Questions Nos. 1 to 41, inclusive, postponed.

Job Losses

Questions Nos. 43 to 54, inclusive, answered orally.

Ceisteanna (42)

Thomas P. Broughan

Ceist:

42. Deputy Thomas P. Broughan asked the Taoiseach the number of job losses to date in 2019, by county. [26958/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Taoiseach)

I am answering this question as Minister of State with delegated responsibility for the CSO. Questions on any policy matters arising should be directed to the relevant line Minister.

The Labour Force Survey (LFS) is the official source of estimates of employment in the State. However, the LFS only measures the level of employment in the quarter, and not the job losses or job gains which contributed to the change in employment. It is a household survey which provides quarterly statistics on the level of employment and unemployment. Changes in the level of employment, as measured by the LFS, are the outcome of both jobs lost and jobs created over the period in question.

The most recent figures available for employment levels are for the first quarter (Q1) of 2019.

The quarterly LFS estimates of employment are produced by NUTS-3 Regions (NUTS-3 is a geocode standard referencing the eight subdivisions of Ireland for statistical purposes). Due to the methodology and sample size of the survey it is not possible to produce reliable county estimates from the LFS.

The number of persons aged 15 years and over in employment in Q1 2019 was 2,301,900. This was an annual increase of 81,200 or 3.7% since Q1 2018, when there were 2,220,700 persons in employment. Employment increased in all eight NUTS-3 regions over the year. The largest rates of increase were recorded in the Mid-East and South-West regions, at 7.4% and 4.2% respectively.

The Q1 2019 total of 2,301,900 was a quarterly increase, before seasonal adjustment, of 20,600 persons in employment since quarter four of 2018. There were quarterly increases in all NUTS-3 regions except the South-East and Midland regions, where employment decreased by 200 and 1,400 respectively. These figures are not adjusted for seasonality.

Questions Nos. 43 to 54, inclusive, answered orally.

Hospital Beds Closures

Ceisteanna (55)

Bríd Smith

Ceist:

55. Deputy Bríd Smith asked the Minister for Health if his attention has been drawn to the planned closure of beds and units at St. Mary's Hospital; the rationale for the closure; and if he will make a statement on the matter. [27926/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

St. Mary’s Hospital in the Phoenix Park provides 150 long term residential beds, located across two modern purpose-built units.  The hospital also provides 75 sub-acute or short stay beds, located separately in the main hospital building which dates back to the 18th century.

A recent Health and Safety Assessment identified significant patient and staff safety risk issues in the main building and in particular on Elms Ward. The risks identified relate to safety, fire safety management, layout, size, age, fixtures, fittings and lighting. Environmental risks were identified in relation to safe evacuation of patients. Elms Ward was found to have significant risk to patients and staff due to its uneven floor.

To comply with legislative requirements, and in the best interests of patients and staff, the HSE needs to close the ward on a phased basis with effect from 1st July 2019, to be completed by August. This decision was based solely on health and safety concerns, and not as a cost saving measure.  There will be some reduction in access to transitional care beds from acute settings, however, all patients will remain in the Hospital until their current care is completed. The Department has been assured that all commitments for booked respite care will be honoured and plans are being put in place to that effect. 

Staff were advised of this decision through consultation with their line management and they will be reassigned within the Hospital. The HSE has advised the Department that significant capital is required to address the health and safety issues and part of the project development process will be to examine all options available to provide safe services.

The primary focus must be on patients.  Engagement with them, their families, staff, union representatives and any other relevant stakeholders is on-going to ensure minimal impact for all concerned during the closure of the ward.

Smith Briefing

Ambulance Service

Ceisteanna (56)

Willie Penrose

Ceist:

56. Deputy Willie Penrose asked the Minister for Health the status of the community paramedic project; if this has reduced the demand and response time for ambulances in rural areas; and if he will make a statement on the matter. [22795/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

An EU Interreg-funded programme is currently being delivered in the border counties of Ireland, Northern Ireland and west coast of Scotland.  The programme aims to assess and treat higher volumes of patients more effectively, both in scheduled and unscheduled care pathways, through improved and reformed service delivery models, on a cross border basis. 

The National Ambulance Service is participating in one of the unscheduled care initiatives.  The initiative, a Community Paramedic pilot programme, involves paramedics treating patients in the community.  As such, paramedics are functioning outside their customary emergency response and transport roles, in ways that facilitate more appropriate use of emergency care resources and enhance access to healthcare for patients in rural and minor urban areas. 

Although the project is at a relatively early stage, the data from the pilot sites indicates that over 86% of patients seen by Community Paramedics were not transferred to an acute setting.  Thus, benefits have been derived in that patients are treated in the most appropriate setting but also there has been a reduction in secondary patient transfers and reduced ED attendance.  It is anticipated that, in time, the availability of a community paramedic model of care could reduce demand for emergency ambulances and help improve ambulance response times. 

The pilot project is expected to be completed in September 2020.  At that stage the results will be evaluated and used to inform any further rollout of the community paramedic model of care.  Of course, this initiative, where the focus is on delivering enhanced patient care in the community, is fully in line with the objectives of Sláintecare.

Mental Health Services Provision

Ceisteanna (57)

Thomas P. Broughan

Ceist:

57. Deputy Thomas P. Broughan asked the Minister for Health the mental health support services he is making available free of charge to families in emergency homeless accommodation; if these are available to all families in hubs and-or hotels and guesthouses; and if he will make a statement on the matter. [21736/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I would like to assure the Deputy that addressing the health needs of homeless persons and improving their access to healthcare services are a priority for the Department of Health and the HSE.  

Currently, health services for the homeless population are delivered by multiple providers including Statutory Services, Non-Government Organisations and charitable organisations. In addition to local Community Mental Health Teams and Acute Mental Health Units, HSE Mental Health Services have established Specialist Homeless Mental Health Teams, dedicated to meet the mental health needs of people who are homeless.  

There are two Specialist Homeless Mental Health Teams located in Dublin, one in Cork and a dedicated mental health homeless team is currently being developed in Kerry.  

The HSE is currently working on a service improvement project which focuses on improving mental health care pathways for people who are homeless. This project will create a stepped model of care to ensure the homeless population in Community Health Organisations 6, 7 and 9 receive timely access and appropriate mental health care which cater for their mental health needs. The model will establish clear mental health care pathways into, and between, primary care, addiction services and specialist mental health services and support mental health staff working within the NGO structures.  

HSE Homeless Multidisciplinary Teams are established in each Community Health Organisation. These teams comprise nurses, social workers, occupational therapists, mental health and addiction workers. These teams ensure that people who are homeless are linked with appropriate health and social care services.   

Counselling is available to homeless persons through a national service, Counselling in Primary Care. Counselling is also available through the HSE Addiction Services and by HSE-funded Non-Government Organisations such as the Dublin Simon Community Sure Steps Counselling service and Merchants Quay Ireland. In 2018, the National Office for Suicide Prevention provided additional funding to the Dublin Simon service for a homeless-specific Out-of-Hours Counselling Service.  

Families in emergency homeless accommodation have access to the all the services mentioned, in addition to the general mental health services that are available to all citizens. Most people with mental health problems can be treated by their GP, but when necessary, are referred to specialist HSE Mental Health Services.

Again, let me assure the Deputy that addressing the matter of persons and families in emergency homeless accommodation is priority for the Government and the mental health and wellbeing of each person is a particular concern for the Department of Health.  For this reason, in 2016, the Department allocated €2 million New Development funding for mental health homeless services. This year, the Department apportioned an additional €1 million New Development funding to boost mental health provision across homeless, travellers, refugees and addiction services.

Community Care Provision

Ceisteanna (58)

Darragh O'Brien

Ceist:

58. Deputy Darragh O'Brien asked the Minister for Health the action being taken to reduce the waiting list for home support hours in the north Dublin local health office area; and if he will make a statement on the matter. [27762/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Improving access to home support remains a priority for Government. Over the past four years we have seen a considerable increase of nearly €140 million in the budget which has grown from €306 million in 2015 to almost €446 million this year.

In 2019, the HSE intends to provide 17.9 million home support hours to 53,000 people and a further 360,000 hours of support through intensive home care packages to 235 people. Up to the end of April, about 5.6 million home support hours were delivered nationally.

In 2019, additional funding has been made available to CHO Dublin North City and County in order to provide 2,813,000 home support hours, an increase of 54,824 hours on last year.  

Despite this significant level of service provision, the demand for home support continues to grow. In the first four months of the year some 5,761 new clients commenced receipt of home support.

I acknowledge that in some cases access to the service may take longer than we would like.  

I recently met with senior HSE management and representatives from CHO management on the issue of home support. Through this engagement,  I have been provided with reassurance that the HSE will meet its service plans targets this year with respect to home support services.

Departmental Agencies

Ceisteanna (59)

Louise O'Reilly

Ceist:

59. Deputy Louise O'Reilly asked the Minister for Health the situation regarding section 39 organisations declaring deficits in service agreements with the HSE; and if he will make a statement on the matter. [27658/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Under Section 39 of the Health Act 2004, the HSE provides funding to bodies that deliver services similar, or ancillary to, services that the HSE may provide. These organisations provide a broad range of services and are governed by Service Level Agreements with the HSE.  

There are approximately 2,200 Section 39 voluntary organisations and 150 of these receive funding from the HSE in excess of €1m per annum.  A substantial number of these Section 39 voluntary organisations provide disability services.  

Significant resources have been invested by the health sector in various services during the past number of years. Since our Government took office, the National Service Plan budget for social inclusion, mental health, disability services, and services for older people, has been increased by €747 million / 24%. This year alone, the Health Service Executive has allocated €3.9 billion to these programmes.  

I understand that a number of service providers have highlighted their individual challenges, which include deficits accrued over many years. My Department and the HSE continue to put significant effort and resources into assisting service providers to manage priority needs within the funding available.  

As Minister of Health, my primary concern is to ensure the continuity of appropriate person-centred services is maintained and delivered in an equitable manner consistent with the care and support needs of individuals.  

Arising from the 2019 Report of the Independent Review Group established to examine the role of voluntary organisations in publicly funded health and personal services, I intend to establish a new dialogue forum between the Department, relevant health agencies and representation from voluntary organisations in the health and social care sector to provide a mechanism for engaging with the sector on the proposed Sláintecare reforms and other policy initiatives and to consider the group's recommendations on governance.  

More broadly, I am continuing my examination of the recommendations of the report in the context of strengthening the relationship between the State and the voluntary organisations in the best interests of the service users. My focus will always be on the service users and their families.

Nursing Home Services

Ceisteanna (60)

Maureen O'Sullivan

Ceist:

60. Deputy Maureen O'Sullivan asked the Minister for Health further to Topical Issue No. 2 of 4 April 2019, the reason his reply indicated difficulties in recruitment of healthcare assistants was due to pay scale and not due to lack of availability in view of the fact that private nursing homes do not receive an equivalent National Treatment Purchase Fund, NTPF, rate; and if comparative NTPF rates for all nursing homes, private, voluntary and public will be supported [27955/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Over the last two years, an additional €45 million has been provided to NHSS budget for the continued provision of services in line with competitive pricing and demand.  As outlined in the HSE's National Service Plan for 2019, the NHSS is expected to support 23,042 people in 2019. The NHSS budget for 2019 is €985.8m which is an increase of €24.3m over its 2018 budget.

The National Treatment Purchase Fund (NTPF) negotiates and agrees maximum prices with registered private and voluntary nursing homes for each private and voluntary nursing home who wishes to be an approved nursing home for the purposes of the Scheme. The NTPF has statutory independence in the performance of its function, and negotiates with each nursing home on an individual basis. Separately, under Sectiion 33 of the Nursing Homes Support Scheme Act 2009, provision is made for the HSE to make charges in respect of long term care services. The provision sets out that charges shall not exceed the cost incurred by the HSE in relation to the provision of such care services. There are no plans to amend the legislation in this regard.

The nursing home sector has raised concerns in relation to staffing, particularly with regard to securing access to appropriately qualified staff. On foot of these concerns nursing home providers have requested the removal of health care assistants from the ineligible list of permits issued by the Department of Business, Enterprise and Innovation to bring in workers from outside of the EEA. The representatives of the nursing homes sector have been advised that there needs to be a clear demonstration that recruitment difficulties are solely due to shortages and not to other factors such as salary or working conditions. The sector has been advised that more evidence is required of the labour shortages and to demonstrate full engagement with the Department of Employment Affairs and Social Protection in relation to recruitment of healthcare assistants from within the EU in the first instance. On provision of this evidence by the sector this matter may be considered further.

Work Permit doc

HSE Planning

Ceisteanna (61)

Stephen Donnelly

Ceist:

61. Deputy Stephen Donnelly asked the Minister for Health his views on whether it is acceptable that the HSE capital plan has not been published to date; his further views on whether this delay amounts to poor financial management; when it will be published; and if he will make a statement on the matter. [27890/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

My Department has been working with the Health Service Executive and the Department of Public Expenditure and Reform to develop a multi annual capital plan for the health services.

The Summer Economic Statement, published recently by the Minister for Finance and Public Expenditure and Reform, provides an expenditure reserve of up to €200m in 2020 to accommodate funding requirements for the new children's hospital and the National Broadband Plan.

This will allow my Department and the HSE to finalise a multi-annual Capital Plan in the near future.

The Health capital allocation in 2019 is now €642m for the construction and equipping of health facilities. This represents an increase of €224m on last year’s capital provision.  

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, the cashflow requirements attaching to each project and the relevant priority.

Hospitals Capital Programme

Ceisteanna (62, 79)

Charlie McConalogue

Ceist:

62. Deputy Charlie McConalogue asked the Minister for Health when capital funding for the development of St. Joseph’s Community Hospital, Stranorlar, Ramelton Community Hospital and Lifford Community Hospital will be allocated to ensure they meet HIQA standards and retain and expand their existing bed numbers in County Donegal; and if he will make a statement on the matter. [27807/19]

Amharc ar fhreagra

Charlie McConalogue

Ceist:

79. Deputy Charlie McConalogue asked the Minister for Health his long-term plans for a number of community hospitals in County Donegal including the community hospitals in Lifford, Ramelton and St. Joseph's Hospital, Stranorlar; and if he will make a statement on the matter. [27806/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I propose to take Questions Nos. 62 and 79 together.

The overarching policy of the Government is to support older people to live in dignity and independence in their own homes and communities for as long as possible. The standard of care delivered to residents in public units is generally very high, but we recognise that many of our community hospitals are housed in buildings that are less than ideal in the modern context. It is important therefore that we upgrade our public bed stock and this is the aim of the Capital Investment Programme for Community Nursing Units.

The HSE is responsible for the delivery of health and personal social services, including the facilities at St. Joseph’s Community Hospital Stranorlar, Ramelton Community Hospital and Lifford Community Hospital, Donegal. The HSE have advised the following in relation to these facilities.

The Community Nursing Unit programme provides for the retention of services at St. Joseph’s Community Hospital Stranorlar and Ramelton Community Hospital with a requirement for refurbishment of both centres.

In the short term the HSE will invest minor capital in both units in 2019 and 2020 in order to deal with HIQA compliance issues and an agreed schedule of works is being finalised with HIQA.

The redevelopment of the Lifford unit on the existing site is not deemed viable. The need for additional beds and the potential to develop a new facility on a greenfield site will be reviewed further post 2021.

Cancer Screening Programmes

Ceisteanna (63)

Alan Kelly

Ceist:

63. Deputy Alan Kelly asked the Minister for Health the number of claims made against the cancer screening programme regarding BreastCheck screening since its commencement; and if he will make a statement on the matter. [27722/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The State Claims Agency (SCA) has a statutory remit to manage personal injury claims, including claims in respect of clinical negligence, on behalf of Delegated State Authorities (DSA’s) including the Health Service Executive. 

I have been informed by the State Claims Agency that a total of 22 claims have been made in relation to the BreastCheck programme. These claims relate to allegations of cancer misdiagnosis, clinical procedures, slip trips and falls, and other physical hazards.

Hospital Consultant Recruitment

Ceisteanna (64)

Stephen Donnelly

Ceist:

64. Deputy Stephen Donnelly asked the Minister for Health his views on whether there is a shortage of full-time consultants in post here and that this shortage is a material contributor to the current waiting lists; if he will commence the unwinding of new entrant pay disparity for consultants in 2019; and if he will make a statement on the matter. [27894/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The public health service in Ireland operates in a global market for medical specialists which is experiencing a world-wide shortage.  Nonetheless, the number of consultants working in the public health service continues to grow year on year. It increased by 125 whole time equivalents (WTE), or just over 4 per cent, in the year to the end of May 2019. In the five years to the end of May 2019 the number of consultants has increased by 533 - over 20 per cent - and now stands at 3,121 WTE's.

While it would be preferable if all vacant posts could be occupied on a permanent basis, the majority of vacant posts not filled on a permanent basis are filled by alternative arrangements; fixed-term, locum or other agency arrangements, to support service delivery. It is recognised that many areas in our health system currently lack sufficient capacity to meet the ever-increasing demand for services and the needs of patients, resulting in unacceptably long waiting times for hospital appointments and procedures. Reducing waiting time for patients for operations and procedures is a key priority for Government. Last year saw a considerable improvement in the number of patients waiting for procedures. As a result of increased activity and the ongoing collaboration between the HSE and the National Treatment Purchase Fund (NTPF), the number of patients waiting for an inpatient or day case procedure fell to 70,204 in December 2018.  This was from a peak of 86,100 in July 2017, and represents a reduction of over 18% in the overall number of patients waiting for a procedure. The number of patients waiting in excess of 3 months fell by more than 17,700, or 31% in the same period from July 2017 to the end of December 2018.

Budget 2019 announced that the Government had further increased investment in tackling waiting lists, with funding to the National Treatment Purchase Fund increasing from €55 million in 2018 to €75 million in 2019.  The joint Department of Health, HSE, and NTPF Scheduled Care Access Plan 2019 was published in March. Under the plan, the HSE, in line with the National Service Plan, will deliver 1.155 million elective inpatient and day case discharges at a value of €1.4 billion in 2019.

Recruitment and retention of consultants has been examined by the Public Sector Pay Commission.  The Commission found that evidence of recruitment campaigns with very low levels of applications was indicative of on-going difficulties regarding the recruitment of consultants. The Commission acknowledged that the difference in pay between the pre-existing and new entrant consultants is greater than that for other categories of public servants. It 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.

The Government accepted the Report of the Commission and recognises that there are significant recruitment and retention challenges in relation to consultant posts. The proposal of the Commission does need to be addressed. The next step is to engage with the representative organisations of medical consultants.

Services for People with Disabilities

Ceisteanna (65)

John McGuinness

Ceist:

65. Deputy John McGuinness asked the Minister for Health the way in which it is planned to address the funding challenges which are impeding the move from congregated settings in County Kilkenny; and if he will make a statement on the matter. [27818/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The Report “Time to Move on from Congregated Settings - A Strategy for Community Inclusion” proposes a new model of support in the community moving people from Congregated settings to the community in line with Government policy. The Report identified around 4,000 people (based on 2008 census) with disabilities in Ireland living in congregated settings, defined as a residential setting where people live with ten or more people.

The Programme for Partnership Government contains a commitment to continue to move people with disabilities out of congregated settings to enable them to live independently and to be included in the community.  The objective is to reduce this figure by one-third by 2021 and ultimately, to eliminate all congregated settings.

By the end of this year, we will have exceeded this target and under 2,100 people with a disability will remain living in congregated settings. I want to emphasise that the appropriate supports and resources are being put in place to ensure that people are supported as they move out of residential centres. The model of care for individuals will be based on a person centred plan (PCP). The PCP may change over time in line with an individual’s needs and circumstances and the model of service delivery applicable at a particular time.

Any opportunity for residents to live in smaller settings in the community will come after considerable planning and discussion with those residents and their families. It will be on the basis that it will enhance their life, and anyone who moves will continue to access the services they require.

The HSE has prioritised the transition of a further160 people from congregated settings in 2019 under its Service Plan, and I am informed that 49 people have moved into their homes in the community to the end of March this year.  

The HSE is responsible for leading out on the recommendations of "Time to Move on from Congregated Settings - A Strategy for Community Inclusion". I am informed that the total budget to St Patrick's Centre Kilkenny is €16.94m. St. Patrick's has submitted funding proposals related to decongregation to the HSE and a validation of these requirements is underway. In the context of same, it is not appropriate to prejudge the outcome of this process until the matter concludes.

Healthcare Infrastructure Provision

Ceisteanna (66)

Catherine Connolly

Ceist:

66. Deputy Catherine Connolly asked the Minister for Health further to Parliamentary Question No. 57 of 13 March 2019, the status of the State property transfer process in relation to the transfer of land on Inisbofin, County Galway by Galway County Council to the Department of Culture, Heritage and the Gaeltacht; if the property has been transferred; if a portion of the property has now been transferred to the HSE via an intra-State property transfer; if the design brief has been updated and a new design team appointed; and if he will make a statement on the matter. [27937/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The HSE is responsible for the delivery of health and personal social services, including the development of primary care facilities at Inisbofin, County Galway. The HSE has advised that Galway County Council is transferring land to the Department of Culture, Heritage and the Gaeltacht who will then transfer a portion of the land to the HSE. The transfer has not yet been completed. The design brief in relation to the development of primary care facilities on the island is currently being updated with a view to seeking approval to appoint a new design team for the project.

Hospital Services

Ceisteanna (67)

Louise O'Reilly

Ceist:

67. Deputy Louise O'Reilly asked the Minister for Health if the establishment of a day hospital in Swords, County Dublin will be considered. [27657/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The National Development Plan 2018-2027 outlines that new dedicated ambulatory/elective-only hospital facilities will be delivered in Dublin, Cork and Galway to tackle waiting lists and provide access to diagnostic services.  

The Sláintecare Action Plan 2019 includes a commitment that the criteria for ambulatory/elective sites will be determined during the course of this year. This will involve policy development to determine the services to be delivered, the facilities required and the relationship with existing hospitals in the catchment area. This work will draw upon international evidence, including the merits of stand-alone facilities or dedicated facilities on the site of a general hospital. In advance of the development of the criteria for site selection, it is not possible to evaluate the merits of the particular proposed location at this stage.

Hospital Waiting Lists

Question No. 69 answered with Question No. 50.

Ceisteanna (68)

Mary Butler

Ceist:

68. Deputy Mary Butler asked the Minister for Health the action he is taking to reduce waiting times for outpatient appointments in Waterford University Hospital in which the number of persons waiting over 18 months stood at 11,412 at the end of May 2019; and if he will make a statement on the matter. [27744/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Reducing waiting times for hospital appointments and procedures is a key commitment of government. While the last 18 months have seen considerable progress in the reduction of waiting times for Inpatient and Daycase treatments, I am conscious that the Outpatient Waiting List remains a significant challenge as demand for acute hospital services continues to grow.

Budget 2019 announced that the Government had further increased investment in tackling waiting lists, with funding to the National Treatment Purchase Fund increasing from €55 million in 2018 to €75 million in 2019. The joint Department of Health, HSE, and the National Treatment Purchase Fund Scheduled Care Access Plan 2019 was published in March. Under the Plan the HSE, in line with the National Service Plan, will aim to deliver 1.155 million elective inpatient and day case discharges at a value of €1.4 billion in 2019, while the NTPF will provide additionality through the provision of 25,000 IPDC appointments, 5,000 GI scopes, and 40,000 outpatient appointments.

South/South West Hospital Group has advised my Department that University Hospital Waterford is focused on the reduction of waiting lists, and is actively working with the NTPF to engage in initiatives to reduce outpatient waiting times. To date this year the NTPF has approved an additional 3,600 outpatient appointments for University Hospital Waterford. These outpatient initiatives are focused on those specialties that have a number of long-waiting patients.

For example, an additional ENT Consultant is focusing on long waiting patients, while UHW Audiology Department is working with an external provider to schedule hearing test assessments for long waiters. Furthermore consultant led Virtual ENT clinics are also being set up.

For the specialty of Urology, a Locum Consultant Urologist has been appointed to focus on the longest waiting patients. An additional clinic has been established to schedule long-waiting patients, and from mid-July an additional urology clinic will also commence as part of the wider South South-West Hospital Group plans in South Tipperary General Hospital.

UHW further advise that to address the Rheumatology outpatient waiting list, extra time slots have been made available for the longest waiting patients at external clinics, while an out of hours clinic has also been set up to deal with other long waiting patients.

In addition to these initiatives, the University Hospital Waterford Central Appointments Office has recently taken over the management of the Outpatient Waiting List for Gastro-Enterology and Paediatrics. University Hospital Waterford has advised that it remains committed to working in collaboration with South South-West Hospital Group, and the NTPF, on waiting list initiative supports.

Question No. 69 answered with Question No. 50.

Community Care Provision

Ceisteanna (70)

Jack Chambers

Ceist:

70. Deputy Jack Chambers asked the Minister for Health the action being taken to reduce the waiting list for home support hours in the north-west Dublin local health office area; and if he will make a statement on the matter. [27764/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Improving access to home support remains a priority for Government. Over the past four years we have seen a considerable increase of nearly €140 million in the budget which has grown from €306 million in 2015 to almost €446 million this year.

In 2019, the HSE intends to provide 17.9 million home support hours to 53,000 people and a further 360,000 hours of support through intensive home care packages to 235 people. Up to the end of April, about 5.6 million home support hours were delivered nationally. 

In 2019, additional funding has been made available to CHO Dublin North City and County in order to provide 2,813,000 home support hours, an increase of 54,824 hours on last year.

Despite this significant level of service provision, the demand for home support continues to grow. In the first four months of this year some 5,761 new clients commenced receipt of home support.

I acknowledge that in some cases access to the service may take longer than we would like.

I recently met with senior HSE management and representatives from CHO management on the issue of home support. Through this engagement,  I have been provided with reassurance that the HSE will meet its service plans targets this year with respect to home support services.

Hospital Accommodation Provision

Ceisteanna (71)

Fiona O'Loughlin

Ceist:

71. Deputy Fiona O'Loughlin asked the Minister for Health if Naas General Hospital will be considered for an extension to accommodate the population growth in its catchment area. [27923/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

In January 2018, I published the Health Service Capacity Review which made clear that we need additional capacity across nearly all areas of the health service over the next decade. The review acknowledged the demographic challenge facing the Irish health service in the near future due to our growing population, with our over 65 population set to increase by nearly 60% and the over 85 population set to double. These latter two groups are high users of health services and it is important that we invest in order to provide safe and timely care to the whole population.  

Arising from the findings of the Capacity Review, the Government committed to investing in an extra 2,600 beds in our hospitals and 4,500 more community beds in the National Development Plan over the period to 2027.  

 The Capacity Review also acknowledged the need for reform of the health service and provided projections based on reform scenarios that align with the Sláintecare vision and reform programme.  It is also clear we should not plan investments in the health service as it is currently configured. Investment and reform should go hand in hand with each driving the other.  

Any proposals for an extension to Naas General Hospital will be considered in the context of service reform requirements overall in the Dublin Midlands Hospital Group and subject to the availability of capital funding and the progress of other priority projects.

Hospital Consultant Recruitment

Ceisteanna (72)

Eamon Scanlon

Ceist:

72. Deputy Eamon Scanlon asked the Minister for Health if the recruitment process to replace the retiring cardiologist serving Sligo University Hospital can be expedited; and if he will make a statement on the matter. [27748/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Pursuant to the Health Acts, the Consultants division of National Doctors Training and Planning Unit, HSE, is responsible for the regulation of the number and type of medical consultant posts engaged in the provision of public services. All applications for Consultant posts should be made using the Consultant Application Portal Module in the Doctors Integrated Medical System (DIME). Where a post is vacant, alternative arrangements are usually made to support service delivery.

The HSE has advised that there are currently two Consultant Cardiologists employed in Sligo University Hospital, one permanent staff member and one temporary staff member. An application has been submitted to fill a retirement post in this service. Once approval is received for this post, Saolta University Health Care Group will advertise the two Consultant posts for the Cardiology service. 

With regard to national cardiac services, the National Review of Specialist Cardiac Services is ongoing. The aim of the Review is to achieve optimal patient outcomes at the population level with particular emphasis on the safety, quality and sustainability of the services that patients receive through establishing the requirements for an appropriate configuration of specialist cardiac services throughout Ireland.

While much work has been completed in relation to informing the optimal configuration of adult cardiac services, some significant and important work remains outstanding. In order to allow this work to be completed, the work of the Steering Group will continue through the summer months. I am advised by the Steering Group that it will be in a position to confirm a completion date this September.

Hospital Staff Recruitment

Ceisteanna (73)

Louise O'Reilly

Ceist:

73. Deputy Louise O'Reilly asked the Minister for Health if the necessary staff have been recruited to ensure that the paediatric outpatient department and urgent care centre at Connolly Hospital can be operational from 8 a.m. until midnight, seven days a week, as was previously committed. [27659/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The new Children’s Health Ireland paediatric outpatient and urgent care centre at Connolly Hospital is due to open on 31 July 2019.  

The unit will provide a range of services, including urgent care for the treatment of minor injury and illnesses and a short stay observation unit, where children are observed and treated for up to 6 hours before being discharged or, in a very small number of cases, referred onwards to one of the children’s hospitals. The delivery of urgent care services will initially be provided on a phased basis. Children's Health Ireland will be confirming the exact opening hours shortly. During the initial opening phase, two specialties will also deliver outpatient services at the unit, Monday to Friday 08.00- 18.00; these are General Paediatric services and Orthopaedic services which will provide a fracture clinic.  

The recruitment of staff for the new unit is well advanced in respect of medical, nursing, health and social care professional and administrative staff. There are recruitment challenges nationally and internationally in certain specialities, such as consultant paediatric radiology.  Children’s Health Ireland has advised that while recruitment is ongoing in this area, contingency plans are under development to support these services at the unit.  

All nursing positions have been successfully filled within the organisation. The Health and Social Care Professionals and administrative and operations posts are being filled through an internal recruitment campaign with an external recruitment campaign to follow if additional posts need to be backfilled within CHI.

Long-Term Illness Scheme

Ceisteanna (74)

Gino Kenny

Ceist:

74. Deputy Gino Kenny asked the Minister for Health his plans to update the long-term illness scheme to include illnesses such as fibromyalgia and myalgic encephalomyelitis; and if he will make a statement on the matter. [27801/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

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 the review of 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.

Hospital Waiting Lists

Ceisteanna (75)

John Brassil

Ceist:

75. Deputy John Brassil asked the Minister for Health the action he is taking to reduce outpatient waiting times; if his attention has been drawn to the fact that the number of patients waiting more than 18 months in Kerry University Hospital has increased by 1,878, 2,347.5%, since May 2016 and stood at 1,958 at the end of May 2019; and if he will make a statement on the matter. [27810/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I am conscious that waiting times are often unacceptably long and of the burden that this places on patients and their families. In this regard, the Government is committed to improving waiting times for hospital appointments and procedures.

The joint Department of Health/HSE/National Treatment Purchase Fund (NTPF) Scheduled Care Access Plan 2019 was published in March and sets out measures to improve care for patients waiting for scheduled care in 2019 by reducing waiting times for inpatient/day case treatment and outpatient appointments.

The Access Plan sets out the activity levels for the National Treatment Purchase Fund (NTPF), who will supply additionality to HSE activity, in order to reduce waiting times experienced by patients for a hospital appointment, operation or procedure.  

 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. For its part the NTPF will aim to deliver 40,000 first Outpatient appointments. 

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. The NTPF has advised that to date in 2019, Kerry University Hospital has received approval for NTPF funding for additional outpatient appointments - including 300 Orthopaedic Outpatient appointments and 260 Neurology Outpatient appointments.

In addition, my Department is working with the HSE and NTPF, under the Access Plan, 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. 

With regard to overall measures being implemented at Kerry University Hospital to address Outpatient Waiting Lists, I have asked the HSE to respond to the Deputy Directly.

Cross-Border Health Services Provision

Ceisteanna (76)

Brendan Smith

Ceist:

76. Deputy Brendan Smith asked the Minister for Health the way in which he plans to tackle the delays in reimbursing patients who have availed of the cross-border treatment directive; and if he will make a statement on the matter. [27813/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The HSE is responsible for the operation of the Cross Border Directive (CBD) and the management of processing reimbursements for treatment under the Cross Border Directive (CBD) is an operational matter for the HSE.  I have, therefore, asked the HSE to respond directly to the Deputy.

As the Deputy is aware, the numbers of persons availing of the Directive has been increasing steadily for a number of years with a corresponding increase in the workload for the CBD office.  I am aware that the HSE is currently considering a business case, and other interim steps, to address the issues which have arisen with regard to the processing of reimbursements.

Departmental Agencies Funding

Ceisteanna (77)

Alan Kelly

Ceist:

77. Deputy Alan Kelly asked the Minister for Health his views on whether it is appropriate for the HSE to be providing significant loans to section 39 organisations; and if there are concerns regarding the governance of these organisations as a result. [27725/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

As this is a matter for the Health Service Executive, I have asked them to respond to you directly.

Hospital Staff

Question No. 79 answered with Question No. 62.

Ceisteanna (78)

Fiona O'Loughlin

Ceist:

78. Deputy Fiona O'Loughlin asked the Minister for Health his views on the staffing levels in Naas General Hospital; and if there are plans to reduce workloads on staff. [27924/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

As this is a service matter, I have asked the Health Service Executive to respond to you directly, as soon as possible.

Question No. 79 answered with Question No. 62.