Questions Nos. 1 to 10, inclusive, answered orally.

Questions Nos. 11 to 37, inclusive, resubmitted.

Questions Nos. 38 and 39 answered orally.

Mental Health Services

Questions Nos. 41 to 46, inclusive, answered orally.

Ceisteanna (40)

James Browne

Ceist:

40. Deputy James Browne asked the Minister for Health the measures being taken to improve mental health services for adults and children with intellectual disabilities and for those with autism; and if he will make a statement on the matter. [49073/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The needs of adults and children with intellectual disabilities and autism are generally best met in services such as HSE Primary Care and HSE Disability services.

However, people may have mild, moderate or severe mental health difficulties in addition to their intellectual disability or autism, which can mean their treatment needs are more complex. The HSE service best suited to an individual patient is determined by the level of the intellectual disability and of the mental health difficulty.

The mental health policy, A Vision for Change, recommended the development of mental health intellectual disability (MHID) teams, to provide population-wide coverage and ensure fair and equal access to mental healthcare for people of all ages with an intellectual disability and autism.

In 2017, the HSE’s national mental health service, in co-operation with social care services, initiated a new service improvement programme, to develop both adult and CAMHS MHID services nationally, and to further the operationalisation of A Vision for Change for this speciality.

Increased Government investment in mental health has enabled this person-centred MHID team model of care, to ensure consistent service delivery. This model is being adopted nationally and will augment existing mental health teams, as needed.

Since 2012, the Government has added €315 million to the mental health budget. This is an increase of 45% over this time. This investment has enabled the enhancement of specialist mental health services in areas such as MHID, eating disorders and ADHD.

A Vision for Change also recommended the development of acute beds and day hospital services for MHID treatment. 10 beds have been specifically dedicated for MHID in the new 170-bed state-of-the-art complex in Portrane, which will replace the Central Mental Hospital in Dundrum. The new facility will modernise the forensic mental health service in Ireland. The complex will also contain a 10 bedroom forensic child and adolescent mental health unit and a 30 bedroom intensive care rehabilitation unit will be co-located on the site.

Investment in acute MHID services will continue to be prioritised and developed as part of the HSE MHID service improvement programme, in conjunction with HSE social care and Section 38 and 39 voluntary agencies. The development of innovative acute treatment services including therapeutic respite for children with intellectual disabilities and significant mental health and behavioural support needs, will also be explored.

Questions Nos. 41 to 46, inclusive, answered orally.

Ambulance Service

Question No. 48 answered orally.

Ceisteanna (47)

Barry Cowen

Ceist:

47. Deputy Barry Cowen asked the Minister for Health the reason for the significant deterioration in ambulance turnaround times in the Midlands Regional Hospital between September 2017 and September 2019. [48781/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Ambulance turnaround times provide the time interval from ambulance arrival time at a hospital, to when the ambulance crew declares readiness to accept another call. The performance target for 2019 is that 95% of all ambulances have an interval of less than 60 minutes from arrival at the ED to when the ambulance crew declares readiness to accept another call. As of September 2019, 87.3% of ambulances at Midlands Regional Hospital Tullamore achieved a turnaround time of 60 minutes of less.

When the emergency care system at Hospitals are under pressure, there is the potential for delay in the transfer of care of patients from ambulance to Emergency Department personnel. An Ambulance Turnaround Framework was developed which sets out the process that alerts management, to increases in emergency demand and activity resulting in the delayed transfer of care of patients and delays in the release of ambulance resources. A management process is then employed to ensure the timely release of all ambulance resources in a safe manner allowing timely service delivery to patients.

My Department has engaged extensively with the HSE this year to identify mitigating actions to bring down trolley numbers and waiting times in the ED in the face of growing demand. The HSE Winter Plan was launched on Thursday 14 November in preparation for the anticipated increase in demand over the winter period and is supported by an additional €26m in winter funding nationally, with specific funding allocated to the Winter Action Teams to support initiatives at local level.

I have been assured that the HSE is committed to ensuring that patient care remains seamless and that patients are clinically handed over in a safe, professional and timely manner; with the safety and dignity of the patient being of paramount importance.

Question No. 48 answered orally.

Emergency Departments Waiting Times

Question No. 50 answered orally.

Ceisteanna (49)

James Lawless

Ceist:

49. Deputy James Lawless asked the Minister for Health the reason to date in 2019 more than 850 persons over 75 years of age have endured emergency department wait times of more than 24 hours at Naas General Hospital. [48777/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The hospital system is currently operating at close to full capacity. The number of patients attending Emergency Departments continues to increase year on year. HSE figures show that for the first ten months of 2019, the number of patients attending Naas Hospital decreased by 1%, however, the number of attendances of patients over the age of 75 increased by 6% compared to the same period in 2018. Similarly, admissions in Naas Hospital decreased by 2.1% while admissions of patients over the age of 75 increased by 3.5% compared to the same period last year. This reflects increasing demand for unscheduled care, especially by patients in the 75 years and over age group. The HSE has indicated that people in this age cohort attending hospital emergency departments are more likely to be admitted and generally stay twice as long as the general population.

The HSE Winter Plan was launched on Thursday 14 November in preparation for the anticipated increase in demand over the winter period. Th Government has allocated an additional 26m to fund the Plan. Nine Winter Action Teams, each aligned to a Community Healthcare Organisation and associated acute hospitals and Hospital Groups, have prepared Integrated Winter Plans. These plans focus on demand management and reduction, staffing availability, timely access to the most appropriate care pathway for patients, and appropriate timely discharge from acute hospitals. Each Action Team has set out a range of initiatives it will undertake within its area to implement the Plan.

I am confident that with the immediate measures being undertaken under the Winter Plan and the strategic approach undertaken by the Government under Sláintecare that progress will be made in addressing the difficulties in the emergency departments.

Question No. 50 answered orally.

Occupational Therapy Waiting Lists

Question No. 52 answered orally.

Ceisteanna (51)

Darragh O'Brien

Ceist:

51. Deputy Darragh O'Brien asked the Minister for Health when progress will be made on reducing waiting times in north Dublin for occupational therapy assessments especially for those under 18 years of age; and if he will make a statement on the matter. [48881/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I acknowledge that the current time to access Occupational Therapy services in North Dublin, and indeed nationally, can be too long and that this may cause anxiety for parents and patients who are seeking to obtain services.

The fact that people are waiting too long to access therapy services such as OT is a reflection of the historical under-investment in the primary and community sector in Ireland. The Government is committed to addressing this deficit and transforming how we deliver health services by implementing the vision set out in the Sláintecare Action Plan. I am determined that we develop a more comprehensive and integrated community and primary care system and shift the focus of our system so that the majority of healthcare is provided, where possible, either at home or close to home in the community.

The Government’s commitment to reform can be seen in Budget 2020 with the allocation of €10m to provide for the enhancement of Community Services, building to a full-year allocation of €60m in 2021. This significant investment by Government will enable the recruitment of up to 1,000 therapists, nurses and other frontline staff. North Dublin, like the rest of the country, will benefit from this investment which will support the development of a more integrated and comprehensive primary and community care system.

Turning specifically to the situation in North Dublin, I understand that the recruitment of six OTs has been approved by the local Head of Service for Primary Care to fill vacancies that currently exist. Derogation from temporary employment controls has been sought and once received all vacant posts will be offered out as appropriate and without delay. It is expected that waiting time swill be reduced significantly once extra resources are in place.

I also understand that North Dublin, along with other CHOs, are implementing local action plans to address waiting times and that these include a focus on long waiters, cross cover arrangements and maximisation of the supports available from administrative staff and OT Assistants.

Question No. 52 answered orally.

Emergency Departments Waiting Times

Ceisteanna (53)

Anne Rabbitte

Ceist:

53. Deputy Anne Rabbitte asked the Minister for Health the reason to date in 2019 more than 1,530 persons over 75 years of age have endured emergency department wait times of more than 24 hours at University Hospital Galway. [48773/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The hospital system is currently operating at close to full capacity. The number of patients attending emergency departments continues to increase year on year. HSE figures show that for the first ten months of 2019, the number of patients attending Galway University Hospital increased by 4.1% and the number of attendances of patients over the age of 75 increased by 7.9% compared to the same period in 2018. This reflects increasing demand for unscheduled care, especially by patients in the 75 years and over age group.

There are a number of factors which may affect the waiting times for older patients. In particular, people in the older age category presenting to EDs are more likely to have complex needs and be admitted then the population generally.

In preparation for the anticipated increase in demand over the winter period the HSE Winter Plan was launched on Thursday 14 November. Nine Winter Action Teams, each aligned to a Community Healthcare Organisation and associated acute hospitals and Hospital Groups, have prepared Integrated Winter Plans. These plans focus on demand management and reduction, staffing availability, timely access to the most appropriate care pathway for patients, and appropriate timely discharge from acute hospitals. Each Action Team has set out a range of initiatives it will undertake within its area to implement the Plan.

There are challenges facing the emergency departments in our hospitals. The Government is tackling these issues through providing funding of €26m for the immediate measures being undertaken in the Winter Plan this year, through the Sláintecare Strategy and the investment being made in accordance Project Ireland 2040. These measures are addressing the issues of access to healthcare and capacity in the system.

I am confident that together with the more immediate measures being undertaken under the Winter Plan and the strategic approach undertaken by the Government under Sláintecare and Project Ireland that progress will be made in addressing the difficulties in the emergency departments.

Primary Care Centres Provision

Ceisteanna (54, 344, 348)

Pat Casey

Ceist:

54. Deputy Pat Casey asked the Minister for Health the status of the proposed new primary care centres in Arklow and Rathdrum, County Wicklow; and if he will make a statement on the matter. [48885/19]

Amharc ar fhreagra

Pat Casey

Ceist:

344. Deputy Pat Casey asked the Minister for Health the status of the primary care centre for Rathdrum, County Wicklow; and if he will make a statement on the matter. [49115/19]

Amharc ar fhreagra

Pat Casey

Ceist:

348. Deputy Pat Casey asked the Minister for Health the status of the development of the Arklow primary care centre; and if he will make a statement on the matter. [49145/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

I propose to take Questions Nos. 54, 344 and 348 together.

I am pleased to be able to inform the Deputy that the development of the Primary Care Centres in Arklow and Rathdrum is being progressed.

I know that there has been some concern around the development of Arklow Primary Care Centre given the decision by the original preferred bidder not to proceed with the project. However, I am pleased to say that an alternative developer has been identified, and a Letter of Intent to develop a centre via operational lease was issued in July 2019. I understand that a review of the existing building design and planning conditions has been undertaken and that a new planning application to amend the existing grant of planning has been submitted.

The Rathdrum Primary Care Centre is further advanced and I understand that the HSE is in contract discussions with the developer.

Unfortunately, it is not possible at this stage to provide a definitive operational date for the two centres. Nonetheless, delivering these projects is representative of this Government's support for the development of the primary care sector. There are now 128 Primary Care Centres in operation with a further 20 centres expected to open by the end of 2020.

These modern, well-equipped and accessible premises support the development of primary care services in line with the vision of Sláintecare.

Home Help Service Provision

Question No. 56 answered orally.

Ceisteanna (55)

Louise O'Reilly

Ceist:

55. Deputy Louise O'Reilly asked the Minister for Health the impact of the waiting list for home help on delayed discharges; and if he will make a statement on the matter. [48896/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Homecare is an increasingly important part of the supports enabling older people to remain in their own homes and communities for as long as possible and for facilitating their discharge from acute hospitals. While we have seen significant investment in recent years in home support there is unmet need and demand is growing for the service. Nationally, at the end of August 7,255 people had been assessed and were waiting for either new or additional home support services.

The HSE has assured the Department that those people who are on a waiting list are reviewed, as funding becomes available, to ensure that individual cases continue to be dealt with on a priority basis within the available resources and as determined by the local front line staff who know and understand the clients’ needs, and who undertake regular reviews of those care needs to ensure that the services being provided remain appropriate. In addition, people being discharged from acute hospitals, who are in a position to return home with supports, are prioritised.

We have made improved access to home support services a priority and an additional investment of €52 million brings the total funding for home supports to approximately €487 million in 2020. Next year the HSE aims to deliver over 19.2 million hours of home support, representing a substantial increase of 1 million hours more than this year’s target.

Delayed Transfers of Care is a complex and challenging issue and a wide range of factors may contribute to this, including process and service-related matters. The Report of the Independent Expert Review of Delayed Discharges, published last year, highlights the complexities involved. The latest data available (19th November) indicates that nationally there were 29 people in hospital classified as delayed and waiting funding for a home support package. This is represents about 4% of all cases. Nevertheless, home support along with other community measures are a long established and recognised feature of support timely egress from our acute hospitals.

The importance of these supports is further recognised in the HSE's recently published winter plan. The Winter Plan provides additional resources to facilitate a reduction in Delayed Transfers of Care by supporting the Nursing Homes Support Scheme, Transitional Care and Home Supports. €2 million of this funding has been allocated for the provision of an additional 1,110 home support packages with 600 of these allocated across the CHOs to deal specifically with clients assessed and waiting for home supports.

Following the 2018 publication of the Independent Expert Review of Delayed Discharges, an implementation group has been established by the HSE to progress the recommendations. I have also established a Cross Divisional Oversight Group within the Department of Health to oversee the HSE’s implementation of the recommendations. Work is progressing in this regard.

Question No. 56 answered orally.

Emergency Departments Waiting Times

Ceisteanna (57)

Seán Haughey

Ceist:

57. Deputy Seán Haughey asked the Minister for Health the reason to date in 2019 over 2,300 people over 75 years of age have endured emergency department wait times of more than 24 hours in the two hospitals in north Dublin. [48767/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

The hospital system is currently operating at close to full capacity. The number of patients attending Emergency Departments continues to increase year on year. HSE figures show that for the first ten months of 2019, the number of patients attending Beaumont Hospital increased by 0.9% and the number of attendances of patients over the age of 75 increased by 7.1% compared to the same period in 2018. However it should also be highlighted that the number of patients recorded as waiting on trolleys in Beaumont Hospital decreased by 1.6% this year compared to 2018 and have remained consistently low throughout 2019.

In relation to the Mater University hospital, HSE figures show that for the first ten months of 2019, the number of patients attending the Hospital increased by 2.5%, however, the number of attendances of patients over the age of 75 decreased by 1.6% compared to the same period in 2018.

The figures for both hospitals show the continued high level of demand for services at emergency departments.

The HSE Winter Plan was launched on Thursday 14 November in preparation for the anticipated increase in demand over the winter period. The Government has provided additional funding of €26m to support the implementation of the Plan. Nine Winter Action Teams, each aligned to a Community Healthcare Organisation and associated acute hospitals and Hospital Groups, have prepared Integrated Winter Plans. These plans focus on demand management and reduction, staffing availability, timely access to the most appropriate care pathway for patients, and appropriate timely discharge from acute hospitals. Each Action Team has set out a range of initiatives it will undertake within its area to implement the Plan.

I acknowledge the challenges that are facing the emergency departments in our hospitals. In addition to the immediate measures being undertaken in the Winter Plan the Government through the Sláintecare Strategy is addressing the issues of access to healthcare. The Sláintecare Action Plan for 2019 has a specific workstream on access and waiting lists. The Government is also increasing investment in health infrastructure and capacity in the system in line with Project Ireland 2040.

I am confident that together with the more immediate measures being undertaken under the Winter Plan and the strategic approach undertaken by the Government under Sláintecare that progress will be made in addressing the difficulties in the emergency departments.

Child and Adolescent Mental Health Services Data

Ceisteanna (58)

Louise O'Reilly

Ceist:

58. Deputy Louise O'Reilly asked the Minister for Health the number of children waiting for a CAMHS appointment at 31 October 2019 or the latest date available in north County Dublin; and if he will make a statement on the matter. [48894/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Enhancement of the specialist CAMHS service, including improved access and reducing waiting lists, remains a priority for both the Government and the HSE.

Cases assessed by professionals as urgent are seen as a matter of priority. There are now 70 CAMHS teams nationally, compared to 49 in 2008, and 3 Paediatric Liaison Teams. All aspects of CAMHS nationally are being improved by the HSE under its annual Service Plans. This includes better out-of-hours and 7/7 day cover, progression of Day Hospital care, developing specialist teams such as Eating Disorders, and improved Prevention and Early Intervention services.

HSE Mental Health services will receive €1.026 billion in funding in 2020, an increase of €315m since 2012.

The national CAMHS waiting list has reduced by around 500 so far this year, from around 2,500 in December 2018 to around 2,000 in August 2019.

There were 63 children awaiting an appointment for the Balbriggan and Swords CAMHS teams at the end of October last, of which, 31 (or just under half) are waiting up to 3 months and 50 (or 80%) are waiting up to 6 months with the remainder waiting between 6 and 12 months.

CAMHS in North County Dublin, which includes Balbriggan and Swords, serves one of the fastest growing catchment areas in Ireland, including a significant young population. Based on Census data, Balbriggan CAMHS serves an under 18 population of nearly 18,000 and Swords CAMHS serves an under 18 population of around 25,000.

Both North County Dublin CAMHS teams have reported higher volumes of referrals this year, of up to 10% to the end of October last along with increased levels of more acute presentations. Both teams have had staffing challenges during this year. This has been addressed by the HSE with posts being replaced and filled across Nursing, Occupational Therapy, Speech and Language Therapy, Psychology, Social Work and Administration support.

This will greatly assist the teams in reducing waiting lists in a defined, coordinated and sustainable manner. The CAMHS service will continue to strive to reduce waiting lists across all of North Dublin.

Ambulance Service

Ceisteanna (59)

Lisa Chambers

Ceist:

59. Deputy Lisa Chambers asked the Minister for Health the reason for the significant deterioration in ambulance turnaround times in Mayo University Hospital between September 2017 and September 2019. [48779/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

Ambulance turnaround times provide the time interval from ambulance arrival time at a hospital, to when the ambulance crew declares readiness to accept another call. The performance target for 2019 is that 95% of all ambulances have an interval of less than 60 minutes from arrival at the ED to when the ambulance crew declares readiness to accept another call. As of September 2019, 77.6% of ambulances at Mayo University Hospital achieved a turnaround time of 60 minutes of less.

When the emergency care system at Hospitals are under pressure, there is the potential for delay in the transfer of care of patients from ambulance to Emergency Department personnel. An Ambulance Turnaround Framework was developed which sets out the process that alerts management, to increases in emergency demand and activity resulting in the delayed transfer of care of patients and delays in the release of ambulance resources. A management process is then employed to ensure the timely release of all ambulance resources in a safe manner allowing timely service delivery to patients.

My Department has engaged extensively with the HSE this year to identify mitigating actions to bring down trolley numbers and waiting times in the ED in the face of growing demand. The HSE Winter Plan was launched on Thursday 14 November in preparation for the anticipated increase in demand over the winter period and is supported by an additional €26m in winter funding nationally, with specific funding allocated to the Winter Action Teams to support initiatives at local level.

I have been assured that the HSE is committed to ensuring that patient care remains seamless and that patients are clinically handed over in a safe, professional and timely manner; with the safety and dignity of the patient being of paramount importance.

Vaccination Programme

Ceisteanna (60)

Michael Healy-Rae

Ceist:

60. Deputy Michael Healy-Rae asked the Minister for Health his views on the safety of the HPV vaccine (details supplied); and if he will make a statement on the matter. [48571/19]

Amharc ar fhreagra

Freagraí scríofa (Ceist ar Health)

As Minister for Health I have no responsibility for vaccine trials.

The Health Products Regulatory Authority (HPRA) is responsible for monitoring the safety and quality of all medicines including vaccines that are licensed in Ireland. All HPV vaccines available in the EU are authorised by the European Medicines Agency (EMA).

The HPRA has advised that the specific HPV vaccine trial has not been identified in this query. This response is therefore only made in relation to the HPV vaccine that been chosen by the HSE for use in current HPV schools immunisation programme, which is Gardasil 9. The EMA website provides information on the authorisation of Gardasil 9 including information for the public and product information for healthcare professionals.

The safety of HPV vaccines have been studied for over 13 years. Over 1 million people have been studied during clinical trials since the vaccine was licensed in 2006. No country has raised concerns about the safety of the HPV vaccine. There is no scientific evidence in Ireland or in any other country that the HPV vaccine causes any long-term medical condition.

All international bodies have continually reported that the vaccines used in Ireland have no long-term side effects. Most people have no problems after the vaccine. The HPV vaccine has many of the same, mild side effects as other vaccines. Some people have an area of soreness, swelling and redness in their arm where the injection was given. This is nothing to worry about as this usually passes after a day or two. Some people may get a headache, feel sick in their tummy or have a slight temperature. If this happens, paracetamol or ibuprofen will help. Occasionally, some people may feel unwell and faint after getting their injection. To prevent this, they should sit down and rest for 15 minutes after the vaccination. Severe allergic reactions to vaccines are very rare. School vaccination teams are trained to treat any severe allergic reaction. If you are worried, you should talk to your GP or a member of the school vaccination team.

All medicines, including vaccines are subject to on-going review and evaluation of all available data from a range of sources, including systematic scientific literature review, to consider any impact that their data may have on the overall assessment of the benefits and risks of a medicinal product.

The HPRA and the EMA continually monitor adverse events to vaccination. The HPRA operates a national adverse reaction reporting system, which members of the public and healthcare professionals are encouraged to submit any suspected adverse reactions to. All Reports received by the HPRA are routinely transmitted to the EMA's adverse reaction database for inclusion in global signal detection and monitoring activities.