Written Answers Nos. 825-844
825. Deputy Bernard J. Durkan asked the Minister for Health the number of patients awaiting scoliosis procedures; his plans to overhaul waiting lists in this area; and if he will make a statement on the matter. [24087/20]
Amharc ar fhreagraIn recent years there has been an increased investment in paediatric orthopaedics and scoliosis services, which has improved access to surgery and outpatient appointments. In 2018 Children’s Health Ireland (CHI; previously the Children’s Hospital Group) was provided with an additional €9 million in funding to address paediatric orthopaedic waiting lists, including the provision of scoliosis services. Scoliosis activity accounts for 20% of overall orthopaedic activity across CHI.
This funding supported the recruitment of approximately 60 WTE in 2018 and 2019 to enable the expansion of paediatric orthopaedic services including scoliosis services. The posts relate to the multi-disciplinary team at diagnosis, pre-assessment, during surgery in theatre, and post operatively. The majority of posts were allocated to each hospital in 2018.
The 2018 investment in paediatric orthopaedics included funding to support transition of adolescents with scoliosis from CHI at Crumlin to the Mater Misericordiae University Hospital (MMUH). CHI and MMUH have developed and agreed the clinical pathways for the transition of adolescents with scoliosis to MMUH. The transition of patients over the age of 16 who were awaiting a first-time outpatient/spinal review appointment at Crumlin commenced in December 2018. Each month, appropriate patients are identified for this pathway via clinical validation.
CHI have advised my Department that the introduction of government restrictions for COVID-19 based on public health advice required CHI at Crumlin and Temple Street to defer all non-emergency spinal operations. CHI at Crumlin and Temple Street have now resumed services on an incremental basis.
Key social distancing measures and Infection Prevention and Control (IPC) requirements have a material impact on the available physical space to deliver services, significantly impacting on the overall capacity and operational activity levels for inpatient / outpatient settings. To the end of August 2020, 177 scoliosis procedures had taken place, compared to 251 for the same period last year, marking a decrease in activity of 29%.
At the end of August 2020 there were 218 scoliosis patients waiting for a spinal procedure at Crumlin, Temple Street and Cappagh Hospitals, across active, TCI (to come in) suspended and planned procedure categories. Of this number, 129 were awaiting spinal fusion procedures, while 89 were awaiting other spinal procedures.
Additional initiatives are being explored to increase access to scoliosis treatment - CHI is working with the National Orthopaedic Hospital, Cappagh to transfer additional patients who meet the clinical criteria for treatment at Cappagh and in conjunction with the NTPF, sourcing additional theatre space.
Scoliosis services, waiting lists, and activity levels are specifically monitored by the Scheduled Care Performance Unit in my Department, through weekly performance monitoring meetings which are attended by representatives from CHI, and through continued engagement between Department and HSE officials.
826. Deputy Bernard J. Durkan asked the Minister for Health the extent to which cancer patients continue to receive appropriate treatment in time; the number on waiting lists for such treatment; his plans to meet their requirements in the short term; and if he will make a statement on the matter. [24088/20]
Amharc ar fhreagraThe HSE's National Cancer Control Programme (NCCP) have advised that they do not collect data on waiting lists. However, they do collect Key Performance Indicators (KPIs) that measure time to treatment for radiation and medical oncology.
It is important to note that 2020 data is indicative data that has not yet been fully verified, as such 2020 data may be subject to change once all data has been verified. Indicative data for the year-to-date shows a similar performance to full-year data for 2019:
|
Clinical Programme |
Key Performance Indicator |
2019 (FY) |
2020 (YTD) |
|
Radiation Oncology |
90% of patients completing radical radiation therapy commenced treatment within 15 working days of being deemed ready to treat |
85.30% |
87.40% |
|
Medical Oncology |
90% of patients receiving new systemic parenteral treatment in the day ward setting commenced treatment within 15 days working days of being deemed ready to treat |
89.80% |
90.40% |
All KPIs are based on internationally benchmarked clinical standards. Targets are set high enough that they are difficult for each cancer centre to achieve whilst also considering anticipated clinical volumes that may confound or delay treatment for more complex patients. Targets are therefore indicative of a high performing unit and missing a target is not necessarily an indication of sub-standard performance.
Data on surgical waiting times is more retrospective. Current data on surgical wait times across the surgical cancer centres indicates:
Breast (within 20 days)
- 2019 (full year): 76.3%
- 2020 (Q1): 75.6%
Lung (within 30 days)
- 2019 (full year): 55.3%
- 2020 (Q1 - only 1 of 4 hospitals returned data): 65.0%
Prostate (within 30 days)
- 2019 (full year): 32.7%
- 2020: data not yet due
Pancreas (within 20 days)
- 2019 (full year): 69.6%
- 2020: data not yet due
Plans for the resumption of cancer services are underway in my Department and the HSE's National Cancer Control Programme as part of the Winter Plan and in the context of the 2021 Estimates.
827. Deputy Bernard J. Durkan asked the Minister for Health the progress in dealing with all waiting lists for various procedures in public hospitals nationwide; and if he will make a statement on the matter. [24089/20]
Amharc ar fhreagraIn response to the Covid-19 pandemic the HSE had to take measures to defer most elective scheduled care activity. This was to ensure patient safety and that all appropriate resources were made available for Covid-19 related activity and time-critical essential work. This decision was in line with the advice issued by the National Public Health Emergency Team (NPHET) in accordance with the advice of the World Health Organization, and the National Action Plan published on 16 March. The trajectory of the disease means there is now an opportunity for increasing the provision of non-Covid care including more routine care and services have resumed in line with NPHET recommendations.
To ensure services are re-introduced in a safe, clinically-aligned and prioritised way, the HSE launched its Strategic Framework for ‘Service Continuity in a Covid Environment’ on 24 June. Its implementation will ensure service resumption is done in an integrated way. This will involve a phased approach to ensure community services are strengthened. The Framework will also consolidate new ways of working and build on international knowledge. Further detail regarding the phases of service resumption are contained in the HSE’s ‘A Safe Return to Health Services’ document, published on their website on 22 July.
The HSE is seeking to optimise productivity through alternative work practices such as telemedicine and the use of alternative settings including private hospitals, community facilities and alternative outpatient settings.
The HSE has advised that in order to continue to provide access for patients there has been considerable growth and investment in virtual outpatient consultations for many specialties across the system. While figures for August are not yet available, the HSE advise that a total of 73,198 virtual outpatient consultations took place in July. This represents 27% of the overall OPD activity for July (266,349).
The number of patients awaiting an Inpatient or Day Case (IPDC) procedure decreased by 2,663 (-3%) at the end of August when compared to the end of July waiting list. While year to date the IPDC waiting list has grown by 17% (up 11,057 since end December 2019), the number of patients actively waiting has continued to fall since May. Part of the reason for the decrease in the numbers waiting is an increase in the number of patients being moved on to the TCI list (To Come In). The consistent increase in the number of patients on the TCI list since April is indicative of increased elective activity, and results in the removal of patients from the active IPDC waiting list.
The HSE is also currently working to secure access to private hospital facilities for urgent and time critical procedures. A procurement process is currently in train to secure access to additional acute services and diagnostic capacity from private providers which is required to address capacity needs over the next two years.
The National Treatment Purchase Fund (NTPF) has recommenced arranging treatment for patients in both private and public hospitals. At the end of August, 19,218 IPDC treatments had been arranged. The NTPF had also arranged 4,604 G.I. Scopes. In terms of Outpatients, the NTPF had approved in principal 66,096 Outpatient appointments.
The NTPF is currently reviewing strategies to maximise activity and benefit for patients, to include, increased use of private hospitals, funding weekend and evening work in public hospitals, funding “see and treat” services where minor procedures are provided at the same time as outpatient consultations, funding hybrid services where public and private hospitals contribute to the treatment of patients, virtual clinics and clinical validation.
828. Deputy Bernard J. Durkan asked the Minister for Health the progress to date in the provision of the Naas General Hospital extension of facilities; and if he will make a statement on the matter. [24090/20]
Amharc ar fhreagraThe Health Service Executive is responsible for the delivery and management of healthcare infrastructure and has advised that funding has been provided to progress the Day Procedures/Endoscopy, Oncology and Physical Therapy Unit at Naas General Hospital in 2020, and specifically capital funding has been made available to appoint technical consultants to progress the project.
It is important to recognise that all capital development proposals must progress through a number of approval stages, in line with the Public Spending Code, including detailed appraisal, planning, design and procurement before a firm timeline or funding requirement can be established.
The final decision to proceed with the construction of a project cannot be made until the tender process has been completed and the costings reviewed to ensure that the proposal delivers value for money and remains affordable, and that sufficient funding is available to fund the project to completion, including equipping and commissioning costs.
The delivery of capital projects is a dynamic process and is subject to the successful completion of the various approval stages, which can impact on the timeline for delivery.
829. Deputy Bernard J. Durkan asked the Minister for Health the number of hospital beds available to the public hospital sector; the number in the private sector; the extent to which both can combine to provide the required accommodation for the various categories of patients awaiting treatment; and if he will make a statement on the matter. [24091/20]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the deputy directly, as soon as possible.
830. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he has identified the areas of the most serious pressure for facilities throughout the public hospital sector; his plans and proposals to address inadequacies; and if he will make a statement on the matter. [24092/20]
Amharc ar fhreagraThe health system must be considered as a whole system and lack of capacity, staffing or resources in one area can impact on other areas. For acute hospitals to function optimally, services at primary care, in the community and services such as home help and nursing home support must also work well. The Sláintecare Implementation Strategy 2018 identified a range of challenges for the public health system.
In addition, the 2018 Health Service Capacity Review identified a requirement for an increase of 2,590 acute hospitals beds by 2031, in a health system reform scenario, to support the projected increase in demand for services in the years ahead.
A Sláintecare Implementation office has been created in the department to drive the Sláintecare Reform programme, and I can confirm that the National Development Plan provides for the full 2,590 beds by 2027.
The COVID 19 pandemic has led to an unprecedented interruption to normal healthcare activity, with both community and acute settings affected. Resuming health and social care services and building our capacity and capability for the pressures of winter 2020/21 and beyond will be particularly challenging in a way that the health service has not experienced in living memory.
In response, the HSE has developed a single overarching plan to set out how it will resume and deliver services (Planning for Health Services Delivery in the Covid-19 Pandemic) in the period to 2021. This overarching plan essentially includes the normal winter plan that would incorporate enhancement to services to cope with winter pressures, but also takes a more strategic approach by considering actions necessary to resume services paused, return reduced services to normal activity and build capacity such that the system can deal with expected demand and pressures to the end of 2021. The intention is that the plan, and the associated investment required, will be considered in the context of the 2021 Estimates process. In the meantime, and recognising the need to immediately commence those initiatives which will have an impact over the coming winter, the Department and HSE intend to publish a Winter Plan, which will be a subset of the overarching plan. The HSE has identified and prioritised a number of actions to a total limit of €600m to form the basis of this Winter Plan.
831. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he plans to improve facilities and staff numbers available for homecare; and if he will make a statement on the matter. [24093/20]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
832. Deputy Bernard J. Durkan asked the Minister for Health the number of posts at all levels awaiting to be filled throughout the public health sector in hospitals and community care; the extent to which numbers have been augmented in the past year to date; and if he will make a statement on the matter. [24094/20]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
833. Deputy Bernard J. Durkan asked the Minister for Health the number of hospital consultant posts awaiting to be filled; the number of such posts already filled in the past year; and if he will make a statement on the matter. [24095/20]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
834. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he plans to facilitate ready access to mental health services in respect of children and adults in all areas nationwide without exception; and if he will make a statement on the matter. [24096/20]
Amharc ar fhreagraAs this is a service matter I have asked the Health Service Executive to respond directly to the Deputy as soon as possible.
835. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he can foresee the restoration of support services for all children with special needs; and if he will make a statement on the matter. [24097/20]
Amharc ar fhreagraThe Programme for Government, Our Shared Future, recognises the need to improve services for both children and adults with disabilities through better implementation and by working together across Government in a better way.
The Government commits to prioritising early diagnosis and access to services for children and ensuring that the most effective interventions are provided for each child, to guarantee the best outcomes.
As this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly.
836. Deputy Bernard J. Durkan asked the Minister for Health the extent to which consideration is being given to the provision of alternative community-based health facilities or accommodation at St. Bridget’s Hospital, Crooksling; and if he will make a statement on the matter. [24098/20]
Amharc ar fhreagraAs the Health Service Executive is responsible for the delivery of public healthcare services and infrastructure projects, I have asked the HSE to respond to you directly in relation to this matter.
837. Deputy Bernard J. Durkan asked the Minister for Health the extent to which BreastCheck, CervicalCheck and other health services are being restored; and if he will make a statement on the matter. [24099/20]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
838. Deputy Bernard J. Durkan asked the Minister for Health if he is satisfied at the extent to which the public and the private sector have combined their efforts to deal with the Covid-19 virus; and if he will make a statement on the matter. [24100/20]
Amharc ar fhreagraAccess to acute private hospitals played a significant part in the country's initial response to the Covid-19 pandemic. In anticipation of the projected surge in Covid-19 cases and the expected impact on the health care system a major part of the response was to urgently ramp up capacity for acute hospital care facilities. A critical element of the strategy was to put in place an arrangement with the private hospitals to use their facilities as part of the public system, to provide essential acute hospital services for the duration of the emergency. Following negotiations with the Private Hospitals Association an overarching agreement with the 18 private acute hospitals was agreed at the end of March. Under the agreement, the HSE secured 100% of the capacity of the private hospitals until the end of June.
Following termination of the agreement the Government mandated the HSE to seek an agreement with the private hospitals on a new arrangement which would provide the HSE with access to private hospital capacity in the event of a surge of Covid-19 cases, and separately with ongoing agreed access, in collaboration with the National Treatment Purchase Fund (NTPF), to private hospital services to address the HSE’s priority needs in providing both essential care and addressing elective care for public patients experiencing delays. The HSE is undertaking bilateral discussions with individual private hospitals to seek to agree new arrangements which would provide the HSE with access to private hospital capacity in the event of a surge of Covid-19 cases.
The HSE continues to work to ensure that capacity exists within the health service to meet the needs of patients during this unique and challenging time. Future planning remains a critical priority for me and my Department.
As part of the Winter and Service Planning process, the HSE is undertaking a strategic approach to service resumption. This includes the development of a longer-term plan to include augmented levels of service to regain a level of provision across community and acute hospitals where capacity was adversely impacted by COVID 19.
The immediate priority for the HSE is the finalisation of a Winter Plan which incorporates the enhancement of services to cope with Winter pressures into early 2021 to ensure the capacity and capability of the health system is prepared for this challenging period. The various initiatives proposed in the plan are designed to reduce attendances and admissions, and improve capacity and throughput in hospitals.
In terms of Service Planning, a range of initiatives have been developed by the HSE, which will support service resumption and increased capacity across the Community and Acute hospital systems, which will be rolled out in the coming weeks and months. This includes establishing key community services envisioned in Sláintecare and the 2018 Capacity Review, while building toward the appropriate level of capacity in our acute hospital services.
The HSE is also currently working to secure access to private hospital facilities for urgent and time critical procedures. A procurement process is currently in train to secure access to additional acute services and diagnostic capacity from private providers which is required to address capacity needs over the next two year. The National Treatment Purchase Fund has also resumed its operations with regard to procuring services to address waiting lists.
839. Deputy Bernard J. Durkan asked the Minister for Health the extent to which heart and lung transplants have continued throughout the Covid-19 crisis; the degree to which he foresees the need for changes in this area; and if he will make a statement on the matter. [24101/20]
Amharc ar fhreagraAll transplant activity was significantly curtailed due to COVID-19, however the HSE’s Organ Donation and Transplant Ireland (ODTI) worked to ensure that the most time critical and life-saving transplants proceeded based on careful risk-benefit assessment. The approach pursed was endorsed by the Expert Advisory Group to the National Public Health Emergency Team.
The Heart & Lung Transplant Programme, Mater Hospital remained active throughout the Covid-19 crisis, however, decisions to proceed with donation and transplant are based on clinical risk-benefit assessments. To the end of August there has been 10 Lung Transplants and 7 Heart transplants carried out in the Mater Hospital. Of these 5 heart and 7 lung transplants were carried out from March to August.
Due to the risk Covid-19 presents to transplant patients, reduced service levels are expected to the end of the year. The ODTI is examining ways to sustain the safe provision of transplant services in the context of Covid-19 and Winter surges including the potential to ringfence facilities such as theatres, ICU beds and recovered beds for transplant.
840. Deputy Bernard J. Durkan asked the Minister for Health the degree to which the time taken to process medical cards is being reduced; if cancer patients continue to receive special treatment in this regard; and if he will make a statement on the matter. [24102/20]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
841. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he envisages the availability of adequate resources to meet the full requirements of his Department arising from normal running costs in addition to the Covid-19 crisis; and if he will make a statement on the matter. [24103/20]
Amharc ar fhreagraThe level of funding available for my Department is being considered as part of the national Estimates and budgetary process for 2021 which is currently underway.
These discussions are still progressing and until they are concluded it would not be appropriate for me to anticipate the outcome.
842. Deputy Bernard J. Durkan asked the Minister for Health the ongoing progress in relation to the construction of the National Children’s Hospital; the extent to which progress is in line with previously identified targets; if costs have similarly remained as anticipated; and if he will make a statement on the matter. [24104/20]
Amharc ar fhreagraLike many other sectors of the economy, the construction sector was impacted by the Covid-19 pandemic. This resulted in construction related work on the site of the new children’s hospital stopping on 31 March this year due to Covid-19 Restrictions. On 18th May the restrictions in respect of the construction sector were eased. From this date, the National Paediatric Hospital Development Board (NPHDB) engaged with the main contractor to ensure the earliest possible reopening of the sites. I am informed that the main contractor of the New Children’s Hospital project returned to site on the 13th of July. There will be delays associated with Covid-19, however it is too early to fully assess the impact of the pandemic on the new children’s hospital project and the Paediatric Outpatient and Urgent Care Centre at Tallaght. The NPHDB continues to engage with the contractor and is monitoring progress on site in the interests of completing the project as quickly and economically as possible.
On that note I want to say that I am acutely aware of how urgently the new Children’s Hospital is needed and I want to see it delivered as quickly as possible on behalf of children, young people and their families.
The NPHDB is continuing to engage with the Main Contractor to obtain an updated programme of works that is in line with its contractual commitments. Any delivery outside of the timelines agreed under the contract could potentially be a matter for dispute resolution and so I wish to be careful in respect of what I say here, but I will reiterate that it is a priority for me and this Government that the hospital be completed as quickly as possible.
The overall project cost advised to the previous Government in December 2018 is €1.73 billion. That figure comprises €1.43 billion which is the overall cost to complete the capital project, and also includes a broader programme of activity associated with the integration and transfer of the services of the three children’s hospitals to the new sites under development. This includes for example investment in ICT, an Electronic Health Record system and the Children's Hospital Integration Programme - the merging of three paediatric hospitals.
The PwC report makes clear that the Guaranteed Maximum Price established through the two-stage tender process does not provide a contractual ceiling on cost and significant residual risks remain of further cost. The residual risks, for which there cannot be cost certainty, include items such as construction inflation, claims and certain uncontrollable risks, such as potential costs relating to BREXIT. I am advised that the main contractor has submitted a significant number of claims which it alleges are outside of the agreed scope. The NPHDB has a robust process in place for the assessment of claims by the Contractor in accordance with the Construction Contract. This process is a commercially sensitive one between the contractor and the NPHDB.
The NPHDB have statutory responsibility for planning, designing, building and equipping the new children's hospital. I have referred the remaining part of your question to the NPHDB for direct reply.
843. Deputy Pádraig Mac Lochlainn asked the Minister for Health the number of persons who have availed of cancer screening at Letterkenny University Hospital in 2018, 2019 and to date in 2020 [24114/20]
Amharc ar fhreagraAs this is a service matter, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.
844. Deputy Pádraig Mac Lochlainn asked the Minister for Health if he will order an urgent independent review of all departments and specialities at Letterkenny University Hospital following the recent findings of the independent review into the gynaecological department at the hospital [24115/20]
Amharc ar fhreagraA Review of Gynaecology Services at Letterkenny University Hospital (LUH) was initiated by the HSE after eight cases of delayed diagnosis were identified in women with endometrial cancer.
The purpose of the Review was to assess the quality and safety of the LUH Gynaecology Service, with a focus on the pathway of care for women presenting with post-menopausal bleeding including subsequent diagnostic pathways for potential gynaecological cancers. The Review found that the gynaecology service at LUH experienced long waiting lists, and operated governance and administrative practices which led to delays and suboptimal patient experience.
The Review Report made six recommendations including increasing capacity and staff capability, reviewing the referral and triage system for gynaecology patients, improving communication processes and improving governance structures.
The HSE has advised that these recommendations are currently being put into effect by an Implementation Group within the Saolta HealthCare Group. In addition, a national level HSE Oversight Group will provide assurance that the recommendations are actively implemented within the agreed timeframe. Furthermore, I am advised by the HSE that a Special Measures Team has been on-site in Letterkenny University Hospital since early July identifying and driving operational changes.
In the Review Report, it was recommended that the LUH Gynaecology Service should undertake a self assessment against the HIQA National Standards for Safer, Better Healthcare, 2012. I am advised by the HSE that work undertaken to date on the self-assessment will be expanded in the coming months, encompassing all services.
