Thursday, 23 Jul 2020

Written Answers Nos. 235-256

Hospital Facilities

Ceisteanna (235)

Joe Carey

Ceist:

235. Deputy Joe Carey asked the Minister for Health if he will provide a report in relation to a project (details supplied) in County Clare; and if he will make a statement on the matter. [17811/20]

Freagraí scríofa

Minister for Health

As the Health Service Executive is responsible for the delivery of public healthcare infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.

Mental Health Services

Ceisteanna (236)

Mark Ward

Ceist:

236. Deputy Mark Ward asked the Minister for Health if he will provide a breakdown of funding allocated to national governing bodies for mental health in tabular form; and if he will make a statement on the matter. [17819/20]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Mary Butler)

The following is the tabular statement:

National Organisations & Governing Bodies	Approved Funding 2020
HSE Mental Health Services	€1.026 billion
Mental Health Commission	€14.832 million (net non-capital expenditure )

Mental Health Services

Ceisteanna (237)

Mark Ward

Ceist:

237. Deputy Mark Ward asked the Minister for Health if he will provide a breakdown of sporting national governing bodies in receipt of mental health funding; and if he will make a statement on the matter. [17820/20]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Mary Butler)

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

Mental Health Services

Ceisteanna (238)

Mark Ward

Ceist:

238. Deputy Mark Ward asked the Minister for Health his plans to provide mental health training to persons involved locally and nationally in sporting organisations; and if he will make a statement on the matter. [17821/20]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Mary Butler)

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

Hospital Funding

Ceisteanna (239, 240)

David Cullinane

Ceist:

239. Deputy David Cullinane asked the Minister for Health the amount of funding made available in each of the years 2017 to 2019 and to date in 2020 to replace income expected from private care in public hospitals [17833/20]

David Cullinane

Ceist:

240. Deputy David Cullinane asked the Minister for Health the amount of income generated from private care in public hospitals in each of the years 2017 to 2019 and to date in 2020, by year, by hospital and hospital group in tabular form; and if he will make a statement on the matter. [17834/20]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 239 and 240 together.

As Income generated from private care in public hospitals is the responsibility of the Health Service Executive (HSE), I have arranged for these questions to be referred to the HSE for direct reply to the Deputy.

Hospital Services

Ceisteanna (241, 277)

David Cullinane

Ceist:

241. Deputy David Cullinane asked the Minister for Health the progress made in eliminating the provision of private care by consultants in public hospitals; when same will be achieved; and if he will make a statement on the matter. [17835/20]

David Cullinane

Ceist:

277. Deputy David Cullinane asked the Minister for Health the net increase in the number of public hospital consultants since the adoption of Sláintecare; and if he will make a statement on the matter. [17871/20]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 241 and 277 together.

Following on from the publication of the Sláintecare Report in May 2017, the De Buitléir Group was established to consider matters relating to the proposal that private care be removed from the public hospital system, as recommended in the Report.

The De Buitléir Group recommended that contracts permitting private care by consultants be phased out gradually and that legislation be introduced to ensure that public hospitals are exclusively used for the treatment of public patients from the conclusion of the ten-year Sláintecare implementation period.

The Programme for Government includes commitments to finalise the Sláintecare Contract and to legislate for public-only work in public hospitals. Arrangements relating to the finalisation of the Sláintecare contract are in train. Its introduction will also require amendment of the FEMPI Acts to enable pay increases for serving 'new entrant' consultants, as the Acts currently prohibit pay increases for serving public servants.

Since the Government accepted the recommendation of the De Buitléir Group in December 2019 in relation to future consultant appointments being confined to the 'Sláintecare public-only consultant contract', the number of consultants has increased by 140 (to end May 2020 wte's), reflecting ongoing growth and also the need to increase capacity in response to COVID-19.

Given the impact of COVID-19 on the acute hospital system arrangements were made to enable consultants holding contracts that allow private activity to move temporarily to the Type A public-only consultant contract under 'fast-track' arrangements. By 7th July 150 consultants had availed of this arrangement and on 15th July my Department approved an extension of the arrangement to the end of December, recognising that the measure is consistent with the future direction of health policy.

Hospital Services

Ceisteanna (242)

David Cullinane

Ceist:

242. Deputy David Cullinane asked the Minister for Health if an independent assessment has been carried out of the separation of private practice from the public hospital system; and if he will make a statement on the matter. [17836/20]

Freagraí scríofa

Minister for Health

Arising from the recommendation by the All-Party Oireachtas Committee on the Future of Healthcare that private activity be progressively removed from public hospitals and that an independent impact analysis of the separation be conducted, an Independent Review Group (IRG) was established to examine the removal of private practice from public acute hospitals.

The Independent Review Group, which was chaired by Dr Donal de Buitléir, made eight recommendations which it considers would be necessary to remove private activity from public hospitals. Five recommendations concern the consultant contract. A sixth recommends legislation to ensure that public hospitals are exclusively used for the treatment of public patients from the conclusion of the ten-year Sláintecare implementation period. Two further recommendations relate to better data collection and HIQA’s role in private hospitals.

The Report was published in August 2019 and in December Government announced the introduction of a Sláintecare consultant contract, based on key recommendations contained in the IRG Report. A link to the published report is enclosed for reference https://assets.gov.ie/26529/aed7ee0317ff49a7a609974772cf2191.pdf

The current Programme for Government, Our Shared Future, contains specific commitments in relation to finalising the new Sláintecare consultant contract and legislating for public-only work in public hospitals, which are fundamental aspects necessary to support progression towards the goal of a single-tier public hospital system.

Hospital Waiting Lists

Ceisteanna (243)

David Cullinane

Ceist:

243. Deputy David Cullinane asked the Minister for Health the number of patients waiting more than 12 weeks for an inpatient procedure, 10 weeks for an outpatient appointment and 10 days for a diagnostic test; and if he will make a statement on the matter. [17837/20]

Freagraí scríofa

Deputy Stephen Donnelly

The information requested by the Deputy is currently being collated by officials in my Department and will be provided to the Deputy directly as soon as it becomes available.

HSE Reviews

Ceisteanna (244, 247)

David Cullinane

Ceist:

244. Deputy David Cullinane asked the Minister for Health the progress made in the HSE directorate becoming a more strategic national centre; and if he will make a statement on the matter. [17838/20]

David Cullinane

Ceist:

247. Deputy David Cullinane asked the Minister for Health the progress made in establishing HSE regional bodies; and if he will make a statement on the matter. [17841/20]

Freagraí scríofa

Minister for Health

I propose to take Questions Nos. 244 and 247 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.

The new Programme for Government, Our Shared Future, recommits to this core Sláintecare recommendation, stating “Enhanced governance and accountability in the health service is a key component of Sláintecare reform. The HSE Board is now in place and we must now bring forward detailed proposals on the six new regional health areas to deliver services for patients locally that are safe, high quality and fairly distributed .”

As agreed, when the new Regional Health Areas geographies were announced last summer, a business plan for the establishment of these health areas was expected to be brought to Government for its approval in 2020.

The intention was that this plan would set out the high-level organisational design for the health system, including: the respective roles, functions, responsibilities and accountabilities of the Department of Health, HSE centre and new regional structures; the relationship between these entities; and the overall legal construct. These proposals should also outline a timeline for the establishment of regional organisations and for any legislative changes required to realise the Sláintecare vision.

Work was underway in my Department and within the HSE to develop these detailed proposals on Regional Health Areas and the HSE “national centre” but understandably this work was paused as a result of COVID-19. This programme of work will be given further consideration in the coming weeks to take account of the Programme for Government commitment and any new considerations relating to COVID-19.

As part of the HSE's work on this, it is now reviewing the HSE Corporate Centre with a view to providing recommendations on a more strategic national centre which will have greater clarity of role and can better complement and support the health services and regions going forward. These changes will also enable greater decision-making to happen at the front line.

It will be important that there is significant engagement with all key stakeholders across the health and social care sector to ensure that any structural changes do not unduly cause disruption and loss of focus on service delivery. This will be even more important now given the challenges facing the health service as a result of COVID-19.

HSE Reviews

Ceisteanna (245)

David Cullinane

Ceist:

245. Deputy David Cullinane asked the Minister for Health the number of HSE national directors that have been relocated to other roles in each of the years 2017 to 2019 and to date in 2020; and if he will make a statement on the matter. [17839/20]

Freagraí scríofa

Minister for Health

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

HSE Reviews

Ceisteanna (246)

David Cullinane

Ceist:

246. Deputy David Cullinane asked the Minister for Health the progress made in aligning hospital groups and community health organisations; the timelines for delivering same; the processes that will deliver alignment; and if he will make a statement on the matter. [17840/20]

Freagraí scríofa

Minister for Health

Following the announcement by the outgoing Government in July 2019 of the geographies for six new regional health areas, a joint action programme co-sponsored by the HSE, the Department of Health and the Sláintecare Programme Implementation Office was initiated to commence work on the reconfiguration of the health service and development of Regional Health Areas. A draft programme plan was considered by the programme sponsors in early 2020, prior to the onset of the COVID-19 emergency. In April 2020, recognising the need for a robust programme plan to support a reform of this scale, the Sláintecare Programme Implementation Office engaged contractors to work with Sláintecare, HSE and DOH to validate (insofar as possible) the draft programme plan for the service reconfiguration and development of the Regional Health Areas and develop recommendations to enhance the plan based upon international learnings and insights. This work was overseen by the programme sponsors and was completed in May. This report, including the enhanced programme plan, is being considered and finalised. As agreed, when the new Regional Health Areas geographies were announced last summer, a business plan for the establishment of these health areas is expected to be brought to Government for its approval. The intention was that this plan will set out the high-level organisational design for the system, including: the respective roles, functions, responsibilities and accountabilities of the Department of Health, HSE centre and new regional structures; the relationship between these entities; and the overall legal construct. These proposals should also outline a timeline for the establishment of regional organisations and for any legislative changes required to realise the Sláintecare vision. Preliminary work on establishing a process to develop detailed proposals has been undertaken but this work was paused as a result of COVID-19. This programme of work will be given further consideration in the coming weeks in consultation with the Minister to take account of the Programme for Government commitment and any new considerations relating to COVID-19.

Question No. 247 answered with Question No. 244.

HSE Reviews

Ceisteanna (248)

David Cullinane

Ceist:

248. Deputy David Cullinane asked the Minister for Health if the HSE has developed and utilised a geographic resource allocation model to ensure equitable allocation of healthcare resources; and if he will make a statement on the matter. [17842/20]

Freagraí scríofa

Minister for Health

Central to improving population health and reducing inequalities is the ability to estimate a populations’ health needs and use this information to design, deliver and evaluate services that meet those needs, within the resources available. One policy measure used to address observed differences between population profiles and promote equitable distribution of available funding is population-based (needs-based) resource allocation. Often referred to as population-based funding formulas, the aim of these frameworks is to adjust capitation funding across the population according to variation in need and the cost of providing required services and supports.

Policy makers are considering the options for implementing population-based resource allocation in Ireland. A review is currently being conducted by the Centre for Health Policy and Management, Trinity College Dublin that aims to inform Irish health care policy by describing models of population-based resource allocation and synthesising evidence about their implementation and impact. Three questions are addressed as part of this review:

1. What are the key concepts and methodological approaches related to population-based resource allocation?

2. How are population-based resource allocation policies specified and realised?

3. What is known about the implementation or impact of population-based resource allocation policies?

This review is expected to be finalised in the coming months.

The HSE 2020 National Service Plan specifies:

Work with the National Health Intelligence Unit to support population health planning and needs assessment in the context of the new regional health areas to develop capacity to support health and well-being services to deliver on health and wellbeing priorities (Health Service Executive 2019)

This work by the HSE had been put on hold during the Covid-19 pandemic.

Departmental Funding

Ceisteanna (249)

David Cullinane

Ceist:

249. Deputy David Cullinane asked the Minister for Health the advancements made in eHealth; the funding that has been made available to ensure the roll out of the electronic health record system; and if he will make a statement on the matter. [17843/20]

Freagraí scríofa

Minister for Health

There have been notable advances made in eHealth in recent times. As part of the COVID-19 emergency response eHealth technologies were deployed at pace and scale to support healthcare workers. The Contact Tracing App was developed to complement manual contact tracing, informing of the spread of Covid-19 symptoms and providing a trusted source of news, information and guidance. Telehealth solutions have also been deployed and have emerged as a significant eHealth response to Covid-19. Current digital integration and existing digital infrastructure are at various states of maturity across the healthcare system and a national programme of work continues to be in place by the HSE to upgrade and install ICT infrastructure across many health settings.

My Department fully supports the implementation of the eHealth Strategy and the cross-party Sláintecare eHealth deliverables including the Electronic Health Record. Plans to deploy an acute EHR initially into the New Children's Hospital are progressing and the procurement exercise for that is currently underway. The Electronic Health Record is a long-term project subject to continuing government approval for further deployments into additional healthcare settings.

In relation to funding, the overall capital investment in eHealth and ICT has increased by €10m to €95m in 2020 and the projected investment for 2021 is €120m.

Departmental Expenditure

Ceisteanna (250)

David Cullinane

Ceist:

250. Deputy David Cullinane asked the Minister for Health the spending in the healthcare system in each of the years 2017 to 2019 and to date in 2020, by year, amount, percentage and other categories (details supplied) in tabular form; and if he will make a statement on the matter. [17844/20]

Freagraí scríofa

Minister for Health

Set out in the table below is the health expenditure by the Health Service Executive 2017 to June 2020. by funding source. Between 2017 and 2020 the level of funding provided by the exchequer increased approximate €2.7bn or 20%.

Health Expenditure by the Health Service Executive 2017 to June 2020 by Funding Source

My Department does not have data in relation to private insurance expenditure on health and social care services outside of the public system. Nor do we have information of the level of out of pocket payments made by citizens in relation to their receipt of health and social care services.

This information is collected by the Central Statistics Office.

Sláintecare

Ceisteanna (251)

David Cullinane

Ceist:

251. Deputy David Cullinane asked the Minister for Health the status of the single national health fund promised under Sláintecare; and if he will make a statement on the matter. [17845/20]

Freagraí scríofa

Minister for Health

As committed to in the Action Plan for 2019, Sláintecare has developed proposals for multi-annual capital and current funding, including a transition fund, to support health care reform. Following Budget 2020, the Sláintecare Programme Implementation Office have been resourced with a total of €45.5 million in 2020 (with an additional €50 million in 2021) in order to progress the resourcing of enhanced community care under the capacity planning framework, and in supporting care redesign initiatives.

There is a commitment to provide €10 million in 2020, with a further committed total of €60 million in 2021, to support the development of enhanced community care that will effect a shift in care from the acute sector to the community. The additional full-year funding will provide for up to 1,000 therapists, nurses, dementia advisors and other professionals in the community. There will be also be resources of €12 million to support care redesign initiatives, along with the existing €23.5 million provided to the SPIO in 2019.

Sláintecare

Ceisteanna (252)

David Cullinane

Ceist:

252. Deputy David Cullinane asked the Minister for Health the number of reports produced by the Sláintecare implementation office; and if he will make a statement on the matter. [17846/20]

Freagraí scríofa

Deputy Stephen Donnelly

In response to the Sláintecare Report, the government approved the Sláintecare Implementation Strategy in July 2018. The Strategy sets out the actions to be taken in the first three years of the Sláintecare implementation process. The Sláintecare Programme Implementation Office was established in September 2018 with the initial task of reviewing and refining the strategy into a detailed Action Plan for 2019. This Action Plan outlines the project management structures and governance approach for the 10-year implementation of Sláintecare, as well as detailed timeframes for 138 projects to be progressed in 2019.

The Sláintecare Programme Implementation Office was established in September 2018 and has had one full year in operation. A series of important Sláintecare reform Government decisions have been made in this time, including the agreement:

1. on the geographies for the six new Regional Health Areas which is a first major step towards restructuring our health services in line with recommendation in the Oireachtas Committee report, which is informing the development of a detailed business case for consideration by Government;

2. on revised GP contractual arrangements in April 2019, which will see a €210 million investment (40% increase) in General Practice over the next four years of which €80 million will be available for the management of chronic diseases, like diabetes and COPD, through family doctors. This is expected to benefit more than 400,000 patients; and

3. on the strengthening of the HSE with the formal appointment of the Health Service Executive (HSE) Board in June 2019 and the introduction of a new HSE Chief Executive Officer.

A Sláintecare Action Plan Year-end Report 2019 was approved by government in April and subsequently published. Including the milestones set out above, 112 actions of 138 were successfully implemented during 2019. This work has been carried out by many stakeholders, including from the Department of Health, the Health Service Executive (HSE) and the voluntary and community bodies and key partners.

Including the Sláintecare Implementation Strategy, the Sláintecare Action Plan 2019 and four quarterly reports on progress, a total of six reports have been published by the Sláintecare Programme Implementation Office since establishment.

All the publications relating to Sláintecare can be found at the following link: https://www.gov.ie/en/campaigns/slaintecare-implementation-strategy/

Sláintecare

Ceisteanna (253)

David Cullinane

Ceist:

253. Deputy David Cullinane asked the Minister for Health the number of times the Cabinet committee on Sláintecare met; the dates of the meetings; and if he will make a statement on the matter. [17847/20]

Freagraí scríofa

Minister for Health

There is no specific Cabinet Committee in relation to Sláintecare. Discussions of Sláintecare formed part of the Social Policy and Public Services Cabinet Committee B. Sláintecare was the topic of these meetings on two occasions on 11 April 2018 and 22 November 2018.

In addition, updates on Sláintecare progress were provided to Cabinet Committee B throughout 2019. There were health specific meetings of this committee on the following dates 21 February 2019, 01 April 2019, 11 July 2019, 10 September 2019, 21 October 2019, 30 October 2019 and 09 December 2019.

Quarterly updates on Sláintecare implementation were also provided to the Cabinet throughout 2019 and 2020 through Memorandum for the Information of Government, which included the quarterly reports that were subsequently published at the following link:

https://www.gov.ie/en/campaigns/slaintecare-implementation-strategy/

Sláintecare

Ceisteanna (254, 255)

David Cullinane

Ceist:

254. Deputy David Cullinane asked the Minister for Health the increase in the health and well-being budget since the adoption of Sláintecare; and if he will make a statement on the matter. [17848/20]

David Cullinane

Ceist:

255. Deputy David Cullinane asked the Minister for Health the funding allocated to resourcing and developing a universal child health and well-being service since the adoption of Sláintecare; and if he will make a statement on the matter. [17849/20]

Freagraí scríofa

Minister of State at the Department of Health (Deputy Frankie Feighan)

I propose to take Questions Nos. 254 and 255 together.

It is not possible to identify in totality how much funding is currently spent on improving health and wellbeing across all Government Departments and agencies and in wider society.

Whilst there was little change to the Health and Wellbeing budget following the immediate adoption of the Sláintecare programme, the budget for the Healthy Ireland Fund was increased from € 5million in 2017/2018 to €6 million in 2019 and 2020.

In 2019, the Department of Health launched the €20m Sláintecare Integration Fund to support successful service delivery projects that will clearly demonstrate how citizens can be offered the right care, in the right place and at the right time. These projects are offering new approaches to sickness prevention, hospital avoidance, and the delivery of care in the community.

In total 122 successful projects were selected, of which 38 related to ‘promoting the engagement and empowerment of citizens in the care of their own health’. There is a total of €6 million allocated to health and wellbeing projects which includes support for Chronic Disease Self-Management, Sexual Health Services, Smoking Cessation, Mens’ Sheds and Social Prescribing among others. This will help deliver care as close to home as possible and prevent avoidable illness at an early stage.

As the Health Service Executive may also have relevant information on this matter I have also referred the Deputy's questions to the Executive for attention and direct response to him.

Sláintecare

Ceisteanna (256)

David Cullinane

Ceist:

256. Deputy David Cullinane asked the Minister for Health the amount spent on removing inpatient charges for public hospital care since the adoption of Sláintecare; and if he will make a statement on the matter. [17850/20]

Freagraí scríofa

Minister for Health

The Health (Amendment) Act 2013, provided for the current public hospital statutory in-patient charge is €80 per night, subject to a maximum of €800 in any twelve consecutive months.

There has be no change to the rate or application of the in-patient charge since its introduction from 1 January 2017.

Removal of the current inpatient charge would cost approximately €30m per annum.