lead to better access to medicines for patients, value for the taxpayer and the cost- effective provision of medicines in Ireland.
A public consultation on a National Biosimilar Medicines Policy was undertaken by my Department in 2017. The responses to that consultation and other possible policy levers are being considered by my Department with a view to developing a National Biosimilar Medicines Policy statement which will be published later this year.
At an operational level, the HSE's Acute Hospitals Drugs Management Programme has a biosimilar strategy in place since 2017 which is making considerable progress using a collaborative approach with hospital pharmacists and clinical teams to bring about changes in prescribing practice. In that respect, hospitals are working towards a targeted minimum prescribing rate for biosimilars of 50%.
The HSE is also working on identifying barriers to the prescribing of biosimilars with a specific focus on education and support. It is seeking to increase understanding of biosimilars through targeted presentations to clinicians and hospitals.
The culmination of these initiatives is a greater uptake in the usage of biosimilars and this is evident by hospital dispensing data. For example, the prescribing rate for the biosimilar drug Infliximab has increased from 5% in 2017 to 40% in 2018.
My Department proposes to build on these positive developments and to bring forward a policy statement that would support and complement the many initiatives which are already underway.
Patient Data
Ceisteanna (73)
James Browne
Ceist:73. Deputy James Browne asked the Minister for Health the number of children presenting at emergency departments nationwide with self-harm injuries, suicide attempts and-or overdoses in each of the years 2014 to 2018; and if he will make a statement on the matter. [20855/19]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
Home Care Packages Provision
Ceisteanna (74)
Fiona O'Loughlin
Ceist:74. Deputy Fiona O'Loughlin asked the Minister for Health if the delays being experienced in the delivery of home care packages in the CHO 7 area in counties Kildare and Wicklow will be addressed; and if he will make a statement on the matter. [20842/19]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
Hospital Services
Ceisteanna (75)
John McGuinness
Ceist:75. Deputy John McGuinness asked the Minister for Health his plans for the future of Kilcreene hospital; and if he will make a statement on the matter. [20908/19]
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.
Health Strategies
Ceisteanna (76)
Alan Kelly
Ceist:76. Deputy Alan Kelly asked the Minister for Health his plans to reduce the level of respiratory illness affecting Irish persons; the policies he is pursuing to this effect; and if he will make a statement on the matter. [20492/19]
Amharc ar fhreagraFreagraí scríofa
Respiratory disease refers to a wide range of conditions of which there are many underlying contributory factors including genetic factors, early life events, nutritional factors, environmental factors, occupational exposures and smoking . The term respiratory disease includes lung cancer, COPD, asthma, pneumonia, influenza, TB, cystic fibrosis, interstitial lung disease, sarcoidosis, obstructive sleep apnoea amongst others.
Inevitably this wide range of acute and chronic respiratory conditions impacts significantly on Ireland’s health care system. It is one of the major health challenges of the 21st century the EU 28. A number of policies and strategies are addressing this.
Healthy Ireland is a government-led initiative aimed at improving the health and wellbeing of everyone living in Ireland. Greater public awareness of signs and symptoms of respiratory disease and the importance of presenting earlier to a primary care physician are crucial for improving quality of life and outcomes and reducing impact on health services. Prevention is a key element of tackling the burden of respiratory diseases and Healthy Ireland encompasses policies that address the many lifestyle changes that can reduce the risk of respiratory disease including smoking cessation, tackling obesity and promoting exercise.
Most people with respiratory disease are cared for in the community by their GP and primary care team. The recent agreement on GP contractual reforms involving my Department, the HSE and the Irish Medical Organisation (IMO) is an important step towards improving care for these patients. Over 400,000 Medical Card and GP Visit Card patients with chronic illnesses, including respiratory conditions such as asthma and COPD will stand to benefit from new and improved chronic disease management programmes.
Significant progress has been made in tackling acute and chronic respiratory diseases through the HSE National Clinical Programmes including the development of models of care, adapting national guidelines, improving integrated care and supporting patient self-care. A recent review of the HSE National Clinical Programmes completed by the Office of Chief Clinical Officer in the HSE has recommended the amalgamation of a number of respiratory disease clinical programmes under one Respiratory National Clinical Programme.
Successive National Cancer Control Strategies over the last 20 years have supported health service providers to prevent cancer, treat cancer, and increase survival and quality of life for those who develop cancer, by converting the knowledge gained through research, surveillance and outcome evaluation into strategies and actions. Specifically the National Cancer Control Programme has published a NCEC endorsed clinical guideline on lung cancer. There are also eight rapid access lung cancer clinics located in each of the Cancer Centres in Ireland.
The reform of our health services, as outlined in Sláintecare is the foundation upon which we will meet the challenges of management of the major chronic diseases including the burden of respiratory disease. This will include continuing to raise awareness and supporting the prevention, early detection and the development of integrated and new models of care across the full spectrum of self-management, primary care and acute hospital services. The Sláintecare Action Plan (2019) has specifically referenced COPD as one of its priorities.
There is no doubt that burden of respiratory diseases on individuals and our population as a whole is a challenge that our health service and indeed all health services across the EU will have to face but I am confident that the policies that we are pursuing will lead to significant population health improvements.
Question No. 77 answered with Question No. 40.
Emergency Departments Services
Ceisteanna (78)
Fiona O'Loughlin
Ceist:78. Deputy Fiona O'Loughlin asked the Minister for Health if his attention has been drawn to the fact that the assessment unit in the Naas General Hospital accident and emergency department in closed; and his plans to reopen the service [20841/19]
Amharc ar fhreagraFreagraí scríofa
As this is a service matter I have asked the HSE to reply to the Deputy as soon as possible.
Hospital Waiting Lists
Ceisteanna (79)
Stephen Donnelly
Ceist:79. Deputy Stephen Donnelly asked the Minister for Health the reason the list for those waiting more than a year and a half for an outpatient appointment increased from circa 13,000 three years ago to over 100,000 in March 2019; and if he will make a statement on the matter. [20744/19]
Amharc ar fhreagraFreagraí scríofa
I am conscious that the Outpatient Waiting List remains a significant challenge as demand for acute hospital services continues to grow. Reducing waiting time for patients for hospital appointments and procedures is a key priority for Government and the Sláintecare Action Plan 2019 which was published by my Department, includes a specific workstream on Access and Waiting Lists.
Sláintecare emphasises the need to invest in increased capacity while also shifting the balance of care from hospitals to community services for better health outcomes and a more sustainable health service. In addition, many of the other service reforms and enhancements included in Sláintecare will support timely access to care for patients in the coming years.
Budget 2019 announced that the Government had further increased investment in tackling waiting lists, with funding to the NTPF increasing from €55 million in 2018 to €75 million in 2019.
I published the joint Department of Health, HSE, and NTPF Scheduled Care Access Plan 2019 in March. The plan sets out measures to improve care for patients waiting for scheduled care in 2019 by reducing wait times for hospital operations and procedures and outpatient appointments. A key element of the Plan is the stabilisation of the Outpatient Waiting List. Under the Plan the HSE, in line with the National Service Plan, will aim to deliver 3.3 million outpatient appointments, of which approximately 1 million will be first appointments. Under the plan the NTPF will use €6 million to deliver 40,000 first Outpatient appointments.
The plan includes a target that the number of patients waiting for a first Outpatient appointment will fall from over 516,000 at the end of 2018 to under 509,000 by the end of 2019. This target takes into account the more than 800,000 new patients who will be added to the Outpatient waiting list in 2019; a figure that is based on trends for the previous two years.
The NTPF advise that over recent months they have placed a particular focus on engaging with hospital groups and individual hospitals to identify outpatient waiting list proposals. While the NTPF have already approved over 38,000 outpatient appointments, they advise that the impact of these initiatives may not be seen until the end of the year. Approximately 75% of appointments approved to date relate to 4 high-volume specialties, specifically Ophthalmology, ENT, Orthopaedics, and Dermatology.
I have asked the HSE, the NTPF and my department, under the Access Plan, to work together with the objective of developing medium-long term improvement initiatives for patient access to hospital procedures. This will include moving care to more appropriate settings and providing care at the lowest level of complexity such as providing ophthalmology in the community; maximising the use of Advanced Nurse Practitioner led clinics; and physiotherapists to manage orthopaedic clinics.
HSE Staff Recruitment
Ceisteanna (80)
Eugene Murphy
Ceist:80. Deputy Eugene Murphy asked the Minister for Health if his attention has been drawn to the fact that, further to the announcement of the HSE recruitment embargo, persons who were in the recruitment process and had consequently officially notified their employers are now unemployed as a result and will have to rely on payments from the Department of Employment and Social Protection. [20658/19]
Amharc ar fhreagraFreagraí scríofa
There is no recruitment embargo in place in the HSE. However, in recent months, officials from my Department have been engaging intensively with the HSE in reaching agreement on a Pay and Numbers Strategy for 2019. The key focus in developing the strategy is to ensure that affordable and appropriate recruitment decisions are made by the HSE and that they need to operate within its pay allocations.
By the end of 2018, the levels of agency, overtime and pay costs had reached unaffordable levels. In light of this, the HSE decided to introduce interim control measures for a consolidation period of three months to the end of June, until they received clarity on plans and financial performance for Q1 2019 from Hospital Groups and CHO’s.
I have been very clear that those locations which provide credible, balanced plans will be supported. Similarly, locations which do not submit such plans need to be scrutinised. It should also be noted that the HSE is continuing to recruit all funded development posts.
I have asked the HSE to respond directly to the Deputy on the remaining elements of the question.