Health Services Reform

Ceisteanna (1780, 1784, 1785, 1789, 1790)

Mary Butler

Ceist:

1780. Deputy Mary Butler asked the Minister for Health when University Hospital Waterford will cease to be part of the South/South West hospital group if the restructuring of health services into six new regional health areas occurs; and if he will make a statement on the matter. [34043/19]

Amharc ar fhreagra

Mary Butler

Ceist:

1784. Deputy Mary Butler asked the Minister for Health the way in which he will determine budgets based on local population needs; if this will include equality of access for all healthcare irrespective of postcode addresses; and if he will make a statement on the matter. [34047/19]

Amharc ar fhreagra

Mary Butler

Ceist:

1785. Deputy Mary Butler asked the Minister for Health if the restructuring of health services into six new regional health areas will result in increased staffing levels in all acute hospitals; and if he will make a statement on the matter. [34048/19]

Amharc ar fhreagra

Mary Butler

Ceist:

1789. Deputy Mary Butler asked the Minister for Health if a targeted reduction in the long waiting lists at University Hospital Waterford is expected for orthopaedics, ophthalmology and urology if the restructuring of health services into six new regional health areas occurs; and if he will make a statement on the matter. [34052/19]

Amharc ar fhreagra

Mary Butler

Ceist:

1790. Deputy Mary Butler asked the Minister for Health if the budget will be made available to facilitate the restructuring of health services into six new regional health areas; if it will be fair and equitable to all six areas; and if he will make a statement on the matter. [34053/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I propose to take Questions Nos. 1780, 1784, 1785, 1789 and 1790 together.

A clear governance and accountability framework was identified as a key building block of Sláintecare by the Committee on the Future of Healthcare. As part of its recommendations in this area, the Committee called for the HSE to become a more strategic and patient-focused ‘national centre’ carrying out national level functions, and the establishment of regional bodies with responsibility for the planning and delivery of integrated care at a regional level.

In time, the regional organisations will have a “one budget, one system” approach with improved accountability and governance and equitable resource allocation. As outlined in the Sláintecare Implementation Strategy, regions will be funded using population-based resource allocation models and will be accountable for achieving population health outcomes within this funding.

Reducing waiting times across the country for hospital appointments and procedures is a key commitment of Government. South/South West Hospital Group has advised my Department that University Hospital Waterford (UHW) 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 advises 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.

Within 12 months, I intend to bring proposals to the Government outlining the roles and responsibilities of the new regions. The development process of these proposals will take account of issues such as waiting list and workforce planning. As I stated last week, I envisage that some elements of workforce planning will be devolved to regional organisations and this will be a key consideration during the development of the detailed proposals.

Hospital Services

Ceisteanna (1781)

Mary Butler

Ceist:

1781. Deputy Mary Butler asked the Minister for Health if out-of-hours cardiac care patients will still be transferred to Cork University Hospital after the establishment of six new regional health areas or instead; if they will be transferred out of hours to St. Vincent's University Hospital, Dublin, as part of area C, while the second cath lab is under construction; and if he will make a statement on the matter. [34044/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

A clear governance and accountability framework was identified as a key building block of Sláintecare by the Committee on the Future of Healthcare. As part of its recommendations in this area, the Committee called for the HSE to become a more strategic and patient-focused ‘national centre’ carrying out national level functions, and the establishment of regional bodies with responsibility for the planning and delivery of integrated care at a regional level.

While the regions will have devolved responsibility for decision making, they will operate within a national framework, including national policies and strategies, such as the National Trauma Strategy and the National Cancer Strategy and national organisation of certain services such as national clinical programmes (such as cardiac services), our screening programmes and ambulance services.

The aim of the National Review of Specialised Cardiac Services is to achieve optimal patient outcomes at 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. A Steering Group is leading this work and it will be in a position to confirm a completion date for the Review in September 2019.

As agreed by the Government, my Department will now progress the development of detailed policy proposals on reconfiguration of the HSE, including the establishment of regional health bodies, and bring these proposals (including timelines for the implementation of this reform) back to Government for approval next year.

Health Services Reform

Ceisteanna (1782)

Mary Butler

Ceist:

1782. Deputy Mary Butler asked the Minister for Health the definition of stakeholders in each of the regional health areas that will be invited to contribute to the design of the services for their new regions; if this will include members of the public; and if he will make a statement on the matter. [34045/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The Sláintecare Programme Implementation Office (SPIO) has committed to working in partnership with key stakeholders. SPIO has identified four key stakeholder groups. Citizens represent one of these key stakeholder groups, along with Staff and Delivery Partners, Elected Representatives, and Wider Determinants Stakeholders. Wider Determinants include groups such as Local Authorities and other representative groups. As outlined in the Sláintecare 2019 Mid-Year Report significant citizen engagement has already taken place:

- A Citizen and Staff Engagement and Empowerment Programme, chaired by Dr. Gráinne Healy, is continuing to ensure the voice of service users is heard in the design and implementation of the reform programme.

- Significant stakeholder engagement, includes:

- 7 citizen engagements events;

- Over 40 stakeholder meetings/presentations/workshops;

- 12 significant presentations to staff, stakeholders, industry and media.

Health Services Reform

Questions Nos. 1784 and 1785 answered with Question No. 1780.

Ceisteanna (1783)

Mary Butler

Ceist:

1783. Deputy Mary Butler asked the Minister for Health the way in which he plans to ensure that communities will play a greater role in the delivery of health in the six new regional health areas; and if he will make a statement on the matter. [34046/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The voices of communities will be crucial to deciding the shape of the new Regional Health Areas. The Government's recent decision on the Regional Health Areas aims to deliver a people-centred health and social care services. A process of co-design of the new Regional Health Areas will take place over the coming months, and this will involve consultation with citizens and staff in each area. The Sláintecare office will be organising this process and details will be communicated in due course.

Voluntary Organisations will be involved in the service planning development of the six health regions.

I have previously acknowledged the valuable role that voluntary organisations play, and I have committed to better dialogue especially on policy initiatives such as a new forum. Additionally, the proposals to develop a population approach to health service planning and delivery on a regional basis are in line with recommendations of the Day Report and should have benefits for providers as well as patients.

Questions Nos. 1784 and 1785 answered with Question No. 1780.

Health Services Staff Recruitment

Ceisteanna (1786)

Mary Butler

Ceist:

1786. Deputy Mary Butler asked the Minister for Health the way in which he plans to deal with the recruitment and retention crisis being experienced across the health sector if the restructuring of health services into six new regional health areas occurs; and if he will make a statement on the matter. [34049/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I have asked the HSE to respond directly to the Deputy on this matter.

Care of the Elderly

Ceisteanna (1787)

Mary Butler

Ceist:

1787. Deputy Mary Butler asked the Minister for Health his plans to increase the number of step-down facilities and respite care for the older population to prevent late discharges in acute hospitals, of which there were 599 in June 2019, if the restructuring of health services into six new regional health areas occurs; and if he will make a statement on the matter. [34050/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

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

Hospitals Capital Programme

Questions Nos. 1789 and 1790 answered with Question No. 1780.

Ceisteanna (1788)

Mary Butler

Ceist:

1788. Deputy Mary Butler asked the Minister for Health if all agreed capital projects including the second cath lab and the new mortuary at University Hospital Waterford will proceed as planned on time and on budget if the restructuring of health services into six new regional health areas occurs; and if he will make a statement on the matter. [34051/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

My recent announcement regarding the restructuring of the public health services is a key reform for the delivery of Sláintecare. We have identified six regions which will be used in developing structures for the delivery of integrated care. This will result in clear financial and performance accountability, empower frontline staff and devolve authority from the Health Service Executive to the local regions. These proposals will help shape the future of healthcare in this country.

The Health Service Executive capital programme will continue to provide for priority capital projects and capital investment programmes. including the second cardiovascular catheterisation laboratory and the new mortuary and post mortem facilities at Waterford University Hospital.

In 2019 the HSE construction and equipment capital allocation is €642 million, which is an increase of €204 million or 46% over the capital allocation in 2018.

Project Ireland 2040 commits to a capital investment of €10,900 million in the public health services over the decade from 2018 to 2027.

Questions Nos. 1789 and 1790 answered with Question No. 1780.

Health Services Reform

Ceisteanna (1791, 1792, 1793, 1797)

Stephen Donnelly

Ceist:

1791. Deputy Stephen Donnelly asked the Minister for Health the timeframe for the implementation of the proposed restructuring of the HSE. [34071/19]

Amharc ar fhreagra

Stephen Donnelly

Ceist:

1792. Deputy Stephen Donnelly asked the Minister for Health if legislation will be required for the restructuring of the HSE as announced on 17 July 2019; and if so, when such legislation will be published. [34072/19]

Amharc ar fhreagra

Stephen Donnelly

Ceist:

1793. Deputy Stephen Donnelly asked the Minister for Health if the proposed restructuring of health services means that no hospital trusts will be established. [34073/19]

Amharc ar fhreagra

Stephen Donnelly

Ceist:

1797. Deputy Stephen Donnelly asked the Minister for Health if the proposed new structures within the HSE will be put on a statutory basis. [34077/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I propose to take Questions Nos. 1791 to 1793, inclusive, and 1797 together.

A clear governance and accountability framework was identified as a key building block of Sláintecare by the Committee on the Future of Healthcare. As part of its recommendations in this area, the Committee called for the HSE to become a more strategic and patient-focused ‘national centre’ carrying out national level functions, and the establishment of regional bodies with responsibility for the planning and delivery of integrated care at a regional level.

As the Deputy will be aware, Hospital Groups were set up in a different policy context, with the view to their eventual establishment as Hospital Trusts under UHI. This policy has been superseded by Sláintecare, which is the result of unprecedented political consensus. It is important that we now drive forward with the Sláintecare vision in order to ensure a sustained reform programme.

While the Government decision approving six regional health areas is a major step towards restructuring of our health services, this is only one of a number of decisions that need to be taken in relation to the future development of our health service structure.

I intend to return to Government within 12 months with detailed proposals regarding the roles and responsibilities of the new regional areas, including their legal standing. These proposals will also outline a timeline for the establishment of regional organisations and any legislative changes required to realise the Sláintecare vision.

Primary Care Centres

Ceisteanna (1794)

Stephen Donnelly

Ceist:

1794. Deputy Stephen Donnelly asked the Minister for Health the examination undertaken of the use of incentives to support investment by general practitioners, dentists and other professionals in primary care centres, technology and service developments. [34074/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I understand that my colleague the Minister for Finance will respond to you on the use of tax instruments to support investment by health professionals.

At this time, no other incentives are offered to health professionals to encourage investment in Primary Care Centres (PCCs).

Under the Primary Care Centre Infrastructure Programme, there are currently 127 centres operational throughout the country which is an indication of the very significant progress made so far. Furthermore, there is a pipeline of over 80 PCC projects that are under construction or development or are in the planning stage, with 21 of them expected to come on stream by the end of 2020. In addition, the HSE advertised nationally in May this year seeking Expressions of Interest from developers for the delivery of the next tranche of 47 PCCs.

The delivery of these centres in the years ahead will dovetail with other initiatives as part of the Sláintecare plan to ensure that more healthcare services will be available in the community.

General Practitioner Services

Ceisteanna (1795)

Stephen Donnelly

Ceist:

1795. Deputy Stephen Donnelly asked the Minister for Health the action taken to support general practitioner practices in disadvantaged urban areas. [34075/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I am pleased that we have recently been able to conclude an agreement with the Irish Medical Organisation on a major package of GP contractual reforms which will benefit patients and make general practice a more attractive career option for doctors.

The outcome of the talks process is a comprehensive service development and reform agreement in return for significant phased increases in funding for general practice services provided by GPs to medical card and GP visit card patients.

As part of the deal, it has been agreed that the GP rural practice allowance will be increased in 2020 and that targeted funding of €2 million will be set aside to provide additional support to practices in deprived urban areas. The full details in relation to how the latter arrangements will operate, including the most appropriate basis on which to determine the extent of deprivation as it relates to the provision of GP services, will be developed by the HSE in consultation with my Department over the coming months.

General Practitioner Data

Question No. 1797 answered with Question No. 1791.

Ceisteanna (1796)

Stephen Donnelly

Ceist:

1796. Deputy Stephen Donnelly asked the Minister for Health the number of general practitioners employed by the HSE on a salaried basis each year since 2016. [34076/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

As this question relates to a service matter, I have arranged for it to be referred to the Health Service Executive for direct reply to the Deputy.

Question No. 1797 answered with Question No. 1791.

Hospice Services Provision

Ceisteanna (1798)

Stephen Donnelly

Ceist:

1798. Deputy Stephen Donnelly asked the Minister for Health the number of hospices in each local health office area in tabular form. [34078/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

At present, there are 214 specialist palliative care or hospice beds in 11 locations nationwide, as set out in the table below. The number of hospice beds has increased by 44% over the past five years.

CHO

Service

Number of beds

1

North West Hospice, Sligo

8

2

Galway Hospice, Galway

18

3

Milford Care Centre, Limerick

30

4

Marymount Hospice, Cork

44

4

Kerry Hospice, Tralee

15

6

Our Lady's Hospice and Care Services, Blackrock

12

7

Our Lady's Hospice and Care Services, Harold's Cross

36

7

St. Brigid's Hospice, Kildare

8

9

St. Francis' Hospice, Raheny

19

9

St. Francis' Hospice, Blanchardstown

24

Total

214

The HSE’s 2019 National Service Plan commits to the full extension of service at St. Brigid's Hospice, Kildare this year and to opening three new inpatient units in Mayo, Waterford and Wicklow in quarter 4, with the latter three units expected to reach full capacity of 49 additional beds in 2020.

A further three units are planned for development in the coming years, serving people with specialist palliative care needs in the Midlands and Border regions. Once these inpatient units are opened, there will be at least one hospice in every CHO region.

Hospital Waiting Lists Data

Ceisteanna (1799)

Stephen Donnelly

Ceist:

1799. Deputy Stephen Donnelly asked the Minister for Health the number of outpatient appointments outstanding for more than two years at the end of June 2019; the number outstanding for more than three years; and the number outstanding for more than four years by each reporting hospital in tabular form [34079/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Reducing waiting time for patients for hospital operations and procedures is a key priority for Government. In this regard, the Government is committed to improving waiting times for hospital appointments and procedures.

Budget 2019 announced that the Government has further increased investment in tackling waiting lists, with funding to the National Treatment Purchase Fund (NTPF) increasing from €55 million in 2018 to €75 million in 2019. The joint Department of Health/HSE/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.

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 advises 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 outpatient appointments approved to date relate to four high-volume specialties, specifically Ophthalmology, ENT, Orthopaedics, and Dermatology.

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.

The data requested by the Deputy is outlined in the attached document.

Outpatient–Long Waiters

Emergency Departments Data

Ceisteanna (1800)

Stephen Donnelly

Ceist:

1800. Deputy Stephen Donnelly asked the Minister for Health the proportion of patients who spent less than six hours in an emergency department during the first six months of 2019. [34080/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

This is a very busy period for our health services, with many hospitals reporting significant numbers of patient attendances. For the first six months of 2019, the number of patients attending hospital EDs increased by 3.6%, and the number of ED admissions increased by 2.5% compared to the same period last year.

Despite the significant increase in demand, our health services have managed better for the first six months of 2019 than in the previous year, and the numbers of patients waiting on trolleys nationally were 4.7% lower than the same period last year.

With regard to the specific question the Deputy has asked, I have asked the HSE to respond directly with the information requested.

Health Services Data

Ceisteanna (1801)

Stephen Donnelly

Ceist:

1801. Deputy Stephen Donnelly asked the Minister for Health the medical assessment units, urgent care centres and minor injuries clinics that have extended their Monday to Friday hours of opening since 2016, in tabular form. [34081/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

As this is a service matter, I have asked the HSE to respond to the Deputy directly with the requested information.

Health Services Data

Ceisteanna (1802)

Stephen Donnelly

Ceist:

1802. Deputy Stephen Donnelly asked the Minister for Health the medical assessment units, urgent care centres and minor injuries clinics that have extended their hours of opening to weekends since 2016, in tabular form. [34082/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

As this is a service matter, I have asked the HSE to respond to the Deputy directly with the requested information.

Emergency Services Personnel

Ceisteanna (1803)

Stephen Donnelly

Ceist:

1803. Deputy Stephen Donnelly asked the Minister for Health the increases in ambulances, EMTs and paramedics in each of the years since 2016. [34083/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

As this is a service issue, I have asked the HSE to reply to you directly.

Hospital Staff Data

Ceisteanna (1804)

Stephen Donnelly

Ceist:

1804. Deputy Stephen Donnelly asked the Minister for Health the proportion of hospital managers and CEOs educated to master’s level in business administration or equivalent or in the process of achieving such a qualification. [34084/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I have asked the HSE to respond directly to the Deputy on this matter.