Download Question 1 (Deputy Eamonn Maloney)

Joint Committee on Health and Children – Thursday, 23rd October 2014
Question 1 (Deputy Eamonn Maloney)
To ask the Minister for Health has consideration been given to the creation of a
dedicated Paediatric Rheumatology Unit for the treatment of children suffering from
arthritis.
Response:
Since 2006, the national paediatric rheumatology service has been provided at Our
Lady’s Children’s Hospital Crumlin and Children’s University Hospital, Temple St. for
children (up to 16 years).
Over 700 children attend Crumlin for treatment and follow up, many of whom require
day case admission for drug therapy. Demand for this service has grown from 300 in
2006 to 800 day case attendances, and over 1100 outpatients, in 2013.
Staffing was increased in 2012, with the addition of a second consultant post, clinical
nurse specialist and additional physiotherapy provision, and again in 2013 with the
addition of a half time general paediatrician.
The physiotherapy team assesses and treats children and adolescents from all over
Ireland with inflammatory disease and non-inflammatory musculoskeletal disorders.
Conditions treated are:
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Juvenile Idiopathic Arthritis (JIA); Systemic Onset Juvenile Idiopathic Arthritis
(SOJIA); Poly JIA; Oligo JIA; Enthesitis Related Arthritis (ERA); Psoriatic JIA;
Reactive Arthritis; Spondyloarthropathies
Juvenile Dermatomyositis (JDM)
Mixed Connective Tissue Disease (MCTD)
Systemic Lupus Erythematous (SLE)
Pain Amplification Syndrome (PAS)
Chronic Pain
Joint Hypermobility Syndrome (JHS)
Chronic Recurrent Multifocal Osteomyelitis (CRMO)
Ehler-danlos Syndrome (EDS)
Scleroderma
The rheumatology service in Crumlin, particularly the physiotherapy service, provides
advice and support to community physiotherapists and those in local hospitals when
children are discharged home.
Rheumatology services are also provided at Temple Street Children’s University
Hospital and both hospitals work together to support the service across both sites.
The HSE National Clinical Programme in Rheumatology is currently developing a
model of care to chart the way forward for paediatric rheumatology. While Crumlin
and Temple St. see a relatively small number of children with rheumatoid arthritis,
there are numerous others with various joint-related conditions or diseases and these
conditions need to be managed.
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Question 2. (Deputy Eamonn Maloney)
To ask the Minister for Health when will the statutory order be signed to authorise use
of the drug Sativex in the treatment of MS and when will a licence be granted for that
medical product.
Response:
On 11th July 2014, the Misuse of Drugs Regulations 1988, were amended to allow for
certain cannabis based medicinal products to be used in Ireland. Subsequently on 18th
July the Health Products Regulatory Authority (HPRA) granted a marketing
authorisation for cannabis based medicinal product Sativex® to be marketed in this
State. Sativex® is indicated for the relief of symptoms of spasticity for people with
multiple sclerosis where other conservative treatments have failed to provide
adequate benefits.
The remaining timeframe for making the product available for prescribing in Ireland is
the responsibility of the holder of the product authorisation, GW Pharmaceuticals PLC
and their European partner Almirall. The Health Service Executive (HSE) has statutory
responsibility for decisions on pricing and reimbursement of medicinal products under
the community drug schemes and has advised that an application is under
consideration from the manufacturer for the inclusion of Sativex® in the GMS and
community drugs schemes. Applications for reimbursement are considered in line with
the procedures and timescales agreed by the Department of Health and the HSE with
the Irish Pharmaceutical Healthcare Association for the assessment of new medicines.
Question 3 (Deputy Clare Daly)
To ask the Minister for Health to outline what steps he proposes to take to put, the
right to informed & voluntary consent, on a statutory basis, in light of, a) the
contravention of the right to consent & informed refusal recognised in the Irish
National Consent Policy, as a result of the Hamilton vs. HSE Ruling, and b) the
breaching of consent and sharing of files with parties uninvolved in a person's
treatment.
Response:
Statutory basis
Part (a) the contravention of the right to consent & informed refusal
recognised in the Irish National Consent Policy, as a result of the Hamilton
vs. HSE Ruling
The key issue in the case essentially was whether the midwife departed from good
practice in taking an initiative to artificially rupture the membranes without prior
discussion with a doctor. The case adds nothing to the judicial discussion of what is
required by informed consent to medical procedures.
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Mr Justice Ryan dismissed the claim against the HSE in its entirety and the actions
were found to be responsible, appropriate and performed by a competent
professional.
The judge made no comments or findings of any consequence around the legal issue
of consent to medical treatment. Having heard all the evidence, he concluded that the
patient had consented to the procedure (“I am satisfied that the probability is that
Midwife xxx obtained the plaintiff's consent and informed her about the ARM that she
was going to perform") and that subsequent treatment delivered was in accordance
with good medical practice and supported by a responsible body of expert opinion.
Part (b) the breaching of consent and sharing of files with parties uninvolved
in a person's treatment (details supplied)
The Treatment Abroad Scheme (TAS) office did not breach consent by the sharing of
files with parties uninvolved in a person’s treatment. The TAS has no role in the
provision of treatment to patients. The function of the TAS is to process applications
for funding under the relevant statutory framework. The HSE can confirm that the
TAS policies, procedures and protocols are proportionate to the functions of the office
and in line with data protection legislation: documentation submitted as an
application is used and disclosed in a manner compatible with the purpose for which it
was submitted.
In processing an application for funding, the TAS must ensure the application meets
the criteria set out in the statutory framework and Department of Health and Children
Guidelines. The TAS is operated on an equitable and transparent basis for all
applicants and ensures the implementation of the governing statutory framework is
applied in a consistent manner. A fundamental part of the processing is the securing
of independent medical advice in relation to the treatment being proposed. Access to
such independent medical advice is wholly proportionate and necessary to the
allocation of public funding under the TAS. Only documents submitted by the
applicant as part of his/her application are submitted to a medical advisor.
The mother of an individual that had made an application to TAS, made a formal
complaint to the Office of the Ombudsman claiming she had suffered adverse financial
affect as a result of maladministration by the TAS. In July 2011, the Office of the
Ombudsman concluded its investigation into the complaint and found that the
decisions of the TAS were correctly taken; there was no finding of maladministration
against the TAS. This finding was appealed by the mother using the appeals
mechanism with the Ombudsman Office and in Sept 2012 the original decision in
favour of the TAS was further upheld.
Question 4 (Deputy Clare Daly)
To ask the Minister for Health in light of the criticisms of the UN Human Rights
Committee of the state's position on abortion, and the subsequent confirmation of
those statements with the revelation of the horrific case of Miss Y which came into the
public domain to indicate what steps he intends to take to revise the state's restrictive
abortion legislation including tackling the constitutional issues through a Repeal of the
Eighth Amendment?
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Response:
As the Deputy is aware Article 40.3.3 of the Irish Constitution states that:
'The State acknowledges the right to life of the unborn and, with due regard to the
equal right to life of the mother, guarantees in its laws to respect, and, as far as
practicable, by its laws to defend and vindicate that right.'
The interpretation of Article 40.3.3 was considered by the Supreme Court in Attorney
General v X in 1992. Further, in December 2009, the European Court of Human
Rights heard a case brought by three women in respect of the alleged breach of their
rights under the European Convention on Human Rights in regard to abortion in
Ireland. This action was known as the A,B, and C v Ireland case.
The Protection of Life During Pregnancy Act 2013 was enacted in July 2013 and
commenced in January 2014. The purpose of this Act is to restate the general
prohibition on abortion in Ireland while regulating access to lawful termination of
pregnancy in accordance with the X case and the judgement in the European Court of
Human Rights in the A, B and C v Ireland case. The Act received very careful
consideration by the Houses of the Oireachtas and the Joint Oireachtas Committee for
Health and Children, including three days of public hearings.
The Guidance Document for the Protection of Life During Pregnancy Act 2013 has now
been published. These guidelines are designed to assist professionals in the practical
operation of the Protection of Life During Pregnancy Act. The Guidance Document
includes advice on identifying referral pathways to fulfil the requirement of the Act to
ensure that women whose life might be at risk can receive appropriate medical care.
I am not proposing any amendments to the Act or the 8th Amendment of the
Constitution at present.
In relation to the case now known as 'Ms Y'. I am awaiting the report by the Health
Service Executive and hope to receive it as soon as possible. Once I have reviewed
the report I will consider if any further action needs to be taken.
Question 5 (Deputy Clare Daly)
To ask the Minister for Health in light of the rates of caesarean section which have
been rising steadily throughout our 19 maternity units; eight of them are recording
rates over 30% & In all units, the blanket use of electronic foetal monitoring which
itself leads to greater numbers of unnecessary caesareans & the fact that this
approach to maternity care is expensive, wasteful, damaging to maternal and foetal
outcomes, and very clearly non-evidence based according to best international
research data, to make a statement regarding the failure to implement a maternity
policy with best practice at its core and what he is going to do about it?
Response:
The Department of Health in conjunction with the HSE is currently working on the
development of a new maternity strategy. Developing the strategy will provide the
opportunity to take stock of current services and identify how the quality and safety
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of care provided to pregnant women and their babies can be improved. Earlier this
year the Department commissioned a review of national and international literature
on maternity services. The review has now been completed and is informing the
development of a maternity services policy paper. On finalisation of the policy paper
it is proposed to establish a high level working group, with appropriate stakeholder
representation, with a view to further progressing and finalising the strategy.
In the meantime, work on the review of services is ongoing within the HSE and
includes:
An analysis of the existing and various reports pertinent to the delivery of
obstetric care in Ireland, using content matter experts.
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Interviews and discussions with a range of small and large maternity services
and staff working within these units, the Obstetric Clinical Care Programme,
front line clinicians, hospital group CEOs and Board chairs, service planners and
consumers groups.
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A range of site visits to obstetric units in the country.
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Collection and collation of relevant data on maternity service throughput,
clinical outcomes, adverse events and staffing profiles. The HSE sought input
from maternity sites in August and presented a draft preliminary report to the
Department in September. Resources have been identified to “drill down” with
individual sites on key aspects of the data submitted.
The HSE will continue to focus on the development of robust clinical governance and
its continuous quality improvement drive in service delivery.
As part of the 2015 estimates process, the HSE has identified a number of additional
resources required that are aimed at directly improving maternity care. The
requirement for additional midwifery staffing will be informed by the outcome of the
national midwifery workforce planning review and the 2015 estimates have made
provision for additional midwifery staff as an immediate requirement.
There is a requirement for additional consultant obstetric posts and midwifery staff
given the number of vacancies nationally and to facilitate implementation of the new
maternity model (when agreed).
Specifically on the issue of caesarean section rates, the Health Research Board (HRB)
has given a grant to Professor Richard Layte, ESRI and Prof Michael Turner, UCD
centre in the Coombe Hospital to use the national databases to study the issue of
variations in CS rates. This is currently ongoing.
It should be noted that caesarean section rates vary across countries. It is noteworthy
that the overall caesarean section rate in Ireland is in line with that in other
developed countries such as the EU 27 countries and the Organisation for Economic
Cooperation and Development (OECD) countries. [See DOH's document: Health in
Ireland Key Trends 2012 [http://www.dohc.ie/publications/pdf/KeyTrends_2012.pdf]
With respect to fetal monitoring, the National Clinical Programme for Obstetrics and
Gynecology has produced a clinical guideline on fetal monitoring. There is a policy of
selective electronic fetal monitoring and there is no "blanket policy". The use of
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electronic monitoring has been shown to increase caesarean section rates only
in countries that do not also use fetal blood sampling to complement electronic
monitoring and thus exclude false positive tracings. Fetal blood sampling in labour is
available in all maternity units in Ireland.
The HSE is currently implementing a range of other initiatives across all hospitals
which includes maternity units and hospitals. These initiatives include:
 Implementation of the National Early Warning Score (NEWS) system across all
acute hospitals.
 Implementation of the Irish Maternity Early Warning Score (IMEWS)
 As part of its regular performance management process with hospitals, the HSE
utilises the Safer Better Healthcare Standards and the Recommendations
contained in all relevant HSE / HIQA Reports and it reviews progress on these
reports.
 As referenced previously and using the National Standards for Safety Better
Healthcare, ensure hospitals review output of self-assessments.
In addition, the National Clinical Programme for Obstetrics and Gynecology aims to
improve choice in women’s healthcare.
Since its establishment in 2010, the Programme has developed 31 peer-reviewed
national clinical guidelines in obstetrics and gynecology. These provide standardised
guidance for all maternity units in the country on a range of clinical issues relating to
women’s health. A further 22 are currently in production and, by December, ten will
have been published in 2014 alone.
Currently, the National Clinical Lead chairs three of the multi-disciplinary sub-groups
of the National Maternity Investigation Group and work is progressing on the
following:
Standardised obstetrics emergency training and induction for clinical teams
composed of anesthetists, obstetricians, midwives and a range of health and
social care professionals
o Quality assurance – working to standardise clinical reporting at all maternity
sites
o Perinatal infection – the development of a series of clinical guidelines
management of infection in pregnant women.
o
Question 6 (Senator John Crown)
In light of the recent reports concerning tragedies in the Midland Regional Hospital,
Portlaoise and Galway University Hospital, will there be a systematic approach to
increasing consultant obstetrician numbers and if so can details of this be provided
and if not, can current consultant obstetrician numbers be detailed and justified in
relation to ensuring patient safety?
Response:
The Department of Health in conjunction with the HSE is currently working on the
development of a new maternity strategy. Developing the strategy will provide the
opportunity to take stock of current services and identify how the quality and safety
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of care provided to pregnant women and their babies can be improved. Earlier this
year the Department commissioned a review of national and international literature
on maternity services. The review has now been completed and is informing the
development of a maternity services policy paper. On finalisation of the policy paper
it is proposed to establish a high level working group, with appropriate stakeholder
representation, with a view to further progressing and finalising the strategy.
In the meantime, work on the review of services is ongoing within the HSE and
includes:
An analysis of the existing and various reports pertinent to the delivery of
obstetric care in Ireland, using content matter experts.

Interviews and discussions with a range of small and large maternity services
and staff working within these units, the Obstetric Clinical Care Programme,
front line clinicians, hospital group CEOs and Board chairs, service planners and
consumers groups.
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A range of site visits to obstetric units in the country.
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Collection and collation of relevant data on maternity service throughput,
clinical outcomes, adverse events and staffing profiles. The HSE sought input
from maternity sites in August and presented a draft preliminary report to the
Department in September. Resources have been identified to “drill down” with
individual sites on key aspects of the data submitted.
In parallel, the HSE will continue to focus on the development of robust clinical
governance and its continuous quality improvement drive in service delivery.
As part of the 2015 estimates submissions process, the HSE has identified a number
of additional resources required that are aimed at directly improving maternity care.
These include provision for additional nursing/midwife staff (100) and 10 additional
consultant obstetricians to particularly address the staffing of maternity units.
There is a requirement for additional consultant obstetric posts and midwifery staff
given the number of vacancies nationally and to facilitate implementation of the new
maternity model (when agreed).
The configuration of required additional midwife nursing staff will be determined by a
maternity workforce study that is currently underway.
The exact configuration and location of these Consultant posts will be determined
based on resource allocations for 2015.
The HSE has also committed to the establishment of a National Maternity Office within
the Acute Hospital Division to ensure that there is a strategic approach to the
planning and development of Maternity services nationally.
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Question 7 (Senator John Crown)
In light of the promised introduction of universal health insurance since the last
general election and the current indications of opinions of senior civil servants that
this may not be possible, what is the Minister’s view regarding universal health
insurance – will it happen and if so, what is the timeline?
Response:
I am committed to a major agenda of health reform, in line with the commitments
contained in the Programme for Government and our policy statement, Future Health.
I want to push ahead as soon as possible with key reforms in areas such as extending
GP care without fees on a phased basis, improving the management of chronic
diseases, implementing key financial reforms including Money Follows the Patient, and
establishing hospital groups as a critical enabler of improving patient quality and
efficiency. These are big milestones on the road to universal health care
When I became Minister for Health I reviewed our progress to date and the timescales
for implementing very important reforms, including Universal Health Insurance, based
on universal entitlement to a single-tier health service that is based on need, not
income.
While I believe that it will not be possible to introduce a full UHI system by 2019, as
envisaged in the White Paper, I want to emphasise my commitment to implementing
these reforms.
In order to do this I want to examine some key elements further and then to decide
on the best way forward, but this is a refocusing of our reforms, not an abandonment
of them.
In relation to UHI my Department initiated a consultation process on the White Paper
following its publication. I recently received the report of the independent thematic
analysis of the 137 submissions received. The report notes that a substantial body of
opinion is represented in the submissions and a wide range of themes covered. It
provides much food for thought that will be useful as we work to develop the best
way forward. I intend to publish this report on the Department’s website.
My Department has also initiated a major costing exercise to estimate the cost of UHI
for households, employers and the Exchequer and is working closely with the ESRI
and the Health Insurance Authority. Initial costings should be available by the end of
the first quarter of 2015.
The independent thematic analysis of submissions from the consultation process on
the White Paper and the results of the major costing exercise on UHI will assist in
charting a clear course towards the objective of a universal, single-tier health service.
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Question 8 (Deputy Mary Mitchell O’Connor)
A health impact assessment for the Department of Health concluded that the
introduction of a sugar sweetened drinks tax would cut consumption and thereby
reduce the number of obese people in Ireland. Do you support the introduction of
such a tax and do you agree with the Irish Heart Foundation’s proposal that at least
€30 million of the estimated €60 million in revenue it would generate should be
invested in a Children’s Future Health Fund to tackle the issues of childhood obesity
and food poverty?
Response:
A Health Impact Assessment on the health and economic aspects of introducing a
Sugar Sweetened Drinks tax was presented to the Minister Reilly.
It is widely recognised that no single initiative will reverse the growing obesity trend,
but a combination of measures should make a difference. The Special Action Group
on Obesity continues to focus on a range of other measures including the Childhood
Obesity Campaign; a choice of healthy foods and drinks in vending machines in post
primary schools; food labelling options; Treatment Algorithms for adults and children
and opportunistic screening and monitoring for earlier detection of overweight and
obesity in children.
A Report and Recommendations of the Special Action Group on Obesity Working
Group to reduce consumption of high fat, salt and sugar foods and drinks from the
Top Shelf of the Food Pyramid, has been prepared and is being considered under the
Healthy Ireland framework. Work is now on-going to progress the Recommendations
and a number of bilateral meetings have been relevant departments.
A new Obesity Policy in now under development and will be finalised in 2015.
An EU-wide Joint Action to facilitate implementation of The EU Action Plan on
Childhood Obesity will commence in March 2015 and end in early 2017. Ireland will
lead on a Work Package which focuses on ‘The cost of Childhood Obesity in Europe
and forecasting the increase in the burden of disease arising from childhood obesity in
the EU by 2020’.
Question No. 9 (Deputy Dan Neville)
To ask the minister for Health to outline the position regarding the regulation of
counselling and psychotherapy under the Health and Social Care Professionals Act
2005.
Response:
1. Legal Position/Establishment of Registration Boards
1.1Under the Health and Social Care Professionals Act 2005 (as amended 2012),
the Minister for Health may designate a health and social care profession if he
or she considers that it is in the public interest to do so and if specified criteria
have been met. The 12 professions to be regulated under the Act are clinical
biochemists, dietitians, medical scientists, occupational therapists, orthoptists,
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physiotherapists, podiatrists, psychologists, radiographers, social care workers,
social workers and speech and language therapists.
1.2To date, six registration boards (Social Workers, Radiographers, Occupational
Therapists, Speech & Language Therapists, Dietitians and Physiotherapists)
have been established. The registration boards for the remaining designated
professions should be established by end of next year (2015) and their
registers open by end 2016. In addition, an interim Optical Registration Board
has also been established pending establishment of the statutory board under
the legislation currently before the Oireachtas (rationalising the Opticians Board
into the Health and Social Care Professionals Council).
2. Immediate Priority/Commitment
I intend to bring counsellors and psychotherapists within the ambit of
the Act as soon as possible, and I hope to be in a position to make the
necessary designation regulations early next year.
3. Issues to be Clarified
A number of issues are still being clarified.
These
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include:
decisions on whether one or two professions are to be regulated
the title or titles of the profession or professions
the minimum qualifications to be required of counsellors and
psychotherapists.
4. Progress
4.1My predecessor, James Reilly, wrote to the Health and Social Care Professionals
Council in May of this year advising it of his intention, to designate by
regulation the profession or professions of counsellor and psychotherapist
under the Act. The Act provides that the Minister for Health is obliged to
consult with the Council in the first instance concerning a proposed designation
and to give interested persons, organisations and bodies an opportunity to
make representations to the Minister. The Council has been asked to advise on
a number of issues concerning the proposed designation and requested that it
take into consideration the recently published report of Quality and
Qualifications Ireland (QQI) on the academic standards necessary for the
accreditation of courses in Counselling and Psychotherapy. This is an essential
element as it will inform, for the purpose of registration, the assessment by the
registration board, when established, of the qualifications of those currently in
practice.
4.2This is the first stage in the consultation process under the Act and the
Council's report is expected to be received in the coming weeks. The next stage
in the process will involve a much wider consultation when the Council's report
has been fully considered. Expressions of interest will then be sought from
qualified persons available for appointment to the new registration board that
will be established to regulate counsellors and psychotherapists.
5. Consumer Protection
It is important to note that while counsellors and psychotherapists are not
currently subject to professional statutory regulation, they are subject to
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legislation similar to other practitioners including consumer legislation,
competition, contract and criminal law.
Question 10 (Deputy Seamus Healy)
To ask the Minister for Health what steps he intends to take to solve the continuing
difficulties with the processing of medical card applications and the restoration of
medical card for those who held medical cards on a discretionary medical basis
including the length of time it is taking to restore cards; the urgent need for access to
a contact person/s with authority ; the long delays (frequently 3 months) in having
applications assessed on medical grounds; the delay in issuing decision letters to
applicants thereby delaying the commencement of the appeals process and the length
of time that appeals are taking.
Question 48 (Deputy Peter Fitzpatrick)
Why is there such a long delay in discretionary medical card being issued?
Response:
Medical Card reviews and assessments are subject to a turnaround target
performance of 90% fully processed within 15 days. This key performance indicator is
currently 96.28% and is published by the HSE PCRS on www.MedicalCard.ie each
week on Monday mornings. This applies to applications which have sufficient
information to allow the assessment to be completed. The HSE made a number of
decisions to increase the input of Medical Officers to resolve some outstanding cases
where medical reports need to be assessed and all backlogs have now been cleared.
Measures have also been implemented to prevent any future backlog of outstanding
cases.
In relation to the restoration of medical cards, this project is now complete and the
total number of discretionary medical cards restored is 11,383.
In light of the Government’s decision to develop a new policy framework of eligibility
for health services, and the work of the HSE’s Expert Panel in this regard, an external
review of the PCRS was commissioned by the HSE. A key consideration in the review
will be enhancing the process from the point of view of applicants and, inter alia, to
aid simplification of application and review processes.
This report is being considered in association with the Report of the Expert Panel.
Question 11 (Deputy Sandra McLellan)
To ask the Minister for Health whether he will prioritise the tackling of childhood and
youth obesity and what measures he will take to do so?
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Response:
Tackling overweight and obesity remains a public health priority for my Department.
It is recognised that alone no single initiative will reverse the growing obesity trend,
but a combination of measures should make a difference. The Special Action Group
on Obesity (SAGO) is concentrating on a range of measures such as calorie posting in
restaurants, a choice of healthy foods and drinks in vending machines in post primary
schools; food labelling options; Treatment Algorithms for adults and children and
opportunistic screening and monitoring for earlier detection of overweight and obesity
in children. The Department of Health has worked with the Broadcasting Authority of
Ireland, with regard to the marketing of food and drink to children for the revised
Children’s Code to restrict marketing of high fat, high salt and high sugar foods and
drinks. The current Food Pyramid guidelines on carbohydrates and fat are being
reviewed by the Health Research Board and results will be presented to the Special
Action Group on Obesity later this month for comment and modification, if necessary.
An EU-wide Joint Action to facilitate implementation of The EU Action Plan on
Childhood Obesity will commence in March 2015 and end in early 2017. Ireland will
lead on a Work Package which focuses on ‘The cost of Childhood Obesity in Europe
and forecasting the increase in the burden of disease arising from childhood obesity in
the EU by 2020’. A Report and Recommendations of the Special Action Group on
Obesity Working Group to reduce consumption of high fat, salt and sugar foods and
drinks from the Top Shelf of the Food Pyramid, has been prepared and is being
considered under the Healthy Ireland framework. Work is now ongoing to progress
the Recommendations.
A new Obesity Policy in now under development and will be finalised in 2015.
Question 12 (Deputy Sandra McLellan)
To ask the Minister for Health whether he will act to reduce waiting times for
orthopaedic surgeries?
Response:
The HSE is continuing to focus on the reduction of waiting times for orthopaedic and
other types of surgeries across all hospitals
There has been a significant reduction in orthopaedic out-patient waiting lists (-10%)
and a more significant reduction in long waiters (-59%). This pattern is reflected
across many of the hospitals with the largest waiting lists. In contrast, surgical daycase and in-patient orthopaedic waiting list numbers are increasing. This is due to a
number of factors which includes increased demand and reduced capacity to provide
appropriate service levels.
The HSE is currently undertaking a range of initiatives aimed at optimising existing
capacity within hospitals and, in parallel, aimed at ensuring strict chronological
scheduling of patients to target the longest waiters first. The use of targeted
initiatives in the future must have regard for enabling sustainable improvement in
waiting lists. Further initiatives are either underway or planned as follows:
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use of standardised referral to support effective clinical prioritisation
bi-monthly comparative performance review
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specific focus on pathways of care with initial focus on areas such as
Orthopaedics, ENT, Ophthalmology, Dermatology and Urology.
The HSE has previously commenced an out-patient improvement programme which
targets specialities with the highest volume waiting list areas (this includes
orthopaedics) and which has already completed a number of improvement steps.
Such improvements include:
 Revised protocol and guidance completed and issued to all hospitals on Out-patient
Referral Handling with structured implementation plans for hospitals with an
accompany web-based monitoring tool to review hospital by hospital progress
 There are now Consultant-led patient-level waiting lists counted for first time
 Hospitals must have in place a defined outpatient management structure in place
 All hospitals provide a monthly standardised data and performance measurement
information. This monthly information provides the basis for regional and local
performance management
 Implementation of an assertive DNA policy which aims to significantly reduce
wasted appointment slots
 Specification of a clinical prioritisation five day turnaround for referrals management
 Chronological management of patients within category initiated
 Referrals centralised to standardise management and reduce risk
 Work with primary care integration has commenced to reduce delays and referral
problems between hospitals and GPs.
 Specialist Musculskeletal Physiotherapy clinics
The HSE is also currently planning the implementation of a number of medium term
actions including a pilot of a text messaging system to reduce “Did not Attends”
(DNAs) and a proposal to initiate a media campaign with the same aim.
There has been an 8% increase in new OPD attendances at hospitals with a
commensurate 15% reduction in the number of patients waiting more than 12
months. Despite the improvements achieved, the HSE still faces significantly
challenges to addressing its waiting lists i.e. referrals to out-patients have increased
by over 10% compared to 2013 resulting in an additional 6,000 referrals each month
compared to the same period 2013. . In addition, emergency admissions to hospitals
have increased by 2% placing additional pressure on hospital capacity. There has
been a 17% increase in patients awaiting discharge in hospitals. Such capacity
constraints have reduced the HSE’s ability to schedule elective appointments in
response to growing demand.
The HSE’s Clinical Surgery Programme is also providing pivotal support to ensuring
that orthopaedic and other types of surgery capacity are improved. The Clinical
Surgery Programme is implementing a range of measures to improve the efficient of
theatre utilisation for orthopaedic and other specialities through the Productive
Operating Theatre (TPOT) “TPOT” programme. TPOT is a process improvement
programme which utilises Lean Methodologies. TPOT delivers significant
improvements to operating theatres and enables theatre teams to transform the way
they work to provide better patient care within a better working environment.
13
Question 13 (Deputy Sandra McLellan)
To ask the Minister for Health whether, in the absence of a generic substitute, he will
reinstate Daxas under the medical card scheme as the cost of hospitalising chronic
lung disease sufferers is surely more expensive than the cost of the drug itself.
Response:
The drug Daxas was never reimbursed under the GMS or any other Community Drug
Schemes. As part of national application process for addition to the Reimbursement
Lists, New Medicines (New Chemical Entities) are required to undergo a formal
assessment process including a full pharmaco-economic evaluation after which a
decision on whether to reimburse new medicines (or not) is made. These processes
are in place to ensure that the HSE can provide access to as best a range of effective
and cost effective medicines as is possible from within the resources provided to it.
Roflumilast (Daxas) was assessed under this process between 2010 and 2012. The
National Centre for Pharmacoeconomics conducted a health technology assessment
and concluded that the manufacturer had not demonstrated the cost effectiveness of
Roflumilast (Daxas). The HSE considered this report and other evidence and was
unable to support reimbursement as the available evidence submitted by the
pharmaceutical company was insufficient. In these circumstances, Roflumist (Daxas),
was not added to the HSE Reimbursement List.
The HSE understands that the pharmaceutical company (Takeda) have a multinational clinical trial (the REACT trial: http://clinicaltrials.gov/show/NCT01329029)
on-going to develop sufficient evidence to allow the HSE (and other international
reimbursement agencies) to re-consider reimbursement. The HSE expects that
Takeda will re-submit a pricing and reimbursement application when the results of
this trial are available (expected later in 2014).
The company (Takeda) manufacturing the product, which is a licensed product, has
been providing the product to patients free of charge for some time. It appears that
the company has decided to stop free of charge supplies. The HSE had no role in
those arrangements and did not agree them with the company.
Question 14 (Senator Jillian Van Turnhout)
To ask the Minister for Health what resources have been provided to the HSE to
prepare, train and support staff in primary care, hospitals, mental health (adult and
child), addiction and disability services for the implementation of the Children First
legislation.
Response:
The HSE has a range of resources and structures in place to prepare for the
implementation of the Children First legislation. The National Director Primary
Care has lead responsibility for the implementation of Children First and represents
the HSE on the Health Sector Oversight Group and attends the Children First
Interdepartmental Group meetings.
A Children First Lead with a child care
background has been appointed to implement Children First and a draft Children First
14
Implementation Plan has been developed.
Also, the draft Children First
Implementation Plan makes provision for the completion of a training needs analysis
and work has commenced in this regard. Requirements in the HSE and the funded
sector will be informed by the output from this action.
A series of governance structures across the organisation have been set up to
coordinate the implementation of Children First at all levels in the organisation
including:




A HSE Children First Oversight Committee- under the auspices of the
Leadership Team
Children First Implementation Committees in each division with representation
from senior managers
Children First Implementation Committees at area and hospital level
Designated Liaison Persons will shortly be appointed in all HSE areas and
hospitals with specific responsibilities to ensure that the standard reporting
procedure to the Child and Family Agency is followed and to provide advice and
support to staff who have a child protection and welfare concern.
In addition, the Memorandum of Understanding (MoU) between the HSE and Child
and Family Agency recognises the importance of the interdependencies between both
organisations and the underlying principles of cooperation and coordination. The Child
and Family Agency is represented on the HSE Oversight Committee and provides
support to a number of sub committees.
Under the MoU, support services provided by children and family services prior to the
establishment of the CFA continue to be provided by the CFA until other
arrangements are agreed and in place. Training advice and support is provided to
HSE staff by CFA staff and Children First Trainers and Information and Advice
Officers in the CFA continue to be available to funded agencies at the same level that
pertained in 2013 .
Question 15 (Senator Jillian Van Turnhout)
To ask the Minister for Health to outline the work undertaken thus far by the HSE’s
National Clinical Programme for Neurology in developing a Model of Care for
Neurology, his assessment of the progress being made to establish a patient pathway
for Multiple Sclerosis and in particular, whether he believes these work streams would
benefit from greater resources and more formal collaboration with patient groups and
the pharmaceutical industry.
Response:
At the time of its inception the primary aim of the Neurology Programme was to look
at outpatient services and attempt to address the deficits in that area with respect to
excessive waiting times. To this end, business cases were developed to secure 10
additional Consultant posts. Submissions for same were successful, and to date, 9 of
these posts have been filled with a successful candidate identified for 10th post which
will be taken up in the coming months. This initiative saw a significant increase in
access to outpatient Neurology Services as outlined below:
15
2009
- Average new patients seen per month 660.
- Average review patients seen per month 1921
2012
- Average new patients seen per month 848
- Average review patients seen per month 2563
The Programme acknowledges that while improvements have been achieved, further
improvements will be required for Neurology Outpatient services to meet national
targets of waiting less than 13 weeks for a first appointment with a Consultant by end
of 2015.
The Neurology programme is now focused on the development of the model of care.
In planning for this, a number of very significant issues needed to be discussed and
decisions made in relation to the scope of the model of care. Neurological conditions
cross all age groups and all divisions with respect to delivery of service and as such,
the potential scope for the programme was vast. A review of scope of other Clinical
Programmes and relevant policy documents was undertaken to ensure all aspects of
the care of these patients were addressed while avoiding duplication.
The following decisions were then made with respect to scope:
- The Model of Care for Neurology will focus primarily on hospital based services,
inpatients and out-patients. Within this scope, there will be consideration of the
paediatric population, rehabilitation services, nurse & therapy led clinics and
links with palliative care. To this end, the Neurology Programme will work in
liaison with the National Clinical Programmes for Paediatrics, Rehabilitation
Medicine, Older Persons and Palliative Care.
-
The following conditions, while they would be within scope of the Neurology
Programme will not be addressed specifically as they have their own condition
specific Clinical Programmes. These are;
o Epilepsy
o Stroke
However as above, the Neurology programme will continue to work in liaison
with these clinical programmes.
-
Included in this model of care will be recommendations with respect to generic
standards which would be applicable to all services and conditions. In addition
to this, the neurology programme is developing specific care pathways for 3
conditions that represent a high proportion of all neurological chronic conditions
in both primary and secondary care. These conditions are;
1. Multiple Sclerosis – Currently there are close to 7,792 (1.84% prevalence)
persons with multiple sclerosis in Ireland
16
2. Parkinson’s Disease – over 6,000 persons aged 60 years and over, have
Parkinson’s Disease (1% prevalence rate). This will increase to over 9,000
persons by the year 2021.
3. Headache - the term headache disorder encompasses a number of
conditions which vary in severity, incidence and duration. As a consequence,
establishing the overall prevalence is difficult. Globally, it is estimated that the
prevalence among adults is 47%. Half to three quarters of the adults aged 1865 years in the world have had headache in the last year. Headache is thought
to affect up to 90% of the population throughout their lifetime.
- A 4th Pathway will also be included looking at a recommendation for the
patient pathway for Motor Neurone Disease. While not as prevalent as the
conditions mentioned above, the level of care and complexity of presentation of
these patients requires specific consideration.
The workstreams looking at these patient pathways are multidisciplinary and
we endeavour to be as inclusive as possible. We acknowledge that these care
pathways are limited somewhat due to the scope of the programme and as
such may not fully capture the ongoing requirements with respect to therapy
and management in the community. To this end, the Programme Manager for
the Neurology Programme is also Programme Manager for the Rehabilitation
Medicine Programme which is addressing the needs of patients requiring
specialist neuro-rehabilitation across the country. This programme is
advocating for specialised community based neuro-rehabilitation teams to
provide this on-going support and treatment of patients in the community.
Patients with more complex specialist neuro rehabilitation needs may also be
within scope for admission to specialist in-patient rehabilitation facilities, both
regional and tertiary levels depending on level of needs. The Working Group for
the Rehabilitation Medicine Programme is also multidisciplinary with experts
from across the range of services delivering specialist rehabilitation services.
- The Model of Care is currently in its 4th draft. It is hoped it will be in substantive
draft form and ready for external review by the time of next meeting of the Clinical
Advisory Group in November of this year.
- In tandem with the development of the Model of Care, the Neurology Programme
has been working with our National Director, Dr Aine Carroll on developing protocols
for the prescription of high cost medications (Alemtuzumab & Natalizumab) for
patients with Multiple Sclerosis. Once agreed, these guidelines will be integral to a
reimbursement scheme planned which will see hospitals providing these medications
reimbursed, thus ending inequities across the country with respect to provision of
these medications.
- With respect to liaison with Pharmaceutical companies, to date this has not been
explored fully. We have had some assistance with respect to templates for care
pathways etc, however there has been no input from pharmaceutical companies with
regard to the content of any aspect of the model of care.
- While we have been approached by a number of pharmaceutical companies with
offers of assistance, the primary resource required by the programme to complete
this body of work is whole time equivalent posts as the vast majority of those working
in workstreams/working groups etc are not backfilled for their time so any work
17
undertaken is done so in additional to significant workloads. It is our understanding
that pharmaceutical companies cannot assist us in this regard.
- We are receiving assistance from the Neurological Alliance of Ireland with respect to
circulating surveys, patient/carer feedback etc. The organisation also has
representation on our working group. While it is understood that this organisation
receives some funding from pharmaceutical companies, the support they give the
Neurology Programme is as a representative body for patient organisational groups.
Question 16 (Senator Jillian Van Turnhout)
Following the Irish Heart Foundation and Irish Association of Cardiac Rehabilitation
survey highlighting chronic inadequacies in cardiac rehabilitation services countrywide
and the undertaking by the then HSE national director of acute services, Ian Carter,
to improve the situation before the end of 2014, what improvements have been made
and what further plans are in the pipeline.
Response:
The HSE has reviewed the findings from the 2013 survey of the Irish Association of
Cardiac Rehabilitation (IACR) and the Irish Heart Foundation (IHF). This survey
showed the high completion rates by patients attending cardiac rehabilitation and the
significant positive impact that cardiac rehabilitation can have on risk of cardiac
mortality (-26%). Whilst there is evidence of growing waiting lists, many patients had
access to a rehabilitation programme within 3 months of discharge from hospital.
The survey did highlight a number of findings that the HSE will continue to focus
upon. The HSE is mindful of the survey’s findings that only 7 of the services believe
they had targeted a high number of eligible patients for a programme and most
significantly, rehab coordinators feel that the quality of service has been reduced.
The National Director of Acute Hospitals has a scheduled meeting with a number of
relevant clinical programmes shortly which has been convened to focus on the issue
of cardiac rehabilitation. It is intended that cardiac rehabilitation specific actions will
follow from this.
It should be further noted that the HSE has developed a range of primary
percutaneous coronary intervention (PCI) centre hospitals which are designated based
on having available catheter laboratories plus a requisite number of cardiologists that
are trained in PPCI. There are 5 designated 24/7 PPCI. The development primary PCI
centres will also assist in the future with the reduction for cardiac rehabilitation.
Question 17 (Deputy Jerry Buttimer)
To ask the Minister for Health and HSE, regarding hospice services and palliative care:
 To set out in details their plans to develop palliative care services to overcome the
regional disparities in hospice services in the country since the HSE’s five-year
development framework is now out-dated.
 To set out any plans to progress the development of a National Strategy on
Palliative Care, End of Life and Bereavement in the health services in line with the
18
main recommendation of the Report on End of Life and Palliative Care in Ireland
published by the Joint Committee on Health and Children in July 2014.
Response:
(on plans to develop palliative care services)
The HSE’s Five Year / Medium Term Framework identified and prioritised the gaps in
specialist inpatient, community and day care services around the country. Although
the Framework was published in 2009 the HSE remains committed to the full
implementation of its recommendations.
Key developments in 2014 – Adult Services:
Despite considerable financial constraints over the period significant progress has
been made.

St. Francis Hospice in Blanchardstown commenced the opening of its
inpatient beds in September of this year; with all 24 beds due to open by the
end of December. The unit also provides a Day Care Centre and will act as a hub
for home care services.

Marymount Hospice in Cork has opened 16 out of their 20 new beds, with
plans to open the remaining beds by the end of the year.

Mayo Hospice - Plans for the building of a new hospice in Castlebar have been
agreed with Mayo/Roscommon Hospice Foundation, and the revenue will be
prioritised in the estimates process for 2017.
Future developments:

Galway Hospice has been working with the HSE to increase the number of its
inpatient beds from 12-18 and to extend its home care services.

Waterford Hospice Group has agreed to provide the capital for the building of
a new 20 bed unit which will be incorporated into the new development at
University Hospital Waterford.

Kerry Hospice Group has plans to co-locate a 15 bed unit in the grounds of
Kerry General Hospital.

Wicklow Hospice Group has recently met with the HSE National Director to
progress the plans for the development of a 15 bed unit for the county and its
hinterland.

Midlands - Draft plans for a hospice have been submitted to the National
Director for consideration
Children’s Services:
Significant progress has also been made in relation to children’s palliative care
services:

The first Paediatric Consultant with a Special Interest in Palliative Care has
been appointed.

8 Children’s Outreach Nurses have been appointed to facilitate continuity of
care for children with life-limiting conditions.
All of these developments will be part of locally integrated in-patient, home care and
day care palliative care services, which will ensure the provision of seamless care for
patients and their families.
19
Performance:
The HSE has in recent years worked closely with its own staff and the voluntary
specialist palliative care providers to ensure access continues to improve, despite a
reduction in budget allocation.
Inpatient:

2013 / 2014 comparison demonstrates a 4% cumulative activity increase.

In August 94% of specialist palliative care inpatient beds were provided within
7 days of referral, meeting the national target.
Community Home Care:

2013 / 2014 comparison demonstrates a 6% cumulative activity increase.

In August 91% of patients referred to specialist palliative home care received a
service within 7 days.(National target 82% )
Day care:

2013 / 2014 comparison demonstrates a 3.5% cumulative activity increase.
Priorities for 2015:
It is recognised that due to changing demographics, quality improvements and better
disease trajectories the demand on palliative care services continues to grow. The
HSE will continue to endeavour to meet this need and in 2015 the key priorities will
include:

Effective and Timely Access – in both Adult and Children’s Palliative Care
services.

The integration of Palliative Care structures.

Quality improvements in Adult and Children’s Palliative Care Services.

A review of existing policies, including a needs analysis.
Response:
(on plans for a national strategy)
National policy on palliative care is based on the 2001 Report of the National Advisory
Committee on Specialist Palliative Care, the HSE’s five-year/medium-term framework
document, and the 2009 Children’s Palliative Care Policy. Given the time that has
elapsed since these documents were drawn up, the Minister has asked the HSE to
carry out a reassessment of current needs and to consider whether any updating or
revision of existing priorities and approaches is now appropriate (see HSE palliative
care priorities for 2015 above).
With regard to the broader proposal for an overarching National Strategy on Palliative
Care, End of Life and Bereavement recommended by the Oireachtas Joint Committee
on Health and Children in July 2014, the range of issues which arise in this context is
very diverse, encompassing, for example, generalist and specialist palliative care,
bereavement counselling, social welfare payments following a death, taxation on
inheritance, legal rules around capacity, public awareness, and funeral services.
Because of the extent of this spread of issues, and the fact that there is often very
little if any direct connection between one set of issues and others, it would be
difficult to achieve coherence in a strategy encompassing all of these elements.
Ensuring effective implementation of such a Strategy on an ongoing basis into the
future would also be cumbersome. However, in implementing Strategies within the
remit of the health services, it is often possible and appropriate to effectively link and
20
co-ordinate issues (across the activities of the HSE and voluntary organisations, for
example), and this will be done to the maximum extent possible.
Question 18 (Deputy Jerry Buttimer)
To ask the Minister for Health and HSE what preparations are in place at acute
hospitals to ensure that accident and emergency departments are ready to deal with
the anticipated increased demand over the forthcoming winter months.
Response:
All hospitals are now required to develop full year demand and capacity plans, to
underpin their response to foreseeable peaks in demand. This includes the production
of specific plans for winter months, when there tends to be an increased demand for
in-patient beds arising from unscheduled hospital attendances. A key driver for this
planning process has been the Special Delivery Unit (SDU). Since 2011, they have
required hospitals to:
1. Proactively plan for peaks periods, including public holiday periods
2. Adjust planned scheduled care activity, to allow for higher unscheduled care
demands in winter months
3. Maximise the efficiency of processes that
a. Deflect patients from admission e.g. rapid multi-disciplinary team
assessment for frail elderly
b. Provide rapid access to senior decision makers e.g. introduce acute
medical assessment units
c. Minimise admission delays when an in-patient bed is required e.g. use
‘Visual Hospital’ systems that facilitate faster identification of beds about
to become available
4. Engage in active discharge planning, including setting predicted dates of
discharge, more frequent ward rounds and discharge from hospital earlier in
the working day, so that beds are available at the optimal time.
5. Have clear linkages and excellent working relationships with community
colleagues, particularly for patients requiring off-site rehabilitation or who
require home support services, whether from HSE health care professionals or
contracted agencies which provide skilled nursing care, e.g. intravenous
treatments, or personal care services from home help agencies.
Each of these measures applies as much to this coming winter as has been the case
in previous years. Together with the benefits of the Clinical Programmes, they have
enabled Hospital Management Teams to achieve a significant reduction in the number
of trolley waits compared to the year the SDU commenced operations, 2011. There
has been a 32.6% reduction in the Irish Nurses and Midwives Organisation (INMO)
national trolley count since that time.
21
Question 19 (Deputy Robert Dowds)
To ask the Minister for Health to outline how he intends to move to a situation
whereby this country creates a fair and equal health service where people receive
health care on the basis of need rather than income?
Response
I am committed to a major agenda of health reform, in line with the commitments
contained in the Programme for Government and our policy statement, Future Health.
I want to push ahead as soon as possible with key reforms in areas such as extending
GP care without fees on a phased basis, improving the management of chronic
diseases, implementing key financial reforms including Money Follows the Patient, and
establishing hospital groups as a critical enabler of improving patient quality and
efficiency. These are big milestones on the road to universal health care
When I became Minister for Health I reviewed our progress to date and the timescales
for implementing very important reforms, including Universal Health Insurance, based
on universal entitlement to a single-tier health service that is based on need, not
income.
While I believe that it will not be possible to introduce a full UHI system by 2019, as
envisaged in the White Paper, I want to emphasise my commitment to implementing
these reforms.
In order to do this I want to examine some key elements further and then to decide
on the best way forward, but this is a refocusing of our reforms, not an abandonment
of them.
In relation to UHI my Department initiated a consultation process on the White Paper
following its publication. I recently received the report of the independent thematic
analysis of the 137 submissions received. The report notes that a substantial body of
opinion is represented in the submissions and a wide range of themes covered. It
provides much food for thought that will be useful in further developing policy in this
area. I intend to publish this report on the Department’s website.
My Department has also initiated a major costing exercise to estimate the cost of UHI
for households, employers and the Exchequer and is working closely with the ESRI
and the Health Insurance Authority. Initial costings should be available by the end of
the first quarter of 2015.
The independent thematic analysis of submissions from the consultation process on
the White Paper and the results of the major costing exercise on UHI will assist in
charting a clear course towards the objective of a universal, single-tier health service.
22
Question 20 (Deputy Colm Burke)
Could the Minister and the HSE set out in tabular form:(a)
The number of approved consultant posts in each publicly funded hospital,
broken down by specialty.
(b)
The number of approved consultant posts in each publicly funded hospital filled
on a permanent basis, broken down by specialty.
(c)
The number of approved consultant posts in each publicly funded hospital that
are unfilled (including positions occupied by a locum or a consultant employed
by an agency), broken down by specialty.
(d)
The length of time each of the unfilled posts have been vacant.
(e)
The date at which the above measurements were taken.
(f)
The number of anticipated retirements to take effect in 2015, broken down by
hospital and in turn by specialty within each hospital.
Response:
(a)
In respect of a) above, please see the attached document entitled ‘Question 20 a)
number of approved permanent consultant posts’
(b)
In relation to question b) above, please note that the extent to which posts are filled
is recorded by an assessment of the number of whole time equivalent (WTE)
consultants in employment. It excludes any Consultant employed on an agency basis.
The Deputy will be interested to note that the WTE hospital based consultants has
increased by 289 WTE (+15%) since September 2007 and now represent 2.7% of all
health service staffing. The table attached entitled ‘Question 20 – b) Hospital
Consultant WTE by Speciality and Hospital’ refers.
(c), (d) and (e)
Regarding c), d) and e) above, the HSE does not collect information on the number of
vacancies as these change dynamically over short periods of time. However, the HSE
has appointed a specific Medical Workforce Lead to the HSE’s Medical Education and
Training Unit. Amongst the roles of the Medical Workforce Lead is the development
and standardisation of data reporting on medical vacancies across hospitals. In
addition, the MET Unit is progressing the development of a standardised Consultant
and NCHD database which will include identified vacancies. Please also note that the
general moratorium on recruitment and promotions continues to be in place in the
health sector to support the reduction of public sector numbers and costs and as such
the moratorium precludes vacancies per se. Thus the vacating of a position does not
in itself create a vacancy as the work of the position may be covered through
redeployment, restructuring or reallocation.
As part of the establishment of the hospital groups, future recruitment of medical
staff will be as part of the group structure. This will allow for significant flexibility in
the rotation of (medical) staff across hospital sites (thus reducing the vacancy level of
23
sites with traditional recruitment difficulties) and allow for an enhanced training
experience for doctors.
The Public Appointments Service recruits permanent consultants on behalf of the HSE.
All of these posts are advertised on www.publicjobs.ie, in the national newspapers, in
medical journals and also on occasion through professional social networks. The
terms and conditions are included in the information that accompanies these
advertisements. It should be noted that consultant posts take a number of months to
fill, as applicants may be finishing training programmes or working abroad gaining
additional experience at the time of their applications and, of course, are duty-bound
to finish out their contracts. Therefore there is often a time lag between a Consultant
post becoming vacant and the permanent filling of that post.
(f)
Regarding f) above, the number of anticipated retirements to take effect in 2015
totals 22, based on projected retirement date. Details by hospital and specialty are as
follows:
Beaumont
Mayo General
Cavan Monaghan
CUH
St James’s
St Lukes
Limerick
Mater
National Maternity Hospital
Crumlin
Roscommon
South Infirmary
Temple St
Tullamore
St Vincent’s
Waterford
HSE South MHS
Surgery
Pathology
Obstetrics & Gynaecology
Radiology
Medicine
Surgery
Radiology
Pathology
Radiology
Anaesthesia
Surgery
Obstetrics & Gynaecology
Paediatrics
Surgery
Anaesthesia
Pathology
Medicine
Medicine
Surgery
Paediatrics
Radiology
Psychiatry
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
1
Question 21 (Deputy Colm Burke)
Could the Minister and the HSE provide details on the availability of respite care for
children ages 16 years or under who have serious chronic disabilities, and in
particular confirm: The total number of places available at any one time.
 The total number of facilities where respite care can be provided for these
children.
24

The total number of children who were provided with and used the facility of
respite care in 2011, 2012 and 2013.
 The total number of cases where parents of children sought the facilities of
respite care in 2011, 2012 and 2013, and where such care was not provided.
Response:
The HSE and its funded agencies provide respite care to children and adults with
disabilities. Respite can occur in a variety of settings for any length of time,
depending on the needs of the family and available resources. It is not always
centre-based and can be provided in a number of ways, e.g. Out-of-Home; In-Home;
Home-to-Home; Home Support; Family Support etc. As a vital part of the continuum
of services for families, respite helps prevent out-of-home placements, preserves the
family unit, and supports family stability.
The HSE is very much aware of the importance of respite service provision for the
families of both children and adults with disabilities, including the impact the absence
of respite service provision can have on other services. However, data on the “total
number of cases where parents of children sought the facilities of respite care in
2011, 2012 and 2013, and where such care was not provided” is not routinely
collected or collated by the HSE.
The data on use of the centre based respite services is captured as part of the HSE’s
Key Performance Indicators (KPI) and is included in our monthly performance reports
published on our website. The information is captured for Adults and Children
combined and is not captured for children only in this format. The most up to date
information is provided in the table below for the period 2012-2014. Information is
not available for 2011.
The number of people with a disability who were provided with and used the
facility of respite care in 2012, 2013 and 2014
The number of people benefitting
from residential centre based
respite services (ID, and/or
Autism, Physical , Sensory)
The number of bed nights in
residential centre based respite
services used by people with
Disabilities (ID and / or autism
and Physical and Sensory)
2012
6039
2013
6,208
2014
5227 (June 2014)
239,239
242,699
90,806 (June 2014)
While the specific information in relation to children utilisation of respite care is not
available we are able to outline below the detail of the number of facilities and the
maximum number of placements available currently in the system.
Number of
facilities
47
Respite Services Dedicated to
25
Number of
Placements
400
Children
Respite Services for both Children
and Adults
Residential and Respite Services
for both Children and Adults
Total
35
238
10
90
92
728
The HSE estimates that children account for about 56% of the total number of respite
bed nights utilised each year. It is the intention of the HSE to capture children and
adults respite data separately in 2015.
As a result of a significant number of respite beds being utilised for long term
residential placements, the numbers of people with disabilities in receipt of residential
respite services and the corresponding number of respite nights are down against
target and down against previous activity. Significantly, the combined number of
respite bed nights for people with ID or a physical and/or sensory disability are down
-36.2% since March 2012. However, the largest drop in residential respite has
occurred in DML, which reflects a significant increase in home support hours at June
2014 (27% above Q2 target, and 59% higher than 2013 Q2 level). This reflects new
models of respite care that are now being delivered (home respite, extended day care
etc.).
In addition to the centre-based respite services outlined above, between 2,000 and
2,500 persons availed of non-centre based respite services such as holiday residential
placement, occasional respite with host family, overnight respite in the home, and
summer camps, allowing people to continue living with their families and in their
communities.
The HSE remains committed to working with all voluntary disability service providers
to ensure that all of the resources available for specialist disability services are used
in the most efficient and effective manner possible.
Question 22 (Deputy Colm Burke)
The Strategic Review of Medical Training and Career Structures (MacCraith Group)
Report made a number of recommendations on the training and employment of
NCHD's. In view of the fact that €250 million will be spent by the HSE for the
employment of agency staff in 2014, would the Minister and the HSE outline what
progress has been made in the implementation of the recommendations in this report
and in particular:(a) If the HSE-MET and the Forum of Irish Postgraduate Medical Training bodies have
met to discuss the implementation of the recommendations.
(b) What specific changes will occur in contracts being offered in January 2015 and in
particular in which specialties.
(c) What percentage of newly appointed NCHD's in January 2015 will be advised in
advance of their placements/locations for the first two years of their training
scheme.
26
Response:
In relation to the three questions above:
(a) A joint HSE-MET and Forum of Postgraduate Training bodies steering group is
established and has met on a number of occasions. One of the primary goals of
the steering group is to implement the recommendations of the MacCraith reports
relating to the training and employment of NCHDs.
(b) The current NCHD contract was implemented in 2010. The contract itself has not
been renegotiated. The contract will continue to be offered by the relevant
employer, no particular specialties will be affected in January 2015.
(c) Appointments to training schemes take place in July each year, with the next
intake due to take place in July 2015. Almost all doctors entering a training
scheme will have certainty over their placements for at least the next two years.
The exception to this is surgery, as surgery has moved to streamlined training.
The first year of training in this speciality is general and the trainees subspecialise in the second year. Trainees will know their first year rotations but
until they choose their sub-specialty during the first year it is not possible to
provide them with their second year rotations.
Question 23 (Deputy Caoimhghín Ó Caoláin)
The need for the HSE to introduce a state-wide strategy to guarantee that all
expectant women will receive the highest standards of safe, reliable, quality care in
all maternity unit settings across the state; the current position by hospital site
regarding the implementation of the recommendations made in the HSE and HIQA
reports following the tragic death of Savita Halappanavar; the status of the
recommendations contained in the report prepared by the team from the National
Maternity Hospital on the tragic loss of baby Jamie Flynn; and if the Minister will make
a statement on the matter.
Response:
The Department of Health in conjunction with the HSE is currently working on the
development of a new maternity strategy. Developing the strategy will provide the
opportunity to take stock of current services and identify how the quality and safety
of care provided to pregnant women and their babies can be improved. Earlier this
year the Department commissioned a review of national and international literature
on maternity services. The review has now been completed and is informing the
development of a maternity services policy paper. On finalisation of the policy paper
it is proposed to establish a high level working group, with appropriate stakeholder
representation, with a view to further progressing and finalising the strategy.
In the meantime, work on the review of services is ongoing within the HSE and
includes:
An analysis of the existing and various reports pertinent to the delivery of
obstetric care in Ireland, using content matter experts.
27

Interviews and discussions with a range of small and large maternity services
and staff working within these units, the Obstetric Clinical Care Programme,
front line clinicians, hospital group CEOs and Board chairs, service planners and
consumers groups.

A range of site visits to obstetric units in the country.

Collection and collation of relevant data on maternity service throughput,
clinical outcomes, adverse events and staffing profiles. The HSE sought input
from maternity sites in August and presented a draft preliminary report to the
Department in September. Resources have been identified to “drill down” with
individual sites on key aspects of the data submitted.
In parallel, the HSE will continue to focus on the development of robust clinical
governance and its continuous quality improvement drive in service delivery.
The HSE continues to implement all recommendations from the HIQA Galway Report
and the HSE Galway Report. In January 2014, all 19 maternity sites were requested
to carry out a self-assessment against the recommendations from the HIQA Galway
Report and the HSE Galway Report. This self-assessment was completed with the
results shared with HIQA. The HSE will shortly be surveying all hospitals to review
progress on initial self-assessment and follow-up.
As part of the 2015 estimates submissions process, the HSE has identified a number
of additional resources required that are aimed at directly improving maternity care.
These include provision for additional nursing/midwife staff (100) and 10 additional
consultant obstetricians to particularly address the staffing of maternity units. The
configuration of required additional midwife nursing staff will be determined by a
maternity workforce study that is currently underway. The HSE has also committed to
the establishment of a National Maternity Office within the Acute Hospital Division.
The exact configuration and location of these Consultant posts will be determined
based on resource allocations for 2015.
The HSE is also currently implementing a range of other initiatives across all hospitals
which includes maternity units and hospitals. These initiatives include:
 Implementation of the National Early Warning Score (NEWS) system across all
acute hospitals.
 Implementation of the Irish Maternity Early Warning Score (IMEWS)
 As part of its regular performance management process with hospitals, the HSE
utilises the “Safer Better Healthcare” Standards and the Recommendations
contained in all relevant HSE / HIQA Reports and it reviews progress on these
reports.
 Using the National Standards for Safety Better Healthcare, the HSE ensures
hospitals review output of self-assessments on a regular basis.
The implementation of the NEWS1 is a high priority item in the National Service Plan
2014. Implementation of same is monitored and reported on a monthly basis in the
HSE Performance Reports (PAR).
1
The former Minister for Health Dr. James Reilly endorsed and launched the first National Clinical Guideline - the
National Early Warning Score on 18th February 2013. This is the first in a suite of National Clinical Guidelines which is
an important patient safety initiative for the Irish healthcare system.
28
Four new National Clinical Guidelines have been commissioned by the National Clinical
Effectiveness Committee (NCEC) as mandated by the Minister for Health in response
to recommendations from the Patient Safety Investigation Report into Services at
University Hospital Galway (October 2013). These guidelines are: National Clinical
Guideline (Sepsis Management), National Clinical Guideline (Maternity Early Warning
System), National Clinical Guideline (Paediatric Early Warning System), National
Clinical Guideline (Clinical Handover).Work is at an advanced stage on these
guidelines.
In addition, the National Clinical Programme for Obstetrics and Gynecology aims to
improve choice in women’s healthcare.
Since its establishment in 2010, the Programme has developed 31 peer-reviewed
national clinical guidelines in obstetrics and gynecology. These provide standardised
guidance for all maternity units in the country on a range of clinical issues relating to
women’s health. A further 22 are currently in production and, by December, ten will
have been published in 2014 alone.
Currently, the National Clinical Lead chairs three of the multi-disciplinary sub-groups
of the National Maternity Investigation Group and work is progressing on the
following:
o
o
o
Standardised obstetric emergency training and induction for clinical teams
composed of anesthetists, obstetricians, midwives and a range of health and
social care professionals
Quality assurance – working to standardise clinical reporting at all maternity
sites
Perinatal infection – the development of a series of clinical guidelines
management of infection in pregnant women.
With reference to obstetric emergency training, over 150 multidisciplinary
professionals from each of the nineteen maternity units attended the inaugural
national meeting on ‘Irish Multidisciplinary Obstetric Emergency Training’ (IMOET) in
Dublin Castle on Tuesday September 30th.
Standardised national ‘IMOET
presentations’ on 10 key topics were presented. An IMOET package of presentations,
video-links, National Clinical Practice Guidelines and associated resources will be
disseminated at www.hse.ie/obsgynae . This aims to support the implementation of
obstetric emergency training (IMOET) across the nineteen maternity units.
Specifically, on the issue of the status of the recommendations contained in
the report prepared by the team from the National Maternity Hospital on the
tragic loss of a named infant:
The National Early Warning Score guideline sets out how to recognise and respond to adult patients in acute hospitals
whose condition is deteriorating.
29
Following the most recent high court hearing in September 2014, at which an order
was issued permanently restraining the HSE from publishing the initial report, the
Cavan & Monaghan Hospital Management Team are in the process of commissioning a
new external review team to undertake an investigation regarding this incident.
Hospital management are also keeping the family up-dated in this regard. This
investigation will follow the “HSE Guidance in relation to Systems Analysis
Investigation into Incidents & Complaints”, dated November 2012.
In the interim, Cavan & Monaghan Hospital has taken action on two fronts:
Addressing any potential delay to access to theatre for emergency C Sections:
 New theatre schedule implemented;
 Daily formal communication process introduced between the labour ward and
theatre with regard to elective caesarean section;
 Resourcing of a dedicated Emergency theatre at all times;
 Weekly audit of Elective obstetric activity;
 Dedicated caesarean section operating theatre is protected 24/7 to ensure full
access.
Strengthening Clinical Governance arrangements for Women's and Children’s
services:
 Weekly multi-disciplinary team audit meeting chaired by Lead Consultant
Obstetrician and Assistant Director of Nursing for Maternity;
 Organisational structure revised;
 Annual Women and Children’s Services report to be produced
Question 24 (Deputy Caoimhghín Ó Caoláin)
What plans has the Minister for Health and his Minister of State team to better
resource our chronically underprovided for mental health services; when will staffing
shortages be addressed; when will we have across the state access to 24/7
emergency care and support; when will we have multidisciplinary community mental
health teams covering all areas of the state; and what steps are being taken to
ensure accessible suicide crisis support services covering all areas of the jurisdiction;
and if the Minister will make a statement on the matter.
Response:
Vision for Change – progress on implementation:
The Report of the Expert Group on Mental Health Policy (2006), A Vision for Change,
provides a framework for action to develop a modern high quality mental health
service over a 7 to 10 year period. Implementation of Vision has included positive
mental health promotion, investment in suicide prevention initiatives, accelerated
closure of the old psychiatric hospitals, the development of community based adult
and child and adolescent services, bespoke new facilities to support the recommended
community-based, recovery-focussed model of care resulting in shorter episodes of
in-patient care and the adoption of a recovery approach in the delivery of services.
30
In addition, the Programme for Government includes a commitment to ring-fence €35
million annually from within the health budget to develop community mental health
teams and services. To date €90m has been provided in the period 2012-2014.
Mental Health Budget 2014:
The HSE National Service Plan provides in the region of €766 million (including the
Programme for Government investment of €20m) for specialist mental health services
in 2014, to employ almost 9,000 clinical, nursing, social care professional staff and
other grades. Mental health services include positive mental health promotion and
suicide prevention; as well as specialised secondary care services for children and
adolescents, adults, older persons and those with an intellectual disability and mental
illness, the national counselling service and forensic mental health services. Services
are provided in a range of settings including inpatient, outpatient, day hospitals,
community and the service user’s own home.
Recent Investment in Mental Health:
Since 2012, an additional €90 million and some 1,150 posts have been funded
comprising as follows:
 €35m with 416 posts in 2012, of which 411.5 (98.9%) were in post at end
August 14, with the remainder being at various stages of the recruitment
process.
 €35m for up to 477 posts in 2013, was reinvested, building on the 2012
commitments and also to support the development of specialist mental health
services. Of the posts allocated in 2013, 352.5 or 75.2% of the WTES had
started before the end August 2014, with a further 6 WTEs or 1.2% with
agreed start dates after 30th August 2014. The remainder are at various stages
in the recruitment process. There are a number of these posts for which there
are difficulties in identifying suitable candidates due to factors including
availability of qualified candidates and geographic location.
Therefore of the above 893 posts, approx. 764 (85%) have taken up duty.

€20m for between 250/ 260 posts in 2014.
The funding is being used to continue to strengthen Community Mental Health
Teams for both adults and children, to enhance specialist community mental
health services for older people with a mental illness, those with an intellectual
disability and mental illness, forensic mental health services, and to enhance
access counselling and psychotherapy in primary care and investment in
suicide prevention measures.
Of 1,150 or so posts being funded, almost 764 (66%) are in post as of end
August 2014.
The €20m funding allocated in 2014 will provide for in excess of 250 posts in mental
health services. The current notified posts by ISA and speciality are indicated in the
table below and the remaining posts will be notified in the coming weeks, specifically
a further 25 posts relating to CAMHS services and national and area based service
improvement and quality & patient safety posts.
31
National Service Plan 2014 indicated that new spend related to this funding would
need to be phased in order to live within the overall available resource, with posts
targeted to be in place by the end of 2014. The near 200 posts in the table above
have been notified to Areas and the initial recruitment processes are underway. It is
expected that although some of the posts may be recruited during this last quarter
2014 from panels in current operation, that the majority of the posts will be recruited
in early 2015, requiring additional targeted campaigns etc.
The delay in allocation of the posts and therefore, recruitment processes not having
started sooner in 2014, has related solely to a more detailed allocation process taking
place based on a review by the Mental Health Division of the current level of staffing
and resources across all Areas and specialties in order to identify the current gaps in
services and inform decisions on allocation of these new posts. The emerging data
and analysis will continue to support the on-going decision making process regarding
resource allocation and utilisation.
Budget 2015
Budget 2015 provides for an additional €35 million ring-fenced for mental health. This
will bring to €125 million the total investment by the Government in mental health
services since 2012. The additional funding will be directed towards the continued
prioritised development and reconfiguration of General Adult teams, including
Psychiatry of Later Life, and also Child and Adolescent Community Mental Health
teams. In addition, the funding will also permit urgent specialist needs to be
addressed, including psychiatric intensive care, forensic mental health, mental health
intellectual disability care, and psychiatric liaison services.
Access to 24/7 emergency care & support:
Acute Mental Health Service provision is delivered on a 24/7 basis.
32
Update on Crisis Intervention
A Vision for Change recommends that, as part of community secondary care
provision, there should be a crisis house available in each catchment area. A number
of mental health services have provided crisis houses as part of their community
residential provision and, as the mental health services move away from the provision
of low and medium support community residences, opportunities to provide the crisis
house model will be explored. In other areas, respite arrangements are in place to
address the emergency needs of service users.
As part of the investment in mental health in 2013, an allocation of 35 posts was
identified to provide for the implementation of the Clinical Programme to address selfharm presentations in emergency departments. 23 of these posts are currently in
place and the remainder are in the recruitment process.
The National Office for Suicide Prevention also funds over 42 services within the
statutory and voluntary sector such as: - Samaritans, Pieta House, Console many of
who provide direct support to individuals in crisis.
There is no specific investment planned from the 2014 investment for crisis
intervention services as the focus continues to be on building the capacity of
community mental health teams across Child and Adolescent, General Adult and
Psychiatry of Old Age to provide a comprehensive community based secondary care
response.
Each Area is covered by Community Mental Health Teams.
The investment in mental health in 2012 and 2013 meant that almost 900 new
mental health professionals are taking their places on community mental health
teams and working to introduce the new clinical programmes
National Office for Suicide Prevention
The HSE’s National Office for Suicide Prevention leads the national implementation of
‘Reach Out’, the Government strategy for suicide prevention and has a budget of
€8.8 million in 2014 (an 8% increase on the budget for suicide prevention in
2013)This represents the health services greatest investment to date in suicide
prevention in a calendar year. The NOSP plays a pivotal role in funding, coordinating
and giving strategic direction to the work of over 40 agencies from the voluntary,
statutory and non-statutory sector working to promote positive mental health and
reduce suicide and self-harm in Ireland.
The Department of Health and the HSE are currently developing a new Strategic
Framework for Suicide Prevention. This will be a Department of Health sponsored
Policy Framework for the period 2015-2018 (query 2018 or 2019?), to be managed
and delivered by the National Office for Suicide Prevention . A national engagement
process was completed in July 2014, and series of bi-lateral meetings with
Departments of Education, Children & Youth Affairs, Justice and the CSO have taken
place will inform the development of the new Framework
In Q2 2014, progress on implementation of the new Strategic Framework included: 6 working groups were established and regular meetings have occurred including
bilateral government department meetings
33
 The Samaritans free-call Connect number was launched in Q1.Regional advertising
of the service at a community level is ongoing
 Work on suicide prevention services mapping has been completed.
 Work on national social marketing campaign continues.
 An internal review of “Reach Out” has been completed.
Work has commenced on the development of a Local Implementation
Planning/Delivery model in Donegal. It is intended that this model can be adapted
nationwide.
 The NOSP has completed a review of training programmes sponsored by NOSP
 (included above)The Community Resilience Fund has been allocated to the
Resource Officers for Suicide Prevention to support local initiatives.
In 2014, the NOSP will continue to work in partnership to deliver local and community
based supports as well as frontline services. The NOSP will also work to improve
access to information and supports for anyone experiencing mental health difficulties
- with the development of:
 The free-call Connect number, which was launched in March with the NOSP’s
partner, the Samaritans – this new number will simplify the signposting to
services for people who may be going through tough times;
 An online portal that will provide easily accessible and accurate information,
which was launched earlier this week (launched on 20th October).
 A new national social marketing campaign, which was launched earlier this
week (launched on 20th October). The campaign will provide information on
how and where people can get information.
In 2014 the National Office for Suicide Prevention will;
 Provide training for over 10,000 people in ASIST and safeTALK, two
internationally recognised suicide prevention training programmes, which are
offered free of charge nationwide It is estimated that approximately 22,000
people in Ireland have received safeTALK training and almost 30,000 people
have received ASIST training since the NOSP began funding the training
programme in 2004. Allowing for some people having attended both training
programmes, it is estimated that 1 in every 100 Irish adults has received
suicide prevention training, through ASIST and SafeTALK, which is offered free
of charge
 Provide funding of over €6million to statutory services and over 30 NGOs, to
carry out a wide array of work in communities across the country focusing on
promoting positive mental health and reducing suicide and self-harm
 Increase from 10 to 16 the number of Suicide Prevention Resource Officers
around the country
Roll-Out of the Suicide Crisis Assessment Nurse (SCAN) Model The Suicide Crisis Assessment Nursing Service (SCAN) provides a skilled mental
health nursing service to Primary Care that will;
 Be available, accessible and speedy in providing a response to GP requests for
a timely assessment of those in suicide/self harm distress
 Carry out a comprehensive (bio-psycho-social) needs and risk assessment of
the client within the GP surgery
34

Work collaboratively in partnership with the GP (and the wider specialist mental
and local community services, as appropriate) to institute a health/social care
plan to meet the risk and care needs of the client
Initially piloted by the National Office for Suicide Prevention in, South Dublin Cluain
Mhuire Mental Health Services, and Wexford Mental Health services the service is
currently under development in the following Areas and will be operational by the end
of 2014.
1.
2.
3.
4.
5.
6.
7.
8.
Wexford Mental Health Services (operational)
Waterford Mental Health Services (recruitment process complete)
Donegal Mental Health Services (recruitment process complete)
Sligo/Leitrim Mental Health Services (recruitment process complete)
Dublin North Mental Health Services (recruitment process complete)
Dublin South Central Mental Health Services (recruitment process complete)
Cork North Lee Mental Health Services (post accepted processing clearances)
Galway/Roscommon Mental Health Services (post accepted processing
clearances)
9. Laois/Offaly Mental Health Services (recruitment process complete)
Question 25 (Deputy Caoimhghín Ó Caoláin)
If the minister for Health will clarify his position regarding;
· Universal Health Insurance.
· Free GP care for under sixes; over 70s and its roll out to the entire population.
· Medical Card entitlement on medical grounds.
· Restoration of cuts in services.
· Restoration of cuts in staffing levels.
· Supplementary budgets.
· Budgetary provision 2015.
And if he will make a statement on what advances in healthcare provision he intends
delivering within the remainder of this Government’s term of office.
Response:
Universal Health Insurance
I am committed to a major agenda of health reform, in line with the commitments
contained in the Programme for Government and our policy statement, Future Health.
I want to push ahead as soon as possible with key reforms in areas such as extending
GP care without fees on a phased basis, improving the management of chronic
diseases, implementing key financial reforms including Money Follows the Patient, and
establishing hospital groups as a critical enabler of improving patient quality and
efficiency. These are big milestones on the road to universal health care
When I became Minister for Health I reviewed our progress to date and the timescales
for implementing very important reforms, including Universal Health Insurance, based
on universal entitlement to a single-tier health service that is based on need, not
income.
35
While I believe that it will not be possible to introduce a full UHI system by 2019, as
envisaged in the White Paper, I want to emphasise my commitment to implementing
these reforms.
In order to do this I want to examine some key elements further and then to decide
on the best way forward, but this is a refocusing of our reforms, not an abandonment
of them.
In relation to UHI my Department initiated a consultation process on the White Paper
following its publication. I recently received the report of the independent thematic
analysis of the 137 submissions received. The report notes that a substantial body of
opinion is represented in the submissions and a wide range of themes covered. It
provides much food for thought that will be useful in further developing policy in this
area. I intend to publish this report on the Department’s website.
My Department has also initiated a major costing exercise to estimate the cost of UHI
for households, employers and the Exchequer and is working closely with the ESRI
and the Health Insurance Authority. Initial costings should be available by the end of
the first quarter of 2015.
The independent thematic analysis of submissions from the consultation process on
the White Paper and the results of the major costing exercise on UHI will assist in
charting a clear course towards the objective of a universal, single-tier health service.
Free GP care for under sixes; over 70s and its roll out to the entire
population
The Government having considered this matter, announced, in Budget 2014, its
decision to commence the roll-out of a universal GP service for the entire population
by initially providing all children under 6 years with access to a GP service without
fees.
The Health (General Practitioner Service) Act 2014, which provides an entitlement for
all children aged under 6 years to a GP service without fees, was passed by the
Oireachtas in July 2014. This measure which will provide a GP service to
approximately 240,000 children that must currently pay to see a GP. The service will
be made available without any user fees or charges, nominal or otherwise.
The Government has decided to prioritise the over 70’s in the second phase of the
roll-out of universal GP care. The Government approved the drafting of a Bill to
provide a GP service without fees for all persons aged 70 years and over. It is
anticipated that the Bill will be published shortly.
The objective is to have the first two phases of universal GP care in place in the
coming months, subject to the conclusion of the present discussions between the
Department of Health, the HSE and the IMO and the completion of a fee-setting
process.
The Government, in the recent Statement of Government Priorities, has reiterated its
commitment to the introduction of a universal GP service for the entire population in
36
line with the Programme for Government. This policy constitutes a fundamental
element in the Government’s health reform programme.
Medical Card entitlement on medical grounds.
New Policy Framework
Earlier in the year, it was agreed that the Minister for Health would revert to
Government with options for providing eligibility for a range of health services on the
basis of specific and defined medical conditions. The Government has not specified
that a person with a medical condition should qualify for a medical card per se.
Instead, it agreed that it will take into consideration the recommendations on the
specific services that would be of best benefit for a certain condition. The Government
also agreed that the options would be developed in consultation with the Office of the
Attorney General and the Department of Public Expenditure and Reform.
To support this process, the Director-General of the HSE established an Expert Panel
to examine and recommend the range of medical conditions that should be
considered as a basis of eligibility. The Expert Panel was chaired by Prof Frank
Keane, Past President of the Royal College of Surgeons Ireland and Clinical Lead,
National Clinical Programme for Surgery. The panel included a range of 23 clinical
experts from primary care, specialist services and therapies. It also included a patient
representative. The work of the Expert Panel was also informed by on-line public
consultation and the convening of a patient representative forum to consider the
issues.
The Report was received by the Department of Health earlier this month. This is a
detailed report and the Minister for Health is now considering the report in full. When
he has considered the report, discussed it with the HSE and consulted as necessary
with the Minister for Public Expenditure and the Attorney General, the Minister will
revert to Government on the matter.
In that context, the HSE suspended further reviews of medical and GP visit cards
where discretion had been exercised to take account of medical circumstances,
pending the outcome of this process and eligibility has been extended. In addition,
over 11,000 medical cards or GP visit cards were re-issued to persons, with a serious
medical condition, who had the renewal of their discretionary card refused by the
HSE, having completed an eligibility review during the period from 1 July 2011 to 31
May 2014.
Restoration of cuts in services/ Supplementary budgets/ Budgetary
provision 2015
Over the past number of years, the health service has been operating within
challenging resource constraints as a direct consequence of the emergency financial
situation which the Government has had to address during its period in office.
These challenges come at a time when the demand for health services is increasing
year on year, which in turn, is driving costs upwards. However, despite these
resource reductions and increasing service demands, the HSE has managed to
37
support a growing demand for its services arising from such factors as population
growth, increased levels of chronic disease, the ageing of the population, increased
demand for prescription drugs and new cost intensive medical technologies and
treatment.
2014 has been a particularly challenging year for the health service and, in order to
ensure the continued delivery of the broadest possible range of health services to the
public, I have already signalled that additional funding of over €500m will be required
by way of a Supplementary Estimate. However, the detail of the Supplementary
Estimate has yet to be finalised.
The Deputy will also be aware that the Government in Budget 2015 has already
signalled increased Exchequer funding of €305 million for the health service next
year, bringing the Exchequer contribution to €13,079 billion. Additional once-off
revenue measures of €330 million will also be available to support services. This
means that there will be an increase of €635 million in current spending for the health
services compared to the start of 2014. The total capital budget for 2015 will be a
further €382 million.
Restoration of cuts in staffing levels
The end of the public service recruitment moratorium was announced in the Budget
and this will allow the HSE to reduce their reliance on agency staff by hiring more
frontline staff on fixed term contracts. This measure will lead to pay savings due to
the increased costs associated with hiring agency staff and will also enhance the
quality of care available to patients and clients through improved continuity of care.
As I said on my appointment, for the remainder of this Government’s term of Office I
will concentrate on achieving a small number of realistic goals while laying the ground
work for further Health reform.
Firstly, I want to achieve a realistic budget for the Department. That will allow for the
maintenance of the existing level of services and for some improvements.
After securing a budget, I will focus on introducing universal GP care without fees.
The legislation to extend it to under 6s is in place and the legislation to extend it to
the over 70s should be in place by the end of the year.
I also want to continue the work of my predecessor Minister Reilly in further
developing and building the Hospital Groups by putting in place Boards, CEOs and
Senior Management Teams and the developments of strategic plans.
I also want to take an active role in promoting healthy living. Changes in lifestyle can
prevent many diseases such as diabetes, heart disease and lung disease.
Other
1.
2.
3.
4.
5.
6.
priorities for the remainder of the Government term include the following:
Stabilise cost of health insurance
Reduce cost of medicines
Retaining doctors and nurses
Five Major Capital Projects
Delayed Discharges
Universal Patient Registration.
38
Question 26 (Deputy Catherine Byrne)
To ask the Minister for Health to provide in tabular form the number of speech and
language therapists, whole time equivalent posts in children’s disability services, as
opposed to the Health Service Executive as a whole, and to clarify if these posts are
currently occupied.
Response:
The HSE staff Census reports on staffing based on the grade, division/ care group and
location and not on the basis of patient/ client served, so the information set out
below relates to staffing for both children and adults.
However in relation to services for children in particular children with a disability
these will be provided through the Primary Care and Disability Care Groups.
Details in relation to the number of speech and language therapists employed by the
Health Service Executive in Disability Services and Primary Care are as set out in the
following table:
Speech & language Therapy Staffing: December 2013 to August 2014
Care Group
WTE
Dec
2013
WTE
Aug
2014
Primary Care &
629
642
Disabilities
source: Health Service Personnel Census
WTE change since
Dec 2013
% change since Dec
2013
+13
+2.06%
In the context of the Service Plan 2014 additional posts have been provided as set
out below and as these posts have only been implemented during the course of the
year they have not be fully reflected in the figures above.
In 2013, additional funding of €20m was provided to strengthen primary care
services. This comprised over €18.5m for the recruitment of over 260 primary care
team posts and over €1.4m to support community intervention team development.
The roll out of the Progressing Disability Services for Children and Young People (018s) Programme will entail targeted investment of €4m and the provision of 80
additional therapy staff, including 30 Speech and Language Therapists, to increase
services for children with all disabilities including autism. Local Health Areas have
received primary notification in respect of approved and funded service developments
as provided for in the National Service Plan 2014. The filling of these posts is not
impacted by the Government Moratorium on recruitment and has commenced. This
measure will have a positive impact on the provision of clinical services for all children
requiring access to health related supports.
39
Question 27 (Deputy Catherine Byrne)
To ask the Minister if he will examine the situation surrounding senior citizens who
have lost their medical card and cannot avail of vital public health services
(particularly home visits by the public health nurse) while they are awaiting a decision
on their appeal/review. This is having a particularly negative impact on senior citizens
who are ill but are being cared for at home.
Response:
The HSE provides access to local health services including Public Health nursing
support on the basis of medical need and according to the resources available to local
areas for the provision of these services. Accordingly, a Medical card is not a
necessary prerequisite for access to such services in most areas.
Nursing and therapy services provided via Community Rehabilitation Teams/Units,
Hospital in the Home Initiatives, Community Intervention Teams, leg ulcer clinics,
elderly care liaison roles, Early Intervention Teams etc, are accessed by reference to
clinical need rather than exclusive reliance on a persons category of eligibility in the
majority of cases.
It should also be noted that 81.8% of those in the 70‐74 age category have a Medical
Card or GP Visit Card and 99.2% of those aged over 75 years have a Medical Card or
GP Visit Card.
Question 28 (Deputy Catherine Byrne)
To ask the Minister if, in light of the recent debate concerning the suitability of the
site for the new National Children's Hospital at St James' Hospital, he will reiterate the
primary reasons for selecting this site, and if his Department is committed to
proceeding with the construction of the hospital at this site?
Response:
In November 2012 the Government announced its decision that the new children’s
hospital will be co-located with St James’s on its campus, ensuring it benefits from
the broadest possible range of adult sub-specialty expertise and research capability.
The intention is ultimately to tri-locate adult, paediatric and maternity services on the
campus. Satellite centres, which will share governance and staffing with the new
children's hospital, will be built on the campuses of Tallaght and Connolly Hospitals.
The Government's decision was based on the over-riding priority of best clinical
outcomes for our children. Tri-location of adult, paediatric and maternity services
brings benefits for children, adolescents, newborns and mothers. In all cases, the
benefits of tri-location are maximised where the adult hospital provides the broadest
possible range of clinical sub-specialties and expertise, readily accessible for
paediatric and maternity patients on the shared campus. In addition, tri-location that
delivers the most significant depth and breadth of clinical and academic research on
site will enhance the potential of research to drive best clinical outcomes. St James's
Hospital is considered the best adult co-location partner for the new children's
hospital, having the broadest range of national specialties of all acute adult hospitals,
as well as strong and well established research and education infrastructure.
40
The National Paediatric Hospital Development Board is the body responsible for
planning, designing, building and equipping the hospital and has been actively
progressing the project on the new site. The Project Brief for the hospital on the St
James's campus has been agreed, a decant strategy for the site is in place and a
design team has been appointed. Design development has begun with the aim of
making a planning submission in June 2015.
Question 29 (Deputy Billy Kelleher)
To ask the Minister for Health to detail in tabular format for each local health office
the number of children currently awaiting an initial assessment for speech and
language therapy for the following waiting times; 0-4 months; 4-8 months; 8-12
months; 12-18 months; 18-24 months; more than 24 months and the same details
for the open waiting list.
Response:
Please note that data on speech and language therapy is broken down by waiting
time only. The numbers on the waiting list are not currently collected by age
category in these disciplines. Details for all patients is as follows:
Total Numbers waiting first assessment for Speech & Language Therapy by wait band – August
2014
Number Waiting for
Assessment - SLT
No waiting
less than 4
months
No waiting
4 -8 months
No waiting
8 -12 months
No waiting
12-18
months
No waiting
Over 18
months
Dun Laoghaire
Dublin South East
Wicklow
Dublin South City
Dublin South West
Dublin West
Kildare West Wicklow
Laois Offaly
Longford Westmeath
DML
Louth
Cavan Monaghan
Meath
Dublin North West
Dublin North Central
Dublin North
DNE
North Lee
South Lee
North Cork
West Cork
68
70
168
111
316
346
555
311
272
2217
282
267
436
369
221
432
2007
377
283
128
78
6
0
69
22
235
187
448
89
119
1175
31
16
140
390
36
126
739
20
35
13
0
4
0
6
0
265
14
271
60
34
654
0
2
4
186
9
0
201
12
24
1
0
5
0
0
0
0
36
4
18
0
63
0
4
0
103
4
0
111
10
19
5
0
0
0
0
0
0
0
0
6
0
6
0
0
0
5
2
0
7
25
53
1
0
41
Number Waiting for
Assessment - SLT
No waiting
less than 4
months
No waiting
4 -8 months
No waiting
8 -12 months
No waiting
12-18
months
No waiting
Over 18
months
Kerry
South Tipperary
Carlow Kilkenny
Waterford
Wexford
SOUTH:
Limerick
Clare
North Tipperary East
Limerick
Galway
Mayo
Roscommon
Donegal
Sligo Leitrim
WEST:
TOTAL:
273
213
177
200
241
1970
342
228
246
1
14
142
1
107
333
16
1
44
0
0
34
0
8
79
5
0
6
0
0
11
0
0
45
3
0
19
12
0
3
0
0
94
0
0
0
425
263
84
319
49
1956
8150
29
0
0
0
0
90
2337
8
0
0
0
0
19
953
5
0
0
0
0
27
246
19
0
0
0
0
19
126
The National Service Plan 2013 provided additional funding of €18.52m for Primary
Care Team posts. The funding was allocated for core primary care posts which
provided for the recruitment of an additional 264.5 posts to support Primary Care
Teams. These were in the grades of Public Health Nurses, Registered General Nurses,
Occupational Therapists, Physiotherapists and Speech and Language Therapists. A
total of 52 Speech and Language Therapy posts were approved from the additional
allocation and all but 1 SLT posts have been filled.
In addition, the roll out of the Progressing Disability Services for Children and Young
People Programme will entail targeted investment of €4m and the provision of 80
additional therapy staff in 2014, including 30 Speech and Language Therapists, to
increase services for children with all disabilities. Local Health Areas have received
primary notification in respect of these posts, which are not subject to the
Government Employment Moratorium, and recruitment is underway. These measures
will have a positive impact on the provision of clinical services for all children
requiring access to health related supports.
Note that since September 2013, the overall number waiting over 12 months for a
Speech and Language assessment has reduced from 1,940 to 372, a reduction of
80%. The plan over the next 12 months is to bring waiting times down to more
acceptable level i.e. less than six months.
Question 30 (Deputy Billy Kelleher)
To ask the Minister for Health to detail in tabular format the most up to date figures
for the number of positions in each public/voluntary hospital in the following
categories; consultants; non-consultant hospital doctors; nursing positions; other
42
health & social care professionals; management/admin; general support staff; and
the number of vacant positions in each public/voluntary hospital for the same
positions.
Response:
Please see attached excel report with three tabs, providing the data in tabular form as
requested by the Deputy. This is as at the end of August 2014. The first part of the
report sets out the overall position in Acute Hospitals by the six staff categories and
provides the additional information sought in respect of Consultants and NCHDs and
this is turn is given by individual hospital. Also included in this part of the report is a
reference to the portion of the staff category of management/admin in the general
grades of Clerical Officers and Grades IV, the two lowest grades, which constitute
over 75% of the staff category. This has relevance in that these grades in hospitals
are primarily in front-line services and are either front-line staff in such areas as
OPD, ED, Clinics, Diagnostics, receptionists, etc, or direct support to clinicians in their
front-line services. Again this break-down is given by individual hospital. The second
tab shows the overall employment levels for Acute Hospitals broken down by grade
groups across the six main staff categories and the third tab shows employment
levels at individual hospital level of the Nurse Graduate Programme and Support Staff
Intern Scheme. Staffs in both these latter schemes are not included in the main
employment data in the first two tabs.
The staffing environment within the health services is dynamic and is subject to
reducing numbers in line with government policy. The general moratorium on
recruitment and promotions continues to be in place in the health sector to support
the reduction of public sector numbers and costs and as such the moratorium
precludes vacancies per se. Thus the vacating of a position does not in itself create a
vacancy as the work of the position may be covered through redeployment,
restructuring or reallocation. In addition, where a front-line post has been approved
for filling, the duties may be covered by agency or overtime in the meantime. It is
not possible therefore, to give a definitive figure for vacancies and information on
vacant positions is not routinely collected in the manner sought by the Deputy. The
one exception is in approved and funded planned new service developments as
provided for in National Service Plans. At the end of August, in respect of Acute
Hospitals, information at this office would indicates 134 Whole-Time-Equivalents
(WTEs) as vacancies planned/or in process but yet to be filled in respect of new
approved and funded service developments.
Question 31 (Deputy Billy Kelleher)
To ask the Minister for Health to detail in tabular format for September 2013 and
September 2014 for each local health area the number of medical cards in circulation;
the number of which are issued on the basis of the exercise of discretion; and the
number of which are allocated to over 70’s.
43
Response: The information requested is detailed below.
Numbers at 1 Sept 2013
Numbers at 1 Sept 2014
Local Health Office
Medical
Cards
Of which
Discretionary
Over
70s
Medical
Cards
Carlow/ Kilkenny
61,405
1,494
10,636
131
59,510
2,015
10,130
148
Cavan/ Monaghan
59,943
1,048
10,472
51
57,809
1,554
10,152
82
Clare
Cork - North Lee
Cork - South Lee
Donegal
49,923
81,753
63,063
91,013
2,054
4,015
2,353
1,836
9,414
13,617
14,710
14,257
341
308
251
84
46,777
78,876
61,039
88,141
2,377
4,595
2,872
2,601
9,009
13,320
13,669
14,186
300
335
256
158
Dublin North Central
53,136
959
11,891
111
54,552
1,327
10,981
137
Dublin South City
38,355
645
8,876
62
37,273
844
7,901
86
Dublin South East
24,330
507
9,026
59
23,348
668
7,684
95
Dublin South West
68,199
1,782
11,908
111
66,560
2,020
11,348
150
Dublin West
Dun Laoghaire
Galway
Kerry
Kildare/ West
Wicklow
Laois/ Offaly
Limerick
62,150
25,121
104,354
61,303
1,193
566
2,566
2,164
7,595
10,471
19,037
13,219
36
85
75
193
60,740
22,572
99,423
59,949
1,577
687
3,368
2,737
7,311
8,506
18,274
12,749
63
103
124
214
76,794
2,694
11,701
160
74,433
3,252
11,334
209
70,609
80,895
2,825
2,882
11,407
15,403
223
494
68,896
78,286
3,372
3,385
11,073
14,627
233
457
Longford/ Westmeath
57,292
1,392
9,695
91
56,453
1,932
9,294
124
Louth
Mayo
Meath
North Cork
North Dublin
North Tipp./ East
Limerick
61,894
67,218
68,441
36,741
81,503
729
1,439
908
2,289
2,518
9,759
13,151
10,543
7,629
17,332
41
46
41
103
301
60,494
64,123
66,246
34,262
77,379
1,191
2,008
1,540
2,517
3,242
9,462
12,842
10,311
7,302
16,224
66
68
61
133
370
30,973
1,755
6,431
197
29,701
1,868
6,236
197
North West Dublin
70,587
1,222
11,198
90
66,333
1,714
10,309
121
Roscommon
Sligo/ Leitrim
South Tipperary
Waterford
West Cork
Wexford
Wicklow
Total National
30,695
43,384
42,762
58,531
22,110
71,817
46,768
1,863,062
988
1,651
1,770
2,019
1,008
1,428
1,189
53,888
6,403
9,080
8,298
10,695
5,755
12,327
8,479
350,415
58
72
192
200
73
67
68
4,415
29,377
41,899
41,429
55,805
21,058
69,831
45,237
1,797,811
1,200
1,960
2,012
2,440
1,202
2,043
1,452
67,572
6,228
8,738
7,953
10,131
5,493
11,970
8,125
332,872
81
116
160
162
86
97
86
5,078
Of which
Discretionary
Medical
Cards
Of which
Discretionary
Over 70s
Medical
Cards
Of which
Discretionary
44
Question 32 (Senator Marc MacSharry)
To ask the Minister for Health on what basis is the HSE continuing to pay for
the training of clinical psychologists, but not the training of other applied
psychologists or other allied health professionals; does the HSE have records of the
funding mechanisms for clinical psychology programmes; how and by whom are those
mechanisms organised and maintained; how many psychologist posts for which
funding was allocated have gone unfilled each year following recruitment campaigns
since 2009; the number of these unfilled posts that are a consequence of the HSE
choosing to employ only clinical psychologists and refuse other applied psychologists
access to employment; why has the HSE sought to recruit clinical psychology
graduates in the UK, while refusing to employ counselling psychologists who have
already passed HSE interviews and remain on panels; why the HSE has supported
senior psychology managers who develop recruitment criteria that breach of the code
of practice for appointments to positions in the public service and civil service and
why it has continued to back those criteria despite being repeatedly made aware that
they are also in breach of the policy and standards of the Psychological Society of
Ireland?
To ask the Minister for Health on what basis is the HSE continuing to pay for the
training of clinical psychologists, but not the training of other applied psychologists or
other allied health professionals
Response
The HSE provides a psychology service to various care groups and the specialities
recruited are determined by the care group assignment. The funding of clinical
psychology training is based on how the service needs can be best met by a skilled
workforce that can provide services across a range of care groups and at different
levels of presentation from mild to severe. Not all disciplines in psychology afford the
HSE the breadth and depth of training; the level of flexibility for service provision and
who have the broad range of clinical experience in the health services as those who
are trained within the health services. This currently operates in all national
recruitment competitions. The HSE employs counselling, educational and clinical
psychologists and, currently, the requirement in the main is for those with the
relevant qualifications in clinical psychology. The programme of training in place for
clinical psychologists is essential to the securing of such professionals and the
provision of clinical psychology services, as trainees provide clinical psychology
services commensurate with their level of training over the duration of their training
and they commit to working for the HSE for a period after they qualify.
Does the HSE have records of the funding mechanisms for clinical psychology
programmes
How and by whom are those mechanisms organised and maintained;
The current process with regard to the training of clinical psychologists consists of two
elements - the recruitment of trainees to the one of the doctoral programmes and
into a trainee position in the HSE (the WTE and associated salary budget for this is
45
held at local level) and; the HSE contribution of 60% towards the students’ course
fees for the duration of the three year programme.
In an effort to develop a unified approach to all aspects of education and training, in
particular, clinical psychology training, the HSE centralised the payment of psychology
fees 2010. This budget is managed centrally from the Health and Social Care
Professions Unit (HSCP) of the National HR Directorate. The HSE fee portion is paid
directly to the HEI concerned following verification of names and invoice details by
psychology managers. There are four HEIs involved - Trinity College Dublin;
University College Dublin; National University of Ireland, Galway and University of
Limerick.
The first invoices paid under this arrangement were paid in October 2010. These
invoices related to intake 2008 – (Year 3 cohort); intake 2009 – (Year 2 cohort) and
intake 2010 – (Year 1 cohort).
The total course fees (60%) paid to the four colleges, i.e. National University
of Ireland, Galway; University of Limerick, Trinity College, Dublin and University
College Dublin, for the period 2010 to 2013 is €3,482,387.60.
How many psychologist posts for which funding was allocated have gone
unfilled each year following recruitment campaigns since 2009
It should be noted that the non-filling of a post due to insufficient numbers who may
have applied does not necessarily mean that the post remained unfilled as other local
arrangements may have been put in place.
The number of these unfilled posts that are a consequence of the HSE
choosing to employ only clinical psychologists and refuse other applied
psychologists access to employment
The HSE does not have any unfilled posts in other disciplines as the service
requirement is for clinical psychologists.
Why has the HSE sought to recruit clinical psychology graduates in the UK,
while refusing to employ counselling psychologists who have already passed
HSE interviews and remain on panels.
The HSE pursues all avenues available in the recruitment of the most qualified staff to
carry out the role identified. The NRS operates within the guidelines of government
recruitment policy and within E.U. migration of Labour Directives. Assignments from
panels are based on the care group to which the candidate is to be placed and where
appropriate counselling psychologists are assigned to relevant posts from panels. At
all times the central issue is the competence required to deliver the particular
psychology service.
Why the HSE has supported senior psychology managers who develop
recruitment criteria that breach of the code of practice for appointments to
positions in the public service and civil service and why it has continued to
back those criteria despite being repeatedly made aware that they are also
in breach of the policy and standards of the Psychological Society of Ireland
46
The CPSA has not found the HSE to be in breach of the standards. It accepts that the
HSE is entitled to define the requirements for employment.
The HSE is satisfied that its recruitment procedures and the criteria employed for the
recruitment of psychology personnel meet the standards outlined by the CPSA. The
CPSA have recently affirmed the HSE practices in this regard and have further stated
that they recognise that HSE Psychology Managers are best placed to determine such
criteria.
Regarding the Psychology Society of Ireland the HSE or its Psychology Managers are
not aware of any standards that have been endorsed by the membership of the PSI
regarding the employment of professionally trained psychologists. The Psychological
Society of Ireland does not have a statutory function regarding the registration of
psychologists.
In relation to promotion it was agreed that relevant experience would be taken into
consideration when making decisions on applications from both clinical and
counselling psychologists.
It should be noted that in the context of significant organisational change and realignment, the National Director for HR has requested a review of the selection
criteria for posts within the Psychology Services. This is to ensure the current and
future delivery of quality Psychology Services to the Irish Public which is efficient and
effective. This review is due to commence in November 2014 and will be conducted in
the context of government policy, models of care and patient safety and the
assignment of staff based on a fit between their professional qualifications and the
requirements of the role.
Question 33 (Senator Marc MacSharry)
To ask the Minister for Health to detail in tabular format for each ambulance station in
the month of August the percentage of Clinical Status 1 ECHO incidents responded to
by a patient-carrying vehicle in 18 minutes and 59 seconds or less; the percentage of
Clinical Status 1 DELTA incidents responded to by a patient-carrying vehicle in 18
minutes and 59 seconds or less; to detail in tabular format the number of ambulance
attendances at each emergency department nationwide in August 2014; the number
of such ambulances that waited longer than of 20 minutes to hand over patients, get
their trolleys back and return to responding to calls; the number that waited longer
than 40 minutes for same; the - number that waited longer than 60 minutes for
same; the number that waited longer than 90 minutes for same; the number that
waited more than 120 minutes for same; and the number that waited more than 180
minutes for same.
Response:
Ambulance activity
It is important to note from the outset that response time reporting is one
month in arrears
The primary role of the ambulance service is to deliver a responsive emergency
service to the public in pre-hospital emergency care situations with patient care at the
heart of the service. Care begins immediately at the time the call is received right
47
through to the safe transportation and handover of the patient to the receiving
hospital.
Every year the National Ambulance Service receives between 275,000 and 280,000
emergency calls which amount to approximately 23,000 emergency calls each month.
During 2013 the NAS experienced a rise of approximately 1,000 emergency calls each
month over the year. Analysis of the overall data for 2013 indicates that there was
an increase of about 10% in all emergency calls.
The data for the first 7 months of 2014 shows a further increase of 4% in emergency
calls compared to the same period last year. Despite this increase the proportion of
calls responded to within the target time of 18 minutes and 59 seconds has improved
significantly.
In relation to ECHO calls, the percentage of these calls responded to within the target
timeframe for the first 7 months of 2014 is 75.3%. This compares to 70.5% for the
first seven months of 2013 which represents a significant improvement.
In relation to DELTA calls, there has been a 10% increase in the volume of calls for
the first seven months of 2014 compared to 2013. This amounts to an additional
5,022 calls. There has been a significant improvement in the proportion of these calls
responded to within the target timeframe of 18 minutes and 59 seconds, particularly
in the context of this increased call volume. At the end of July 2014 the percentage
of DELTA calls responded to within 18 minutes and 59 seconds was 64%. Had the
call volume remained steady the percentage responding within the target time would
have improved significantly.
The ability to improve on our response times has been enabled through the increased
use of Intermediate Care Vehicles. The Intermediate Care Service was set up to
provide a safe and timely transfer for non emergency patients when transferring
between hospitals within the healthcare system or moving to step down facilities in
the community. In July, 77% of all inter hospital patient transfers (AS3) were handled
by Intermediate Care Vehicles. This has grown from 44% in December 2013. Over
3,000 calls per month are now carried out by Intermediate Care Vehicles.
EMERGENCY CALL VOLUME AND RESPONSE TIMES
NAS Activity
National
North
Leinster
DFB
South
West
July
YTD
2014
Call Volume
Total AS1 and AS2 (Emergency) calls
7,964
6,059
5,322
5,076
24,421
169,021
Total Clinical Status 1 ECHO calls
64
80
45
55
244
1,798
Total Clinical Status 1 DELTA calls
2,153
2,567
1,529
1,474
7,723
54,286
Response times are for patient carrying vehicles. Paramedics may arrive on the scene and commence
treatment in advance of the arrival of an ambulance which is capable of carrying the patient to hospital.
48
NAS Activity
National
North
Leinster
DFB
South
West
July
YTD
2014
Response Times
% of Clinical Status 1 ECHO incidents
responded to by a patient-carrying vehicle in 18
71.9%
88.8%
71.1%
60.0%
74.6%
75.3%
73.8%
66.7%
67.8%
56.6%
67.0%
64.0%
minutes and 59 seconds or less
% of Clinical Status 1 DELTA incidents
responded to by a patient-carrying vehicle in 18
minutes and 59 seconds or less
Ambulance Turnaround Times
The NAS continuously monitor the turnaround times at hospitals on a national and
local basis i.e. ambulance arrival time through clinical handover in the Emergency
Department or specialist unit to when the ambulance crews declares readiness of the
ambulance to accept another call.
In August 64% of vehicles were released and had their crews and vehicles available
to respond to further calls within 30 minutes or less. 93% of calls had crews and
vehicles clear and available within 60 minutes.
At times of pressure in the emergency care system, there is the potential for delay in
the transfer of care of patients from ambulance resources to acute hospital
Emergency Departments. A national framework document was developed to clarify
the process of clinical handover to establish clear lines of responsibilities and the
standards expected. This document sets out the escalation process to be used by NAS
to alert the required levels of management both within NAS and the wider healthcare
system and delays in the release of ambulance resources. The Framework document
is currently being reviewed and a joint working group has been established between
the National Ambulance Service and Acute Hospitals to see how this can be improved.
A number of pilot projects are underway in this regard.
Ambulance turnaround data is currently manually aggregated across multiple
Computer Aided Dispatch (CAD) systems. The accuracy of this data can be adversely
affected by failure to activate timestamps within the CAD when arriving and clearing
the ambulance at the hospital.
The National Ambulance Service is developing a more robust solution to this data
requirement through the implementation of a new single national CAD system which
is part of the NAS Control Centre Reconfiguration Programme. The new CAD system
has been successful procured and will take approximately 9 months to implement.
The HSE signed the contract with the successful bidder on 5th August 2014. The new
single CAD system will significantly enhance the NAS ability to dynamically deploy
ambulance resources and improve response times and services to patients which is a
key priority for the National Ambulance Service.
49
Question 34 (Senator Marc MacSharry)
To ask the Minister for Health with regard to the €20 million allocated for mental
health posts in Budget 2014 the number of posts that this is intended to support in
each local health area and the number of these posts that have been filled in each
local health area.
Response:
The €20m funding allocated in 2014 will provide for in excess of 250 posts in mental
health services. The current notified posts by ISA and speciality are indicated in the
table below and the remaining posts will be notified in the coming weeks, specifically
a further 25 posts relating to CAMHS services and national and area based service
improvement and quality & patient safety posts.
National Service Plan 2014 indicated that new spend related to this funding would
need to be phased in order to live within the overall available resource, with posts
targeted to be in place by the end of 2014. The near 200 posts in the table above
have been notified to Areas and the initial recruitment processes are underway. It is
expected that although some of the posts may be recruited during this last quarter
2014 from panels in current operation, that the majority of the posts will be recruited
in early 2015, requiring additional targeted campaigns etc.
The delay in allocation of the posts and therefore, recruitment processes not having
started sooner in 2014, has related solely to a more detailed allocation process taking
place based on a review by the Mental Health Division of the current level of staffing
and resources across all Areas and specialties in order to identify the current gaps in
services and inform decisions on allocation of these new posts. The emerging data
and analysis will continue to support the on-going decision making process regarding
resource allocation and utilisation.
50
Question 35 (Deputy Robert Troy)
To ask the Minister for Health to detail in tabular format on the basis of each local
health areas the number of home help hours provided in 2010; 2011; 2012; 2013
and to date in 2014; and to detail in tabular format on the basis of local health area
the number of people on the waiting list for the Fair Deal in September 2013 and the
number for September 2014.
Response:
Home Help Service
The home help service is a highly valued core community service supporting large
numbers (47,000 people in receipt of home help in August 2014 up from 41,400 in
January 2006) of mainly older people to remain in their own homes, preventing
admission to acute services, delaying or preventing admission to continuing
residential care and facilitating early discharge from the acute sector to the
community. The demand for the home help services and for additional supports
through the Home Care Package Scheme continues to grow as the population of older
people expands and as many more of older people with complex care needs are
maintained at home.
The capacity of the HSE to provide approved target levels of home help services is
reviewed in the context of overall resources available to the HSE. As with every
service there is not a limitless resource available for the provision of Home Help and
Home Care Packages and while the resources available are substantial, they are
finite. Accordingly the level of home help service to be provided in any year, and as
set out in the Service Plan, is determined in this context. Local Health Managers must
ensure that Home Help services & Home Care Packages are delivered within the
allocated budgets and targets set out in the Service Plan. This requires a stringent ongoing review of the application of the resources.
Levels of services provided by the Home Help Service to individual clients are
therefore reviewed regularly to ensure that they continue to support the clients
assessed care needs and as a result of such reviews the level of service to the
individual case may increase, decrease or may remain the same based on the
assessed need of the individual. Professional staff on the front line who are aware of
local circumstances as well as undertaking the initial needs assessment also
undertake care needs reviews so as to ensure that services are targeted at those
clients with a high level of dependency and in accordance with their assessed need.
Personal care and essential household duties are prioritised over the lesser priority
area of non-essential household duties.
Home Help Service funding of approximately €185m will provide for 10.3m home help
hours in 2014 i.e. the same level of service/funding that was provided for in 2013 and
2012. Data (to the end of August 2014) confirms that the actual level of home help
hours provided is on target for 2014.
The Home Care Package Scheme which provides for a range of services including
primary care services such as nursing and therapies, enhanced home care hours,
respite care etc. for more dependent older people, commenced nationally in 2006. In
the period 2007 to 2011 the allocation was increased year on year (from €55m in
2006) as the scheme was rolled out. The budget available for the scheme in 2014 is
51
€130m i.e. the same level of funding as applied in 2013 and 2012. The number of
clients availing of a HCP at any time has increased from 8,035 in 2007 to 13,057 at
end of August 2014.
Table 1 below sets out the number of home help hours provided in each of
the years 2010, 2011, 2012, 2013 and 2014 to date by Region. Data for each
LHO is set out in Table 1a.
Table 2 sets out the numbers of people in receipt of a Home Care Package in
each Region on 31st December in each of the years 2010- 2013 and on 31st
August 2014.
Table 1: Home Help Hours
Home Help
Hours
excluding
Home Care
Package
Hours
Dublin Mid
Leinster
Dublin
North East
2010
2011
2012
2,063,683
2,006,675
1,801,574
2,423,689
2,034,416
1,585,376
HSE South
3,860,460
3,777,730
3,375,651
HSE West
HSE
National
3,332,684
11,680,5
16
3,273,616
11,092,4
36
3,125,126
9,887,72
7*
2013
To 31st
August
2014
1,661,54
5
1,891,90
2
3,219,80
3
2,963,36
0
9,736,6
10
1,098,10
9
1,331,44
6
2,379,05
6
2,072,48
5
6,881,0
96
2014
Projecte
d Total
1,647,164
1,997,169
3,568,583
3,108,728
10,321,6
44
Table 2: Home Care Packages – Number of people in receipt of a HCP
Dublin Mid
Leinster
Dublin North
East
HSE South
HSE West
HSE National
2010
2011
2012
2013
31st
August
2014
2,297
2,594
2,637
3,266
3,586
3,087
2,424
2,133
9,941
3,652
2,424
2,298
10,968
3,829
2,307
2,250
11,023
4,299
2,088
2,220
11,873
4,770
2,222
2,479
13,057
52
Nursing Home Support Scheme
Clients on National Placement List for NHSS Funding
Dublin South, Kildare
& Wicklow
Laois / Offaly
Longford /
Westmeath
Dublin Mid-Leinster
Cavan / Monaghan
Meath
Louth
Dublin North
Dublin North East
Cork & Kerry
Carlow / Kilkenny
South Tipperary
Waterford
Wexford
South
Donegal
Sligo / Leitrim
Roscommon
Mayo
Galway
Limerick, Clare &
North Tipperary/
East Limerick
West
National Total
30/09/2014
30/09/2013
Total by Office
Total by Office
457
68
118
70
57
582
83
52
49
224
408
337
43
50
62
48
540
64
72
28
71
85
58
150
85
53
50
230
104
346
44
51
64
49
138
66
74
29
73
87
190
510
50
131
2040
523
The HSE is provided with a set level of funding for the Nursing Homes Support
Scheme each year. While it is hoped that there would be sufficient funding to support
all applicants who require long term residential care services as defined in the Nursing
Homes Support Scheme Act 2009 and who have been deemed eligible for financial
support under the scheme, there are situations where a person’s name must go onto
a national placement list until funding becomes available. People are placed on the list
as at the date that the HSE makes a determination of their application. As resources
become available which is based on agreed budgetary profiles, financial support is
offered to applicants on a chronological order basis from the national placement
list.
53
Funding for the scheme in 2014 is €938.7m (€974.3m - 2013, a reduction of €35.6m)
which is to support 22,061 people by year end. The HSE’s 2014 National Service Plan
sets out that there are increased options available in the current year to support older
people to remain at home and as a result, wait times for long term residential care
would increase in 2014.
In August 2014, the scheme provided financial support for 22,038 people in long term
residential places.
It should be noted that the scheme continues to take on new clients within the limits
of the resources available, in accordance with the legislation. In the first eight months
of 2014, 3,928 new clients were funded under the scheme.
Delays in getting a place in a nursing home may occur for a number of reasons
including - the person cannot source a suitable nursing home place, the person may
require other health services prior to going into long term residential care or the
person is on the scheme's national placement list awaiting release of funding under
the scheme. The length of time an applicant remains on the placement list depends
on the number of new applications awaiting approval for the scheme at any given
time and the number of applicants currently receiving payment under the Scheme.
Therefore, the duration of the national placement list fluctuates over time.
The number of people on the National Placement List as at the end of 15th October
2014 was 2,182 people, with a wait time of 15/16 weeks weeks. The position as at
the end of September 2013 was a total of 523 people on the national placement list
with a wait time of 4 weeks. The length of time an applicant remains on the
placement list depends on the number of new applicants awaiting approval for the
scheme at any given time and the number of applicants currently receiving payment
under the Scheme. Therefore, the duration of the placement list fluctuates over time.
Table 1a:
Number of home help hours provided in each of the years
2010, 2011, 2012, 2013 and 2014 to date
Home Help
Hours
(excluding
Home Care
Package Hours)
Dun Laoghaire
Dublin South East
Wicklow
Dublin South City
Dublin South
West
Dublin West
Kildare/West
Wicklow
Laois/Offaly
Longford/Westme
ath
2010
2011
2012
2013
Year to
date August
2014
Projected
Year end
position
2014
112,726
110,358
269,860
154,109
85,992
104,179
250,041
144,883
85,519
114,403
225,148
150,265
79,216
118,135
207,016
121,864
54,069
72,509
142,777
74,803
81,104
108,764
214,166
112,205
193,843
286,660
184,672
259,881
171,293
232,302
158,967
226,672
97,866
138,865
146,799
208,298
363,346
286,148
359,328
286,779
289,159
242,770
280,693
224,061
175,551
180,612
263,327
270,918
286,632
330,922
290,715
244,921
161,057
241,586
54
Home Help
Hours
(excluding
Home Care
Package Hours)
Louth
Cavan/Monaghan
Meath (2010 incl
HCP Hrs)
Dublin North
West
Dublin North
Central
Dublin North
North Lee
South Lee
North Cork
West Cork
Kerry
Sth Tipperary
Carlow/Kilkenny
Waterford
Wexford
Limerick
Clare
Nth Tipperary
Galway
Mayo
Roscommon
Donegal
Sligo/Leitrim
2010
2011
2012
2013
Year to
date August
2014
Projected
Year end
position
2014
263,038
548,094
205,779
435,744
169,069
347,988
184,069
318,534
143,210
226,129
214,815
339,194
463,634
335,454
375,355
396,302
279,790
419,685
148,027
169,096
151,953
254,691
165,073
247,610
580,477
420,421
515,952
461,298
426,611
272,394
765,800
436,026
374,811
221,046
386,522
524,671
181,529
310,489
629,019
408,789
230,387
607,617
440,183
11,680,5
16
536,432
351,911
456,240
442,792
435,944
274,080
747,006
403,398
352,130
313,313
352,827
390,782
178,319
323,739
674,363
407,066
241,947
638,847
418,552
11,092,4
36
311,054
229,957
444,414
457,470
410,712
249,888
548,718
303,698
289,278
310,826
360,647
380,455
168,342
320,429
620,811
379,895
218,132
624,554
412,508
9,887,72
7
375,356
362,950
414,190
416,234
384,220
299,554
525,116
285,704
310,122
230,925
353,738
364,542
186,194
308,839
605,032
338,206
217,129
569,581
373,837
9,736,6
10
237,380
279,864
319,858
320,072
286,221
235,331
394,871
197,446
206,976
171,778
246,503
260,956
126,359
206,158
435,038
228,418
151,672
397,561
266,323
6,881,0
96
356,070
419,796
479,787
480,108
429,332
352,997
592,307
296,169
310,464
257,667
369,755
391,434
189,539
309,237
652,557
342,627
227,508
596,342
399,485
10,321,6
44
Total
Total
Total
2,063,683
2,006,675
1,801,574
Dublin North East
2,423,689
2,034,416
1,585,376
HSE South
3,860,460
3,777,730
3,375,651
HSE West
3,332,684
11,680,5
16
3,273,616
11,092,4
36
3,125,126
9,887,72
7*
Total
1,661,54
5
1,891,90
2
3,219,80
3
2,963,36
0
9,736,6
10
Total
1,098,10
9
1,331,44
6
2,379,05
6
2,072,48
5
6,881,0
96
Home Help
Hours
excluding Home
Care Package
Hours
Dublin Mid
Leinster
HSE National

Projected
Total
1,647,164
1,997,169
3,568,583
3,108,728
10,321,6
44
The capacity of the HSE to provide approved levels of home help services is
reviewed in the context of overall resources available to the HSE. Accordingly
for 2012 the level of home help service to be provided, and as set out in the
Service Plan, was revised to 10.7m hours which was a reduction of 3.5% when
55
compared with 2011 final outturn. The target was further revised in relation to
a technical adjustment for the DNE area resulting in a final 2012 target of
10.3m hours. The target of 10.3m hours applied in 2013 & applies in 2014.
Question 36 (Deputy Eamonn Maloney)
To ask the Minister for Health to outline the time-frame for the construction of the
Urgent Care Centre to be located at Tallaght Hospital Dublin 24.
Response:
Following the decision to locate the new children’s hospital at the St. James’s Hospital
campus it was necessary to review plans to locate an Ambulatory and Urgent Care
Centre at Tallaght, which had been predicated on locating the new children’s hospital
at the Mater campus. In January 2014, the Minister for Health announced that
following this review, two satellite centres will be developed at Tallaght and Connolly
Hospitals.
The satellite centres will be an integral part of, and come under the governance of,
the new children’s hospital. The centres will provide services and environments of the
same quality as those delivered in the new children’s hospital and staff working in the
satellite centres will rotate through the main hospital.
The satellite centres together will provide a significant level of urgent care in the
Greater Dublin Area annually. Each centre will also provide secondary outpatient
services including rapid access general paediatric clinics. All other services will be
provided on the main site at the St James's campus.
The National Paediatric Hospital Development Board is the body responsible for
building the new children’s hospital. Following a rigorous procurement process, the
Board has now appointed the design team for the project and design development
has begun. As part of its brief, the design team has reviewed and validated the
programme. The validated programme sets a target for completion of design
development in June of next year, at which time a planning application will be
submitted. This will include both the main hospital at the St James's campus and the
satellite centres to be built at Tallaght and Connolly Hospitals, which are considered
to be an integral part of the overall project and which will be designed in parallel.
Allowing an appropriate period of time for a planning decision to be made, it is
expected that subject to permission being granted, the project will be on site at all
three locations – the main hospital on the St James’s campus and the satellite centres
at Tallaght and Connolly Hospitals - in January 2016. It is estimated that the satellite
centres on the campuses of Tallaght and Connolly Hospital will be complete and in
service in mid-2017, well in advance of the main hospital.
Question 37 (Deputy Seamus Healy) – (Re South Tipperary General Hospital)
To ask the Minister for Health what steps have been taken to solve the overcrowding
at South Tipperary Hospital Accident & Emergency Department with particular
reference to the following:
56
(i)
(ii)
(iii)
(iv)
(v)
(vi)
Appointment of temporary A&E Consultant
Appointment of permanent A&E Consultant
Appointment of additional A&E Nursing and Support Staff
The relocation of the Medical Assessment Unit closer to the A&E Department
The construction of a Unit to house the CT Scanner
The opening of additional step down beds, as requested by hospital
management and HSE South East Management.
Response:
There has been a sustained improvement in South Tipperary General Hospital trolley
performance for the period June to date. Specifically, the numbers waiting in ED have
reduced dramatically compared with 2013 and at the same time patient experience
time has improved significantly. This is attributed to a number of initiatives that have
been undertaken under the direction of the new hospital manager to support the
elimination of trolleys. Key initiatives include:
 Strong engagement by the multidisciplinary team who have adopted a zero
tolerance approach to trolleys
 Implementation of 7 Day Discharges
 Establishment of a Discharge Lounge
 Weekly GP Rapid Access Clinic
(i&ii) Appointment of second permanent A&E Consultant – Approval has been
conveyed for appointment of a second permanent consultant post. In order to
fill this immediately the post has been advertised on temporary basis with
interviews scheduled for late October 2014, an early commencement date will
be pursued for the successful candidate. Simultaneously, the permanent post is
being progressed through the Consultant Applications Unit.
(iii)
Appointment of additional A&E Nursing and Support Staff – Work is
underway on an ongoing basis to address staffing issues in all departments in
the hospital, given the significant improvement in trolleys there has been
reduced pressure on existing staff in the A&E Department
(iv)
The relocation of the Medical Assessment Unit closer to the A&E
Department – The relocation of the MAU is being considered in the context of
an overall Development Control Plan for the Hospital. In the meantime, as a
result of the review of patient processes and pathways there has been an
increase of throughput through the MAU which has contributed to the
sustained improvements in reducing patient volumes and wait times in the
Emergency Department.
(v)
The construction of a Unit to house the CT scanner – Planning permission
to be lodged by the Estates Department in mid October, pre planning meeting
held.
(vi)
The opening of additional step down beds, as requested by hospital
management and HSE South East Management. – Integrated Discharge
Planning Group established by the Chief Executive Officer of the South/South
57
West Hospital Group, hospital and community stakeholders are members of
this group, next meeting scheduled for mid October 2014. ‘Winter
Preparedness Group’ established in South Tipperary General Hospital, regular
meetings being held in South Tipperary General Hospital, focus of both groups
to ensure appropriate and adequate winter capacity for the patients of South
Tipperary.
As with all capital projects this project must be considered within the overall capital
envelope available to the health service. There will always be more construction
projects than can be funded by the Exchequer. The method and timescale for the
delivery of health care infrastructure is a dynamic process which is constantly
evolving to take account of changing circumstances, including the feasibility of
implementation. There is limited funding available for new projects over the period
2015-2019 given the level of commitments and the costs to completion already in
place. The HSE is concentrating on applying the limited funding available for capital
works in the most effective way possible to meet needs now and in the future.
Question 38 (Deputy Seamus Healy)
To ask the Minister when the 6 vacant Public Health Nurse Posts in South Tipperary
will be filled.
Response:
There are currently 6 PHN vacancies across the South Tipperary area. These
vacancies were brought about by a combination of factors including historic
retirements, promotions within service, and special leave without pay. As with other
HSE areas and services, given the national Public Service Recruitment Moratorium,
there are staffing challenges, particularly in replacing staff that have left the service.
However in order to meet increasing service demands and current staffing challenges
a number of measures have been implemented within South Tipperary Community
Services to ensure continued access to Public Health Nursing services. Cross-cover
arrangements have been put in place to ensure service continuity. The organization
and delivery of Public Health Nursing Services within the area has been reviewed and
deficits addressed through skill mix initiatives and as with other service areas,
workload prioritisation and waiting lists are in operation to ensure continued access to
Public Health Nursing services. Two PHNs posts are currently being recruited.
The HSE will continue to monitor the provision of Public Health Nursing services and
every effort will be made to progress the recruitment of PHNs/Community RGNs
within South Tipperary.
Question 39 (Deputy Jerry Buttimer) – (Re Cork University Hospital)
To ask the Minister for Health and HSE to provide and update on delivery of the
following services in Cork:
(i)
Retinopathy, if additional doctors will be recruited to ensure diabetic
patients are seen within recommended time frames and if they will make
a statement on the matter.
58
(ii)
Spinal surgery services, what are the current waiting times and what
measures are being implemented to reduce these waiting times.
Response:
With reference to the query on Diabetic Retinopathy there are two elements
to this service
(a) Diabetic Retinopathy Screening Programme
Cork University Hospital is one of the designated treatment centres for the review
patient requiring screening for retinopathy and who are referred from the NCSS
Diabetic Retinopathy Screening Programme.
The following principles of the national diabetic retinopathy screening programme
have been adopted by the NSS (National Screening Service).







It will be a population based call-recall programme, delivered on an annual
basis.
Eligible patients will include all those with diagnosed diabetes, aged 12 years
and over and who are not excluded.
The screening service shall be accessible to all eligible patients.
Screening will be carried out using digital retinal photography.
A database of eligible people with diagnosed diabetes will be established and
maintained by the programme office.
A number of designated and approved grading centres will grade the images.
There will be timely referral, assessment and treatment of abnormalities
discovered.
The service commenced in CUH September 2014 and to date, 164 patients have been
reviewed following referral form the screening programme. All patients reviewed
within the appropriate timeframe as set out by the screening programme
(b) CUH Endocrinology /Diabetes Service
Diabetes mellitus (DM), also known as simply diabetes, is a group of metabolic
diseases in which there are high blood sugar levels over a prolonged period. This high
blood sugar produces the symptoms of frequent urination, increased thirst, and
increased hunger. Untreated, diabetes can cause many complications. Diabetic
Retinopathy is an ocular manifestation of diabetes, a systemic disease, which affects
up to 80 percent of all patients who have had diabetes for 10 years or more.
Patients who attend this service are reviewed by the Consultant Endocrinologist and if
the patient is diagnosed with Diabetic Retinopathy they will as part of the treatment
pathway be referred for further treatment to a Consultant Ophthalmologist.
Presently within CUH we have 2 WTE Consultant Endocrinologist providing this
service. The Executive Management Board cognisant of the demand for this service
have identified the requirement for additional Consultant support and this
requirement has been submitted to the CEO South-South west Hospital Group for
consideration in the 2015 Estimates- Service Plan.
59
Spinal Surgery Services
Spinal surgery services, what are the current waiting times and what
measures are being implemented to reduce these waiting times
Patients requiring spinal surgery are admitted under the care of the Consultant
Neurosurgeons.
As of 2nd October there are 60 patients on the inpatient and day case waiting list of
which 13 patients are on the day case waiting list and 47 are on the inpatient waiting
list. Within this cohort of 60 patient 2 patients are waiting > 12 months and this is
due to the patients other clinical conditions which at this time do not allow for spinal
surgery to proceed.
Question 40 (Deputy Robert Dowds)
To ask the Minister for Health for an update on plans to alter the roll out of clinical
services for children and adults with physical disabilities in the constituencies of
Dublin Mid-West, Dublin South West, Kildare North and Kildare South?
Response:
The HSE has commenced the reconfiguration of children’s disability services into
geographically-based early-intervention and school-aged teams as part of the
Progressing Disability Services for Children and Young People Programme. The
objective of the Programme is to provide one clear referral pathway for all children
(0-18s), irrespective of their disability, where they live or the school they attend. The
transition to this service delivery model is governed by a consultation and
engagement process with all stakeholders, including service users and their families,
and is being implemented on a phased basis, with full implementation of the model
scheduled for the end of 2015.
There is a National structure to underpin this change management programme with
National, Regional and Local Implementation Groups in place. All elements of the
implementation structure include multi stakeholder involvement including
representatives from the Department of Education and its relevant service strands
including the National Educational Psychology Service and the National Council for
Special Education.
Vision for Service Delivery
 Every child and their family will have access to required services
 There will be equity and consistency across the country
 Effective teams will be working in partnership with parents
 Resources will be used to the optimum
 Health and education will work jointly to achieve best outcomes for children
The intention is to roll out an integrated care model that will allow children, whatever
the nature of their disability, to be seen as locally to their home and school as
possible; at primary care level when their needs can be met there and by a network
60
specialist interdisciplinary team if their needs are more complex. The primary and
network teams will be supported as appropriate by specialist support services with a
high level of expertise in particular fields.
The roll out of the Programme will entail targeted investment of €4m and the
provision of 80 additional therapy staff, to increase services for children with all
disabilities. Local Health Areas have received primary notification in respect of
approved and funded service developments as provided for in the National Service
Plan 2014. In this context, Dublin South has been allocated 14 new posts (5 Speech
and Language Therapists; 4 Occupational Therapists; 2 Physiotherapists and 3 Clinical
Psychologists), and Kildare/West Wicklow has been allocated 8 new posts (1 Speech
and Language Therapist; 1 Occupational Therapist; 4 Physiotherapists and 2 Clinical
Psychologists). The filling of these posts is not impacted by the Government
Moratorium on recruitment and has commenced. This measure will have a positive
impact on the provision of clinical services for all children requiring access to health
related supports.
South of Dublin Region
A comprehensive implementation process has been established for the South Dublin
area as a whole because:
 Voluntary Service Providers provide services across the HSE boundary areas in
the South of Dublin and reconfiguration is interdependent;
 and, the children attending special schools with Voluntary Service Provider
patronage come from across the region.
There is great enthusiasm and energy surrounding this approach to developing a
coordinated structure for the delivery of Disability services for Children across the
south of Dublin. The HSE including Beechpark, along with CRC, Enable Ireland,
StewartsCare, St John of God Community services, Cheeverstown House and St
Michael’s House as well as parents are all represented on the Governance group.
The implementation process known locally as The South of Dublin Region (SDR) aim
to have reconfigured services into Disability Network Teams (DNT) by the end of
2015. There will be two Disability Network Teams in each of the 5 former local health
offices of Dublin South, Dublin South City, Dublin South East, Dublin West and Dublin
South West. The SDR have agreed that the Disability Network Team for the
geographic area in which CRC Scoil Mochua sits will provide the therapy service for
the children in the school regardless of their home address (this includes Kildare
children attending the school). It is acknowledged that this will require an enhanced
team to reflect the additional case load. Children currently receiving services from
CRC in mainstream school will receive their service from the Disability Network Team
in which they reside.
As this process is rolled out there will be close liaison with all of the agencies involved
and with parents and service use representatives
61
Question 41 (Deputy Robert Dowds)
To ask the Minister for Health to list the clinical services to be provided on the site at
Scoil Mochua, Clondalkin after the alterations to the roll out of clinical services in the
wider geographic area, and who will be able to avail of them?
Response:
The HSE has commenced the reconfiguration of children’s disability services into
geographically-based early-intervention and school-aged teams as part of the
Progressing Disability Services for Children and Young People Programme. The
objective of the Programme is to provide one clear referral pathway for all children
(0-18s), irrespective of their disability, where they live or the school they attend. The
transition to this service delivery model is governed by a consultation and
engagement process with all stakeholders, including service users and their families,
and is being implemented on a phased basis, with full implementation of the model
scheduled for the end of 2015.
There is a National structure to underpin this change management programme with
National, Regional and Local Implementation Groups in place. All elements of the
implementation structure include multi stakeholder involvement including
representatives from the Department of Education and its relevant service strands
including the National Educational Psychology Service and the National Council for
Special Education.
As outlined above, the roll out of the reconfiguration of children’s disability services
into geographically-based early-intervention and school-aged teams as part of the
Progressing Disability Services for Children and Young People Programme, is a major
change programme that requires meticulous planning. In this context, it is not
possible at this stage to give exact details of the locations of the teams and how
many staff they will have.
The transition to this service delivery model is governed by a consultation and
engagement process with all stakeholders, including service users and their families.
As part of this process consideration will also be given to the entire population of
children accessing the Team. In this context the bases or sites for the Disability
Network Teams (DNT) for Dublin West have not yet been finalised.
Where bases are not located on specific school sites the DNT will work into the school
as required. The core DNT will have Occupational Therapy, Physiotherapy, Speech
and Language Therapy and Psychology. The HSE can confirm that existing Nursing
provision will remain in Scoil Mochua.
Question 42 (Deputy Robert Troy)
To ask the Minister for Health the number of obstetricians at the Midland Regional
Hospital, Mullingar and the recommended number for same; how maternity services
at the Midland Regional Hospital, Mullingar compare to those at other maternity
hospitals in terms of staff ratios and funding allocations.
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Response:
Currently, there are three obstetricians Whole Time Equivalents (WTE) at Mullingar.
While the number of births is not increasing, the gynaecological and obstetrical
workload is increasing across maternity services
The seventh edition of Health at a Glance provides the latest comparable data on
different aspects of the performance of health systems in OECD countries
(http://www.oecd-ilibrary.org/social-issues-migration-health/health-at-a-glance2013_health_glance-2013-en).
It presents the number of obstetric medical and midwife staffing across countries
including Ireland. On the issue of interpreting obstetric consultant staffing numbers, it
makes a number of points that should be borne in mind:
 “In countries with a medicalised approach to pregnancy, obstetricians provide
the majority of care. Where a less medicalised approach exists, trained
midwives are the lead professional, often working in collaboration with general
practitioners, although obstetricians may be called upon if complications arise.
Regardless of the different mix of providers across countries, the progress
achieved over the past few decades in the provision of pre-natal advice and
pregnancy surveillance, together with progress in obstetrics to deal with
complicated births, has resulted in major reductions in perinatal mortality in all
OECD countries.”
 “There is little evidence that systems that rely more on midwives are less
effective. A review of a number of studies finds that midwife-led models of care
resulted in fewer complications (Hatem et al. 2008). Another review found that
midwives are equally effective in providing pre-natal care and advice in the
case of normal pregnancies (Di Mario et al., 2005), although support from
obstetricians is required for complications.”
Graph 3.3.2 in Health at a Glance 2013 shows that Ireland has the tenth highest
number of midwives across all OECD countries.
The table below includes staffing (midwives and care assistants) at maternity sites
with between 1800 and 3000 births in 2013 by way of comparison with Mullingar
(2,461).
Maternity Services Staffing Nationally Week of 3rd
Hospital/
No of
No of
Maternity Unit
Midwives Maternity
– HSE +
Care
Agency
Assistants
March 2014
No of
Ratio of
Births
Midwives
- 2013 to Births
Waterford Regional
60.60
0.00
2,215
1:37
Kilkenny
50.40*
2.84
1,815
1:36
Portiuncula
52.00
6.86
2,044
1:39
Letterkenny
48.00
10.20
1,798
1:37
Cavan
47.06
4.30
1,915
1:41
Wexford
39.85*
0.00
1,990
1:50
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Hospital/
Maternity Unit
No of
Midwives
– HSE +
Agency
No of
No of
Maternity Births
Care
- 2013
Assistants
Ratio of
Midwives
to Births
MRH Mullingar
57.82*
3.00
2,461
1:42
MRH Portlaoise
40.31*
4.30
1,983
1:49
* Includes agency nurses in HSE hospitals only week of 3rd March.
A total of 35 (0.9 WTE) additional hours were worked by Maternity Staff in Portlaoise
during the 1st week of March through a combination of overtime and additional hours
by part time staff when included with above would give 41.22 WTE with ratio: 1:48
The table uses the number of midwives to births to calculate the staff ratios. The
Maternity Care Assistants are not included as the range and breadth of work
undertaken by them varies across the country.
The HSE Office of the Nursing and Midwifery Services Director (ONMSD) is currently
engaged in a Workforce Planning (WFP) Project on Midwifery workload and workforce
review using Birthrate Plus ®. This project is expected to report by end of November.
Birthrate Plus® is currently the only validated tool available internationally for
calculating midwifery staffing levels.
Maternity service funding is part of overall hospital funding and is allocated to the
service as determined at local hospital level.
Question 43 (Deputy Robert Troy)
To ask the Minister for Health what action he and the HSE can take to assist St.
Christopher’s Services to continue providing a safe and quality service to the
residents of Morlea House, Longford and Marian Avenue, Ballymahon, many of whom
have a life-long relationship with the services; if he is aware that owing to reductions
in HSE funding St. Christopher’s cannot sustain the cost of the additional staffing
required within our current budget allocation; if he is conscious that the Board of
Directors and the Senior Management Team have been engaging with the HSE over
the last year in an endeavour to secure adequate funding to continue providing a safe
service to the most vulnerable people in our organisation.
Response:
St. Christopher’s Services was founded by parents and friends to provide a service to
people with intellectual disabilities. St. Christopher’s works in partnership with the
HSE to provide a high quality, community-based service, based on identified
individualised needs, enabling service users to reach their full potential.
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HSE Funding & Governance
St. Christopher’s Services is funded under Section 39 of the Health Act and subject to
Service Arrangements (SA) which provides detailed information on services delivered
locally. The SA which is renewed and signed each year is monitored and reviewed via
quarterly review meetings with HSE Disability Management. The agency is being
allocated €8,241,770 from the HSE Midlands in 2014. This is broadly in line with
previous years.
Services Provided
St. Christopher’s provides residential, day, respite and pre-school services to adults
and children with intellectual disabilities in the Longford / Westmeath area. The HSE
together with St. Christopher’s is committed to developing local services of high
standards, according to accountable, flexible and cost effective programmes. This
includes providing residential services to40 people with intellectual disability in
various locations across Longford. St. Christopher’s has embraced the supported
living/independent living model of care with nine people availing of this model. Day
Services are currently provided to 146 people with intellectual disability. Respite
Services are provided in two separate locations for adults and children. The adult
respite house provides respite to 53 service users with varying degrees of intellectual
disability. The children’s respite house provides respite to 18 children with varying
degrees of disability.
Background to Marion Avenue and Morlea House
St. Christopher’s applied to the Department of the Environment for capital assistance
to build two properties in the Longford area, one being Marion Avenue. Numerous
requests were received from St. Christopher’s Service to the HSE regarding the
commissioning of a residential service in the vacant property at Ballymahon (vacant
for four years by December 2010). As part of the transfer programme six people
were identified (through an agreed process) to move to the house at Marion Avenue.
Funding for this service was agreed as follows:

Original funding = €713,000 full-year costs (including Ballymahon Day Service
€100,000).

2014 funding available €714,460.
Note: Average cost of community houses in HSE Lough Sheever Services (Pay, Nonpay and Income) = €651,000 per house.
Current Situation
Like all non-statutory providers, St. Christopher’s is responsible for the management
of their resources within their allocated funding. The HSE has been notified by St.
Christopher’s Services of financial difficulty and in particular in relation to services at
Marion Avenue, Ballymahon and Morlea House, Longford. It should be noted that the
HSE agreed a level of funding for these services with St Christopher’s and this has
65
been maintained. The two Community Houses - Morlea House, Longford and Marian
Avenue, Ballymahon - have recently had their H.I.Q.A. monitoring inspections; the
reports indicate that the staffing levels are adequate to maintain a safe service.
The HSE met with St. Christopher’s management team and Board of Directors to
discuss their funding concerns. The HSE advised that no additional funding was
available, Disability Management as part of the Service Arrangement (SA) quarterly
review meeting with St. Christopher’s (including the chair of the Board of Directors)
proposed other options in order to address the financial difficulties i.e. review of
roster, reduction in number of service users in both these houses and review service
users. This was agreeable to St. Christopher’s Services.
The HSE has engaged extensively with St. Christopher’s since June of this year, as
highlighted in the table below.
The HSE acknowledges that there is a significant level of changing needs throughout
the disability sector and most providers are responding to this by maximising all the
enablers outlined in the Haddington Road agreement or by reconfiguring services in
line with the VFM Policy Review Framework.
The HSE at National level has arranged a meeting with St. Christopher's early in
November in an endeavour to resolve the issues.
Summary of contact between HSE and St. Christopher’s Services:
10th June
2014
2nd July 2014
7th July 2014
29th July
2014
5th August
2014
8th h Sept
2014
9th Sept 2014
17th Sept
2014
25th Sept
2014
HSE Management met with Board of Directors of St.
Christopher’s Services.
Email from Maura Morgan, General Manager to St.
Christopher’s requesting they identify people for Fair Deal.
Quarterly review meeting with St. Christopher’s Services and
the HSE, plan of action agreed on how to address immediate
issues.
Forum meeting attended by Area Manager with CEO of St.
Christopher’s present.
HSE Management (Area Manager, General Manager, Finance
Manager) met with St. Christopher’s Board of Directors.
Area Manager advised at this meeting that HSE would go to
tender.
Email sent from HSE Disability Manager to St. Christopher’s
CEO attaching sample rosters.
Email from Residential Co-ordinator seeking additional
information on sample rosters.
Disability Manager sent e-mail to Residential Co-ordinator
where all questions regarding sample rosters were addressed.
HSE Disability Manager met with St. Christopher’s Residential
Co-ordinator to discuss:
 Transfer of service user in Ballymahon back to HSE
Services, which would eliminate FYC of €72,000.
 Progress Fair Deal for suitable service users.
 Review sample rosters in line with other similar
organisations (sent to St. Christopher’s Services for
66
30th Sept
2014
1st Oct 2014
4th Oct 2014
16th Oct
2014
June to
October 2014
their review)
 Reduce bed numbers in both Marion Avenue and Morlea
to 5 in each house
Discussion by phone between Disability Manager and St.
Christopher’s Residential Co-ordinator where plan agreed at
meeting of 25th September was re-iterated.
HSE General Manager wrote to St. Christopher’s Services
requesting an update with regard to progression of the plan
and an update on financial savings from implementation of
plan.
Residential Support Group - issue again discussed.
Residential Support Group – issue again discussed.
Numerous phone conversations and email contact between
St. Christopher’s Services and the Disability Manager.
Question 44 (Deputy Ciara Conway) – (Re University Hospital Waterford)
To ask the Minister for Health for an update on the progress of setting up a 24/7
Cardiac Care unit in University Hospital Waterford, as promised in the Higgins Report.
I understand there has been some recruitment of Consultant Cardiologists and a
business plan has been put forward. Can we have a commitment that this will be
priority with the required funding earmarked in the capital plan?
Response:
Cardiac Catheterisation Services
The Cardiac Catheterisation service at University Hospital Waterford provides cardiac
procedures including diagnostic angiography, percutaneous intervention (stents),
pacemaker and defibrillator implants, cardiac structural procedures, and many other
procedures. Patients presenting with an acute myocardial infarction in the South-East
can now receive emergency percutaneous coronary artery intervention (PCI) to open
the blocked artery immediately and limit the damage to the heart muscle.
Currently the service is available within working hours Monday to Friday to
patients from the South East.
Staffing
The department is now staffed by 3 Consultant Cardiologists. 1 permanent
Consultant commenced 1st September 2014, and a 3rd Consultant commenced on a
temporary basis in August 2014.The department is also staffed by 1 Cardiac
Physiologist, 1 Radiographer, 2 Nursing staff and I Admin Grade IV.
Service Expansion
A business case has been prepared and was forwarded as part of the 2015 Estimates,
for expansion to a twenty four hour service, seven days a week ( 24/7), and the
associated requirement for a 2nd Cath Lab. The required 24/7 PCI service can only be
achieved when significant resources are available. Discussions will commence with the
Clinical Programme, it is essential that patients have 24/7 close access in line with the
standards and timelines as set out in the Clinical Programme. This will ensure that
67
patient care is in line with best practice and that optimal reperfusion is achieved with
the best outcome for the patient within the South East.
The total Capital Costs for the 2nd Cath Lab are €1.9m. The total Revenue Costs for
the 24/7 expansion of services and the 2nd Cath Lab are € 2.7m.
To enable the Cath Lab operate on a twenty four hour service, seven days a week
basis will require a staffing complement of 6 Consultant Interventional Cardiologists.
There are currently 3 funded posts in place and UHW has sought funding to allow the
recruitment of the 4th post in 2015.
Maintenance Closures
The UHW Cath Lab closed on 13th Aug for planned maintenance. This maintenance is
completed 4 times per year. This maintenance is completed between 9m and 5pm as
it is the least expensive option agreed under the annual preventative maintenance
contract. This is the normal practice in other hospitals throughout the country. There
was no interruption to services as additional sessions were put in place in the Cardiac
Cath Lab to ensure that patients were not disadvantaged.
As with all capital projects this project must be considered within the overall capital
envelope available to the health service. There will always be more construction
projects than can be funded by the Exchequer. The method and timescale for the
delivery of health care infrastructure is a dynamic process which is constantly
evolving to take account of changing circumstances, including the feasibility of
implementation. There is limited funding available for new projects over the period
2015-2019 given the level of commitments and the costs to completion already in
place. The HSE is concentrating on applying the limited funding available for capital
works in the most effective way possible to meet needs now and in the future.
Question 45 (Deputy Ciara Conway) – (Re University Hospital Waterford)
To ask the Minister for Health for an update on progress on the regional Palliative care
unit for University Hospital Waterford, if he can confirm that funding is secure for this
project in the Capital Plan and if we can have a detailed timeline for completion and a
progress report, together with a commitment that all the staffing needs will be fully
met
Response:
Proposed development of 5 storey block including Specialist Palliative Care
Inpatient Unit
Work on the development of this €20m unit is progressing. Enabling works which
commenced in October 2013 have recently been completed to the front of the
hospital in the proposed unit site. These works included the construction of a new
roadway to relocate the access road to the Old School of Nursing and RCSI to the east
end of the campus. This work also involved the relocation of services to the perimeter
of the site and the completion of new car parks adjacent to the Laboratory.
The Design Team was appointed in the summer of 2014, and an initial presentation
and discussion is arranged with the architects on Thurs 9th October 2014. This
68
meeting will provide clarity to the architects regarding optimal shape, sitting and
access features to the new unit. Following on from this meeting and the other detailed
work of the Design Team, it is expected that the planning application for the unit will
be lodged in March 2015. Construction is planned to commence (subject to funding
approval by the HSE Estates Office) in Q2 2016. Construction is expected to be
completed in Q3 2017 and following commissioning and equipping the Unit is planned
to open Q1 2018.
The Palliative Care Unit at UHW was approved on the basis that it is revenue neutral.
This will be staffed by existing resources currently working in Palliative Care, both in
acute and sub acute services and across the South East. Resources will be in place to
operate the unit as planned in 2018 in line with the Project Plan.
This full capital development will be revenue neutral and other floors and services in
the build will be staffed within existing resources.
Question 46 – Deputy Ciara Conway
To ask the Minister for Health if he will commit to developing and implementing a
National Policy on Hospital food that would ensure that appetising, nutritious,
balanced and varied choices are available in all our hospitals, if he can outline what
work his department has done in relation to this, or what it intends to do, preferably
in a process that would involve a range of stakeholders and expertise.
Response:
In 2010 a single national procurement operating model was implemented by the HSE
which has been a key enabler in achieving cost reduction, increased efficiencies and
the adoption of streamlined standardised procurement processes.
An Evaluation Team has been established comprising Dieticians, Catering Managers
and Procurements Specialists to ensure a tender process which delivers a high
standard of products purchased by the HSE.
The three categories of food encompassed by the procurement process are; Fresh
Food (73%) which can be purchased on a national, regional or local level and which
includes fresh meat (poultry, pork, fish etc.), fresh fruit and vegetables, dairy
products, fresh bread. The standard sought by the HSE from tenderers is that they
should reach at a minimum An Bord Bia Quality Assurance Programme or equivalent
quality assurance scheme; Dried / Ambient Products (20%) which represents cereals,
pasta, preserves, beverages e.g., tea, coffee, cooking products e.g., flour, grains etc.
and which are generally purchased on a national level for cost efficiencies; Frozen
Food Products supplementing Fresh Produce (7%) – 4% would include products such
as ice-cream, poultry and frozen vegetables which also carry nutritional value. The
remaining estimated 3% refers to processed ford which includes pizza, sausage rolls,
burgers etc. This category, are again purchased on a national level. A policy on
vending has been introduced in HSE premises and calorie posting throughout HSE
eating facilities will soon be implemented.
The Chief Medical Officer of the Department of Health is writing to the HSE Director
General to request that a working group be established to develop a sustainable and
patient centred Healthy Food Policy to be implemented throughout all its hospitals
69
and facilities which will encompass procurement, catering, cooking, serving and waste
minimising.
Question 47 (Deputy Peter Fitzpatrick)
Under the current terms of the Fair Deal Scheme, if a person has transferred their
productive assets (such as a farm) in good faith three years before needing nursing
home care and applying for the Fair Deal scheme, they are treated the same as if
they have made no transfer of the assets. In other words, the farm is counted as their
asset indefinitely when meeting the costs of their care, because the asset has not
been transferred for a minimum of five years. This potentially uncapped liability for
non-residential, productive assets is creating uncertainty and anxiety that the viability
of the family farm business will be undermined or lost when attempting to meet the
costs of care.
The question therefore is, can the Fair Deal scheme be amended to provide for a
maximum % charge to be applied to non-residential, productive assets, in all
circumstances? This would provide greater certainty to farm families, and other
families with small business assets, and allow them to make the most appropriate
decisions in meeting the costs of care
Response:
The Nursing Homes Support Scheme is a system of financial support for individuals
who require long-term nursing home care. Under the Scheme, individuals make a
contribution towards the cost of their care, based on their means, and the State pays
the balance. The average contribution under the Scheme is currently about €285 per
week. Therefore, in the vast majority of instances the State is paying by far the larger
share.
The Nursing Homes Support Scheme Act 2009 provides that assets whose ownership
is transferred in the five years prior to initial financial assessment or any subsequent
financial reviews are taken into account in the financial assessment or review. This is
an anti-avoidance mechanism which is necessary to ensure that participants make the
contribution to their own costs in accordance with the intention of the relevant
legislation, and that the scheme is equitable and financially sustainable.
Individuals contribute up to 80% of their assessable income and a maximum of 7.5%
of the value of any assets per annum towards their cost of care. The first €36,000 of
an individual’s assets, or €72,000 in the case of a couple, is not counted at all in the
financial assessment.
An individual’s principal residence is only included in the financial assessment for the
first three years of their time in care. This is known as the three year cap. This three
year cap also extends to farms in circumstances where all three of the following
criteria are met:


The person suffered a sudden illness or disability which causes them to need
long-term nursing home care;
The person or their partner was actively engaged in the daily management of
the farm up until the time of the sudden illness or disability; and
70

A family successor certifies that he or she will continue the management of the
farm.
In the case of a couple, the measure applies where the applicant suffered a sudden
and unforeseen illness and either or both members of the couple have been engaged
in the running of the family farm. This stipulation is in keeping with the key principle
of joint assessment of couples.
The three year cap was extended to farms because there was concern about the
potential impact of the Scheme on the sustainability of family farms, particularly in a
situation where care is required from an early age and for a prolonged period. It was
intended to ensure the financial sustainability of farms in cases where a person
suffered a sudden illness and did not have an opportunity to put appropriate
succession arrangements in place. It affords additional protection because it ensures
that a person’s maximum contribution is fully quantifiable.
The Nursing Homes Support Scheme is currently the subject of a review. The review
is considering the long-term sustainability of the Scheme as well as looking at related
aspects of home and community care. The Irish Farmer’s Association raised this issue
with Officials from the Department and it will be considered in the context of the
Review. Work on the review is on-going. It is expected that the review will be
completed in the coming months and the report will then be made publicly available.
Question 48 (Deputy Ciara Conway)
To ask the Minister for Health if he will commit to developing and implementing a
National Policy on Hospital food that would ensure that appetising, nutritious,
balanced and varied choices are available in all our hospitals, if he can outline what
work his department has done in relation to this, or what it intends to do, preferably
in a process that would involve a range of stakeholders and expertise.
(Question Nos 10 and 48 taken together)
Question 49 (Deputy (Peter Fitzpatrick)
The Oncology Unit in Drogheda is now open from Monday - Thursday and sometimes
only a limited service is available on Fridays. Is this due to under staffing and if so
what is the full complement? And when will the urgently required extra staff be
employed there?
Response:
The Oncology Unit previously operated a 5 day service, Monday – Friday, opening 8
hours a day.
Hospital Management re-configured the opening hours of the service in 2014.
Thus, the Oncology Unit now provides services over an extended working day from
Monday to Thursday, operating from 08.00hrs to 18.00hrs, with a shorter working
day on a Friday from 08.00hrs to 16.00hrs.
71
The staffing complement approved for the unit is 17 WTE.
There is no Oncology waiting list at present.
72