Written Answers Nos. 51-70
52. Deputy Alan Dillon asked the Minister for Health if an update will be provided on capital funding projects for Mayo University Hospital; the efforts that are being made to accelerate the delivery of works to the emergency department; and if he will make a statement on the matter. [17056/22]
Amharc ar fhreagraAs 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.
53. Deputy Duncan Smith asked the Minister for Health if an update as of March 2022 will be provided on the delivery of the new national maternity hospital; and if he will make a statement on the matter. [16979/22]
Amharc ar fhreagra100. Deputy Bríd Smith asked the Minister for Health the legal advice he has received in relation to the proposed national maternity hospital that any proposed agreement with a private entity can be described as representing unbreakable legal stipulations; when the proposals will go to the HSE; when the memo to Cabinet will be finalised; and if he will make a statement on the matter. [17060/22]
Amharc ar fhreagra101. Deputy David Cullinane asked the Minister for Health the status of plans regarding the relocation of the national maternity hospital; and if he will make a statement on the matter. [16801/22]
Amharc ar fhreagra416. Deputy Bernard J. Durkan asked the Minister for Health the progress towards the provision of the new maternity hospital; and if he will make a statement on the matter. [17272/22]
Amharc ar fhreagraI propose to take Questions Nos. 53, 100, 101 and 416 together.
The Government is committed to the development of the new National Maternity Hospital (NMH) planned for the St Vincent’s University Hospital Campus at Elm Park, as set out in the Programme for Government. The Government is also aware of the concerns that have been raised regarding ownership and governance of the new NMH, and recognises that these matters must be addressed.
The proposed corporate and clinical governance arrangements for the new NMH were set out in the Mulvey Agreement, that provides for the establishment of a new company - National Maternity Hospital at Elm Park DAC - which will have clinical and operational, as well as financial and budgetary, independence in the provision of maternity, gynaecology and neonatal services.
The draft legal framework subsequently developed, with the support of legal advisers, is designed to copperfasten these arrangements and will address both the ownership and governance of the new hospital, in order to:
- ensure that all clinically appropriate and legally permissible services will be available in the new NMH;
- prevent any undue influence, religious or otherwise, on the operation of the new hospital; and
- safeguard the State’s significant investment in the hospital.
There is a process ongoing to finalise the legal arrangements and the HSE is a key part of that process. I will not bring any proposal on ownership and governance of the new National Maternity Hospital to Government unless it provides assurances around full healthcare for women being provided there in line with the objectives I have set out above.
54. Deputy Pa Daly asked the Minister for Health the number of beds that are currently provided in University Hospital Kerry; and if all patients have access to adequate shower and toilet facilities. [16198/22]
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.
55. Deputy Bernard J. Durkan asked the Minister for Health the extent to which he anticipates an urgent reform of the health services to take into account the serious issues arising from Covid-19 and long waiting lists, in general and at accident and emergency departments, while incorporating Sláintecare, with a specific timetable and with a view to achieving the maximum level of confidence in the health services from the point of view of both the patients and those working within the services; if he will ensure that a properly co-ordinated approach is undertaken; and if he will make a statement on the matter. [16969/22]
Amharc ar fhreagraAs the Deputy will appreciate, the COVID-19 pandemic has had a significant impact on the health service over the past two years which undoubtedly has impacted several reforms programmes. However, the pandemic also demonstrated the benefits of a universal approach and the capacity of the system to change and respond. The Covid response, by necessity, accelerated many positive aspects of the Sláintecare vision. This included fast-tracking service innovation, new pathways of care, new ways of working and changes implemented rapidly in line with the Sláintecare vision and principle (www.gov.ie/en/publication/0d2d60-slaintecare-publications/#slaintecare-integration-fund-projects). In effect, these changes accelerated the move from a hospital-centric system to one where more services are provided in the community and near a person’s home.
My Department will continue to progress the Sláíntecare reform programme as outlined in the Sláintecare Implementation Strategy and Action Plan 2021-2023. This was written and apporved by Government one year after the onset of the pandemic and hence the COVID-19 pandemic context was accounted for during its drafting. Slaintecare reforms are overseen by the Slaintecare Programme Board which is accountable to me. This board ensures there is progress on and coherence between reform projects.
Substantial key achievements included progressing plans for new, elective hospitals in Cork, Galway and Dublin; establishing the Regional Health Areas Advisory Group to support the alignment of community and hospital services based on defined population need; and mainstreaming innovation through the Sláintecare Integration Fund.
56. Deputy Mark Ward asked the Minister for Health if he will provide an update into the national review of CAMHS that was to take place after the scandal in South Kerry CAMHS; and if he will make a statement on the matter. [16681/22]
Amharc ar fhreagraThe Government and the HSE are committed to implementing the 35 recommendations of the independent report on South Kerry CAMHS as quickly as possible. 6 have already been implemented, with 13 having commenced implementation.
As part of the recommendations, a full nationwide audit will be conducted of compliance with existing HSE CAMHS operational guidelines by all CAMHS teams. An independent led prescribing audit for each of the CAMHS teams, which I sought as an additional action beyond the recommendations set out in the Maskey report, will include a review of prescribing for all diagnoses and medications - details of this are currently being finalised. In addition to these two audits, the HSE will expedite the development of clinical standards for prescribing practice in children with and without psychosis. Once these standards have been developed and implemented, an annual audit will be carried out to measure compliance against these standards (in line with recommendations in the Maskey Report).
Separately, the HSE is commissioning qualitative research to identify the experiences of children, young people and their families using CAMHS nationwide.
HSE supports are available for children, young people and families affected by the report, with a dedicated helpline available to those who need it. The Executive also established about two weeks ago a Clinical Support Team in Killarney to assist the families concerned, and has liaised with the South Kerry Support Group in this regard.
Minister Butler has met with representatives of the Kerry CAMHS Family Support Group. The HSE will continue to meet as appropriate families or representatives at local level to keep them informed of developments. I will continue to liaise closely with the HSE to ensure that the above initiatives are progressed as quickly as possible.
In addition to these audits, the Mental Health Commission has commenced a separate review.
Finally, details of a non-adversarial scheme for compensation for those children, young people and families affected by the report are being progressed by me. Proposals are at an advanced stage and will be finalised very shortly.
57. Deputy Alan Farrell asked the Minister for Health the detail of the efforts of his Department to support Ukrainian refugees with both mental and physical health supports; and if he will make a statement on the matter. [16101/22]
Amharc ar fhreagraInterim health service support has been established in Dublin Airport, providing health information, immediate medical assessment, provision of prescriptions for existing conditions, management of minor ailments and first aid requirements.
Other CHOs are responding locally at other ports of entry.
A streamlined Medical Card application process for the Ukrainian population is now in place. Additionally, a series of temporary Generic Medical Card numbers has been generated to facilitate urgent access to care. Enhanced translation services have been put in place and communicated to all services, including GPs.
CHOs' response has been significant, including establishment of in reach services to hotels/B&Bs, nursing assessments for children have commenced, provision of in reach maternity supports, emergency dental services, and Covid vaccination clinics.
Acute referral pathways for the Ukrainian population into Acute care services are streamlined and operational processes for urgent referrals/medical evacuees are in place and working well.
Ukrainian nationals will also be entitled to avail of health care services for children’s health, mental health, disabilities, maternity care, older people etc.
Additional health supports will be provided where required, for mental health issues and to support people who have suffered trauma.
58. Deputy Róisín Shortall asked the Minister for Health if an update will be provided on the preparation of a business plan under the public spending code for the new national maternity hospital. [17065/22]
Amharc ar fhreagraAs the National Maternity Hospital (NMH) relocation is a project initiated prior to the updated Public Spending Code (PSC), the Project Board undertook additional work to ensure full compliance with the new PSC.
The PSC is designed to ensure that investment decisions are underpinned by a clear policy rationale, and that costs are well understood. In 2019, the PSC was updated and introduced a new project lifecycle, tightening the arrangements for project decision-making, and clarifying the roles of the parties involved including the responsibilities for Sponsoring Agencies and Approving Authorities. The PSC also provides detail on the requirements at each stage of the new project lifecycle.
A business case for relocation of NMH has been submitted to the Department by the NMH Project Board. The Business Case is subject to technical review by the Department of Health, including through the External Assurance Process recently introduced by the Department of Public Expenditure and Reform. Pending favourable review under the Spending Code, a Memorandum for Government will then be brought forward to progress the programme for the NMH.
If approval in principle is granted, the project can move to preparation of tender documents in line with EU law and deployment of a tendering strategy.
59. Deputy Donnchadh Ó Laoghaire asked the Minister for Health the detail of the current waiting list for CAMHS services in Cork city; and if he will make a statement on the matter. [17023/22]
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.
60. Deputy Jackie Cahill asked the Minister for Health the status of the development of a new model of intensive home supports. [16865/22]
Amharc ar fhreagraThe Programme for Government agreed in 2020 commits the government to ‘Introduce a statutory scheme to support people to live in their own homes, which will provide equitable access to high-quality, regulated home care’.
Consequently, work is on-going within the Department of Health to progress the development of the new statutory scheme for the financing and regulation of home-support services. Taking place within the broader context of the Sláintecare reforms, this work encompasses the development of the regulatory framework for the new scheme; the examination of the options for the financing model for the scheme; and the development of a reformed model of service-delivery.
With the aim of ensuring that all service-users are provided with a standard, high-quality level of care which is safe, effective, and person-centred, it is envisaged that the regulatory framework will comprise: (i) primary legislation for the licensing of public and private home-support providers; (ii) minimum requirements (i.e., regulations); and (iii) HIQA National Standards for Home Support Services.
In April 2021, Government gave approval to draft a General Scheme and Heads of a Bill to establish a licensing framework for home-support providers. This is being progressed by the Department with a view to bringing it through the Houses of the Oireachtas at the earliest opportunity. It is expected that the primary legislation will give the Minister for Health the power to make regulations in respect of minimum requirements which will form the criteria against which a provider’s eligibility to hold a licence will be determined. A regulatory impact analysis will be undertaken by the Department in 2022 to ensure effectiveness and mitigate risks.
In collaboration with HIQA and in consultation with the Health Service Executive and other key informants, the Department developed draft regulations and a targeted stakeholder consultation was undertaken in January 2022. Evaluating the feedback of this consultation is informing amendments in the draft regulations in advance of a public consultation planned in Q2 2022.
On 24th February, the ESRI published a report on the demand for and cost of home support. This is the final output from a programme of research that the ESRI has undertaken to support the Department of Health to progress the development of the new home support scheme. This research will form an important part of the evidence base for the development of a sustainable funding model for home support services in the context of our ageing population. Government approval will be sought in due course on any proposed legislation to provide for a financial support scheme, taking into consideration the cost associated with the various options.
In addition, work is ongoing in relation to the development of a reformed model of service delivery for the new scheme. In 2021, funding was secured for the Health Service Executive to: (i) progress the roll-out of interRAI as the standard assessment tool for care-needs in the community; (ii) pilot a reformed model of service-delivery for home-support; and (iii) establish a National Office for Home Support Services.
The Pilot for testing of a reformed model of service for the delivery for home-support is fully operational. It commenced in November in CHO 8, which is the first of the four pilot sites. The three other sites CHO2, CHO 4 and CHO 7 became operational in January 2022. Funding has been approved for 128 interRAI Care Needs Facilitators to progress the national rollout of interRAI as the standard assessment tool for care-needs. The interRAI outputs and pilot site evaluation will be critical to the development of the new home-support scheme. A National Home Support Office is in the process of being established.
61. Deputy David Stanton asked the Minister for Health the future plans for the Owenacurra Mental Health Centre and site in Midleton, County Cork; and if he will make a statement on the matter. [16875/22]
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.
63. Deputy Thomas Gould asked the Minister for Health if an update will be provided on the establishment of a national family support network. [16960/22]
Amharc ar fhreagraThe National Drug Strategy, Reducing Harm, Supporting Recovery, commits to strengthening services to support families affected by substance misuse. The HSE funds a number of organisations that provide family support services at both local and regional levels. The strategy also recognises the role that families can play in the planning, design and delivery of drug and alcohol services and polices.
The Department is aware of the closure of the National Family Support Network (NFSN). This was a voluntary organisation, made up of local and regional family support networks.
The Department has engaged with local and regional family support networks following the closure of the NFSN and is supportive of their efforts to work together. However, the Department of Health has no role in establishing a national family support network.
I am committed to working with family support networks to implement the national drugs strategy.
64. Deputy Richard Boyd Barrett asked the Minister for Health his plans for dealing with the chronic overcrowding in hospitals, the ever-growing waiting lists and the crisis in non-Covid-19 care; if he considers that it is now time to take over the capacity in the private hospitals; and if he will make a statement on the matter. [16848/22]
Amharc ar fhreagraI acknowledge the distress overcrowded Emergency Departments (EDs) cause to patients, their families, and frontline staff working in very challenging conditions in hospitals throughout the country.
The current congestion in Emergency Departments is due to constrained bed capacity caused by combination of the high number of patients in hospital with COVID-19 (1624 nationally on Monday 28th March), the increased number of delayed transfers of care cases which is partly due to COVID outbreaks in nursing homes and the very high number of people attending EDs in recent weeks.
The three highest attendances ever recorded in our EDs have occurred in recent weeks with attendances trending over 28,000 a week.
While attendance and admission numbers are now exceeding pre-pandemic levels, the continued requirement to provide separate Covid-19 and non-Covid-19 pathways presents an additional challenge to patient flow in all hospitals and Emergency Departments.
Investment of €1.1bn was provided in budget 2021 to expand capacity, increases services and support reform and this level of investment is being maintained in budget 2022. A further €77 million has been invested in the 2021/22 Winter Plan. To date over 800 additional beds have been provided in acute hospitals since the start of 2020.
To provide leadership, governance and oversight of the implementation of the Winter Plan at local level and national level, the Chief Operations Officer has established the Integrated National Operations Hub (INOH) with defined membership from all relevant service and enabling functions with a clear Terms of Reference. For the purposes of coordinating the response to COVID-19, each geographical area has an Area Crisis Management Team (ACMT). Many of the Winter Plan measures will continue for the rest of the year.
The current situation in hospital Emergency Departments is under constant review by my Department through ongoing engagement with the HSE.
The 2022 Waiting List Action Plan, which was launched on 25 February, allocates €350 million to the HSE and NTPF to reduce active waiting lists for acute scheduled care by 18% this year, which will bring the number of people waiting to their lowest point in five years.
Under this Plan, the Department, HSE and NTPF intends to deliver urgent additional capacity to treat 1.7 million people as well as investing in longer term reforms to bring sustained reductions in waiting lists.
The 2022 Waiting List Action Plan will also progress work towards the achievement of intermediate waiting time targets this year, as set out in the National Service Plan (of 18 months for OPD; 12 months for IPDC; and 12 months for GI scopes).
As a response to the recent surge in both ED attendance and COVID-19 cases the CEO of the HSE has written to the CEOs of all hospital groups advising them of the need to prioritise unscheduled COVID-19 care and urgent time sensitive work for 14-day period. The resulting curtailment of elective care (and associated staff shortages) will negatively impact achieving waiting list reduction targets.
The HSE has confirmed to the Department that patient safety remains at the centre of all hospital activity and elective care scheduling. To ensure services are provided in a safe, clinically-aligned and prioritised way, hospitals are following HSE clinical guidelines and protocols. The Waiting List Task Force continues to regularly monitor the impact of COVID-19 on waiting list reduction targets. Additional capacity is bring sought through the Private Hospitals to minimise the impact of the current surge on core activity.
With the onset of the 4th wave of Covid-19 at the end of December 2021 and January 2022 the HSE with the support of the Department negotiated a new amended Agreement with the Private Hospitals to run to the end of June 2022. The new Agreement sought to draw on the lessons from the operation of Safety Nets 2 and 3.
The most significant change from the previous Safety Net Agreements was the adoption of a dual approach to obtaining access to the private hospital capacity. As with the outgoing agreement it would allow access of up to 15% or 30% of the private hospitals’ capacity depending on which metrics were met. At each level, the HSE would have the option to seek access on either a reasonable endeavours basis i.e. voluntarily, or by issuing a guaranteed capacity demand, which would require the private hospitals to provide the capacity. Under the agreement payments for capacity unused by the public system i.e. retainer payments will not be payable where the agreement is invoked on a reasonable endeavours basis but will be payable where a guaranteed capacity notice is issued.
In addition, in August 2021 the HSE established a procurement framework to allow public hospitals to access services in private hospitals. The procurement framework that was put in place sought tenders from private hospitals, based on competitive pricing, for approximately 700 types of medical and surgical procedures for adult and paediatric inpatient, day care and critical care beds. A separate procurement framework was put in place for diagnostic services. The Framework is in place for a period of 4 years.
65. Deputy Seán Haughey asked the Minister for Health if he will report on the community wait list initiatives in the 2022 HSE service plan. [16779/22]
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.
66. Deputy Mairéad Farrell asked the Minister for Health the estimated or projected final cost of the national children's hospital given ongoing legal challenges and remarks in the media (details supplied) before Christmas 2021; and if he will make a statement on the matter. [11388/22]
Amharc ar fhreagraThe new Children’s Hospital (NCH) project comprises the main hospital on a shared campus at St James’s, the Outpatient and Urgent Care Centre at Connolly Hospital, Blanchardstown, and the Outpatient and Emergency Care Centre at Tallaght University Hospital.
In 2018, Government approved a capital budget of €1.433bn for the NCH project. This included the capital costs for the main hospital at St James's Hospital campus, the two satellite centres, equipment for the three sites, and the construction of the carpark and retail spaces. The capital budget has not yet been depleted and to date, €963.75m of the €1.433bn budget has been drawn down for works on the project across the three sites.
There are a number of items not included in this investment figure as there was no price certainly for them and nor can there be, for some, for the duration of the project. These include construction inflation, the impact of Covid-19, statutory changes, any change in scope resulting in healthcare policy changes, and the Employment Order.
Additional costs in relation to the integration and transfer of the services of the three children’s hospitals to the new sites brings the total programme cost to €1.73bn. This includes investment in ICT, a new Electronic Health Record system and the Children's Hospital Integration Programme (the merging of three paediatric hospitals) including commissioning.
Brexit, the pandemic and recent geopolitical developments have severely impacted supply chains and NCH project is not immune to these external challenges. Every effort is being taken to mitigate the risks but these externalities beyond the control of the contractor and the NPHDB make speculation and more definitive forecasting unwise.
Definitive updates on costs cannot be provided due to the fact that we are talking about a live contract and speculation on any costs will be detrimental to the Development Board’s commercial engagements.
The contractor has submitted a number of substantiated claims, which it is entitled to do. Equally the National Paediatric Hospital Development Board (NPHDB) is entitled to defend claims that it and its advisors consider to be inappropriate. The NPHDB will enforce the contract and defend those claims, where appropriate.
There are three matters relating to the New Children’s hospital before the High Court. The decisions to issue these proceedings rests with the NPHDB and the contractor. As the matters are now before the Courts, I do not wish to say anything that could in any way prejudice those proceedings.
67. Deputy Cathal Crowe asked the Minister for Health the number of anaesthetists who are employed to work within the UL Hospitals Group; and the way this compares with other hospital groups. [16796/22]
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.
68. Deputy Bríd Smith asked the Minister for Health the way in which he plans to reconcile the requirements for full healthcare for women, including termination of pregnancy, in the new national maternity hospital if it is built on land owned by a Vatican-approved successor organisation to a Catholic religious congregation; and if he will make a statement on the matter. [17061/22]
Amharc ar fhreagraLet me begin by restating that I will not bring any proposal on ownership and governance of the new National Maternity Hospital to Government unless it provides assurances around full healthcare for women, including termination of pregnancy, being provided there.
Under the proposed legal framework, neither the Vatican nor the Religious Sisters of Charity will play any role in the governance or operation of the new hospital. The Sisters will be transferring their shareholding in St Vincent's Healthcare Group to the new company St Vincent’s Holdings. The published constitution of St Vincent’s Holdings makes no reference to Canon Law and my Department has previously been advised, in writing, that Canon Law will not impact on that company.
However, regardless of who owns the land on which the new NMH will be built, the legal framework that is being developed will address both the ownership and governance of the new hospital, in order to:
- ensure that all clinically appropriate and legally permissible services will be available in the new NMH;
- prevent any undue influence, religious or otherwise, on the operation of the new hospital; and
- safeguard the State’s significant investment in the hospital.
Work is ongoing to finalise the legal arrangements that will underpin this vital project and I hope to be in a position to bring a Memorandum to Government on this matter in the coming weeks.
69. Deputy James Lawless asked the Minister for Health if he will provide a report on the CAMHS telehealth hubs initiative. [16872/22]
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.
