Post Office Network (Continued)
  Written Answers Nos. 1-25
  Accident and Emergency Services Provision
  Care of the Elderly Provision
  Nursing Staff Remuneration
  Speech and Language Therapy
  Maternity Services
  General Practitioner Services
  Consultancy Contracts
  Air Pollution
  Cancer Screening Programmes
  Patient Safety
  Health Services Provision
  Ambulance Service Provision
  Health Services Staff Recruitment
  Midwifery Services
  Hospital Waiting Lists

Thursday, 13 February 2014

Dáil Éireann Debate
Vol. 830 No. 3

  6 o’clock

Written Answers Nos. 1-25

The following are questions tabled by Members for written response and the ministerial replies as received on the day from the Departments [unrevised].

  Questions Nos. 1 and 2 answered orally.

Accident and Emergency Services Provision

 3. Deputy Finian McGrath   asked the Minister for Health   the position regarding the trolley issue in the accident and emergency department at Beaumont Hospital, Dublin; and if he will make a statement on the matter.  [6978/14]

Minister for Health (Deputy James Reilly):   The Department of Health, the HSE SDU and the INMO are at one in regarding trolley waits to be an unacceptable feature of the Irish healthcare system which must be addressed. However, year to date on a national basis we are 2.9% ahead of 2013 and 33.7% ahead of the baseline 2011 trolley count. These percentages are equivalent to 237 and 4,015 fewer patients on trolleys respectively.

  I am advised by the HSE that the Emergency Department in Beaumont Hospital has been under pressure for some weeks. Since the start of 2014, the rate of admission to the hospital from the ED has increased from just below 1 in 5 patients attending its ED to just below 1 in 3. This indicates that those presenting so far this year have tended to be sicker and requiring more care and treatment. Notwithstanding this, Beaumont has achieved reductions in the first 6 weeks of 2014, as it did also in 2013.

Beaumont Hospital: Patients on Trolleys for first 6 weeks of the year: 2012/2013/2014

  Questions Nos. 4 to 6, inclusive, answered orally.

Care of the Elderly Provision

 7. Deputy Finian McGrath   asked the Minister for Health   if he will provide details of the services for senior citizens living on the north side of Dublin; and if he will make a statement on the matter.  [6901/14]

Minister of State at the Department of Health (Deputy Kathleen Lynch):   In line with Government policy, the Health Service Executive provides a range of community-based services aimed at ensuring older people receive safe, timely and appropriate care and treatment at the lowest level of complexity, and as close to home as possible. This means that they are facilitated and supported to stay in their own homes and communities for as long as it is viable, in accordance with the views expressed consistently by older people themselves. Older people with care needs must be provided with a continuum of services such as home care, day care, community support and/or intermediate care beds to avoid unnecessary acute hospital admissions, as well as longer term residential care.

The Local Health Office, which provides information, advice and assistance, is the entry point to community health and personal social services. HSE North Dublin provides a wide range of health and personal social services including Home Help services, Home Care Packages, Respite Care, Day Care, Meals on Wheels and various health promotion initiatives and programmes.

Home help Services are provided by three HSE funded organisations in north Dublin. The number of Home Help hours to be delivered in 2014 will be maintained at 2013 levels. Home Care Packages are provided by a range of agencies and almost 1,000 clients were in receipt of such packages at end of 2013. Arranged daycare and Alzheimer/Dementia services are provided through a range of community supports. A Social Worker for the protection of Older Adults provides a service to vulnerable clients in north Dublin Finally meals on wheels services are provided by 17 different providers.

In addition, there are two public long stay units in North Dublin. Lusk Community Unit provides 45 long term care beds and 5 respite beds. Raheny Community Nursing Unit provides 100 long term beds.

Further details of Older People Services, including useful contact resources for people in the Dublin North area are available from the HSE website.

  Question No. 8 answered orally.

Nursing Staff Remuneration

 9. Deputy Mick Wallace   asked the Minister for Health   if he will reverse the cut to the starting salary level for newly graduated nurses; and if he will make a statement on the matter. [6954/14]

Minister for Health (Deputy James Reilly):   Under the Haddington Road Agreement, revised salary scales for 'new entrant' nurses are being prepared. These new salary scales will address the imbalance between those who entered the public service following 1 January 2011 and those who entered prior to this date. They are to apply retrospectively from 1 November 2013.

In a time of very limited recruitment opportunities in the public service, I am very pleased that up to 1,000 two-year contracts are being made available to graduate nurses and midwives in our health services under the Graduate Nurse/Midwifery Programme. In addition to giving employment opportunities, a major objective of the Nurse Graduate scheme is to put in place more cost-effective service delivery arrangements, having regard to the high rates of expenditure on agency staffing and overtime. The Minister for Public Expenditure and Reform agreed to the initiative on the basis that it would be outside the Employment Control Framework and deliver significant savings.

Under the Haddington Road Agreement it was agreed that participants will be paid 85% of the first point of the new entrant scale in the first year and 90% in the second. Alongside these valuable employment opportunities, those who take up offers will also be able to avail of supported further professional development. The scheme will support the retention of graduate nurses and midwives within the Irish health system and enable them to gain valuable work experience and development opportunities post-graduation. Participants will have access to a variety of care settings while gaining clinical experience.

The educational component of the graduate nurse and midwife programme comprises a 2 year part-time 3 module Certificate Graduate Education Programme that will be NMBI approved and academically accredited. This formally accredited programme will have currency for accreditation for prior learning by Higher Education Institutes when graduates wish to undertake further study and progress towards a Masters Level Award at a later stage in their careers.

Under the Programme, by the end of January 2014 the recruitment of over 600 graduate nurses was completed or in train, over 1,000 applications having been received.

  Questions Nos. 10 to 13, inclusive, answered orally.

Speech and Language Therapy

 14. Deputy Joe Higgins   asked the Minister for Health   if his attention has been drawn to the long delays in assessment and access in respect of speech and language therapy in Dublin 15; the measures he will take to resolve same; and if he will make a statement on the matter.  [6797/14]

Minister of State at the Department of Health (Deputy Kathleen Lynch):   Health related supports and interventions for children can be accessed through HSE Primary Care and Disability Services. The National Service Plan 2013 provided for additional funding of €20m to strengthen primary care services. This comprises over €18.5m for the recruitment of over 260 primary care team posts and over €1.4m to support Community Intervention Team development. Of the additional posts allocated, 52 whole-time equivalent Speech and Language Therapy posts were approved. The recruitment process is ongoing in relation to these posts, with the majority of the posts filled or offered, subject to start dates being agreed.

  Five Speech and Language Therapy posts have been assigned to Dublin 15 which will bring the total number for this area to eleven. I have been informed that all of these new therapists are in place as of this week. Significant reductions in waiting times for speech and language therapy services have already been achieved and further improvements should be seen over the coming weeks.

  In terms of disability services, therapy services for children are being reconfigured into geographically-based multidisciplinary teams, as part of the Progressing Disability Services for Children and Young People Programme. The objective of the Programme is to achieve a national, unified approach to delivering disability health services so that there is a clear pathway to services for all children, regardless of where they live, what school they go to or the nature of their disability. The National Service Plan 2014 provides for targeted investment of €4m for the roll out of this Programme which equates to 80 additional therapy posts, including Speech and Language Therapy posts, with the northside of Dublin identified as one of the priority areas for 2014.

Maternity Services

 15. Deputy Charles Flanagan   asked the Minister for Health   the steps he will take to restore public confidence in the quality of the maternity service being provided at the Midlands Regional Hospital, Portlaoise, in view of the number of expectant mothers who will attend the hospital in the coming weeks and months.  [6703/14]

Minister for Health (Deputy James Reilly):   I believe that it is vitally important that we restore public confidence in the quality of the maternity services at Portlaoise, and have already taken steps to do so. My priority is to establish how our services failed the families involved and, if so, take remedial action to ensure that it can never happen again. I therefore moved immediately to ask the Chief Medical Officer to provide me with an urgent report on the issues arising. This report will inform the terms of reference of any subsequent HIQA review into this issue.

I am acutely aware of the concerns of many pregnant women throughout the country, and I want to reassure them that Ireland is a safe country in which to have a baby. Compared to neighbouring countries, we have low rates of perinatal deaths, and the rates continue to fall. The perinatal mortality rate is estimated by the ESRI at 5.9 per 1,000 live births and stillbirths in 2012 – a decline of 31% since 2003. Advances in antenatal, obstetric and neonatal care have contributed to our declining perinatal mortality rate.

The Deputy might also like to note that my Department, in conjunction with the HSE, will develop a new National Maternity Strategy this year. This will provide the strategic direction for the optimal development of our maternity services to ensure that women have access to safe, high quality maternity care, in a setting most appropriate to their needs. The Strategy will ensure that going forward our services are fit for purpose and in accordance with best available national and international evidence.

General Practitioner Services

 16. Deputy Niall Collins   asked the Minister for Health   the number of GP dispensing facilities that have been withdrawn by the primary care reimbursement services since the start of 2013; and if he will make a statement on the matter. [6937/14]

 71. Deputy Niall Collins   asked the Minister for Health   the reason the PCRS is unilaterally withdrawing dispensing facilities from GPs; and if he will make a statement on the matter. [6936/14]

Minister of State at the Department of Health (Deputy Alex White):   I propose to take Questions Nos. 16 and 71 together.

The General Medical Services (GMS) Scheme provides for general practice dispensing services in certain limited circumstances where there is no pharmacy in an area and clients are unable to access prescribed drugs or medicines from retail pharmacies. In 2013, the HSE conducted a review of doctor dispensing arrangements, the purpose of which is to improve standards and accountability for stock orders. The review identified where doctor dispensing arrangements are no longer required as pharmacies have opened in particular geographic areas or where doctors are no longer providing a dispensing service as patients are accessing medicines in local pharmacies.

At the time of the review, there were 94 dispensing doctors nationally. The HSE considered that 34 of these were no longer providing dispensing services. Of these 34 doctors, 17 asked the HSE to review its decision and offered some further information which is being considered by the HSE. The 17 doctors who did not request the HSE to review its decision had their dispensing status removed at the end of January 2014.

From 1st April 2014, new arrangements will be introduced by the HSE, including standards for doctor dispensing and the introduction of a computerised on line system to record items dispensed. Following engagement with the Irish Medical Organisation, the HSE will make the appropriate software available to the relevant GPs.

Consultancy Contracts

 17. Deputy Catherine Murphy   asked the Minister for Health   if he will confirm if the Health Service Executive has engaged the advice of external professional consultants on the appointment of persons to boards under the HSE's remit; the total cost in each case; if his attention has been drawn to instances where a person appointed to a HSE board after recruitment advice was received from professional external consultants was subsequently deemed to be unqualified for the duties and responsibilities attached to the role; and if he will make a statement on the matter. [6840/14]

Minister for Health (Deputy James Reilly):   My officials have received confirmation from the HSE that an organisation called Boardmatch Ireland was used to assist in identifying replacement candidates to fill vacancies on the Board of the Central Remedial Clinic. The HSE has also confirmed that it has not been able to identify any instance where a person appointed to a HSE board after recruitment advice was received from external professional consultants, was subsequently deemed to be unqualified for the duties and responsibilities attached to the role.

Details of the cost of engagement of the external consultants will be provided directly by the HSE to the Deputy.

Air Pollution

 18. Deputy Joan Collins   asked the Minister for Health   his view regarding a potential health risk from the recent fire at the Oxigen plant in the Ballymount industrial estate (details supplied) in Dublin 12; and if he will indicate if there have been health implications resulting from this fire.  [6699/14]

Minister for Health (Deputy James Reilly):   Matters relating to air quality and the Environmental Protection Agency (EPA) are matters for the Department of the Environment, Community and Local Government in the first instance.

I have been advised that the results from the EPA's national ambient air quality monitoring network show that there was no breach of air quality standards at any of the monitoring stations in the network for the duration of the fire. Elevated pollution levels were recorded by the closest monitor, located at Ballyfermot Library, but these were still within prescribed pollutant limit values for the protection of human health set out in national and EU air quality legislation.

The EPA issued health related advice to local residents. EPA inspectors undertook additional air monitoring over the duration of the fire. While it is too early at this stage to provide a fully detailed air quality report, these results are being compiled and a report on the monitoring undertaken will be prepared by the EPA. The HSE has advised that individuals most at risk from exposure to hazardous combustion products are those who have pre-existing respiratory diseases, such as asthma or chronic obstructive pulmonary disease. Acute exposure to smoke is likely to exacerbate these conditions. Elderly individuals, smokers and those with cardiac conditions may also be at greater risk than the general population. I am further advised that as the exposure was short-term, it is very unlikely to give rise to any long-term health effects.

Cancer Screening Programmes

 19. Deputy Brendan Smith   asked the Minister for Health   when BreastCheck will be extended to women aged 65 to 69; and if he will make a statement on the matter.  [6949/14]

 43. Deputy Éamon Ó Cuív   asked the Minister for Health   the reason the pledge to extend BreastCheck to women aged 65 to 69 is not being honoured in 2014; and if he will make a statement on the matter.  [6935/14]

Minister for Health (Deputy James Reilly):   I propose to take Questions Nos. 19 and 43 together.

The BreastCheck Programme provides free mammograms to all women aged 50-64. Ireland has improved breast cancer survival rates due to a combined approach of screening, symptomatic detection and improved treatment. Breast cancer 5 year survival is now estimated at 81.8% for people diagnosed between 2003-2007, up from 76.8% for people diagnosed between 1998-2002.

Given the level of funding available, and the competing demands, it was not possible to include the age extension in the HSE's National Service Plan for 2014. The BreastCheck Programme aims to extend the upper age range to include the 65-69 age cohort as soon as possible in line with available resources. A priority of BreastCheck at present is to maximise national uptake in the 50-64 year age cohort and, in 2013, over 144,000 women were screened, compared with 128,800 in 2012.

Patient Safety

 20. Deputy Denis Naughten   asked the Minister for Health   the position regarding the recommendations contained in the patient safety investigation report into services at University Hospital Galway and as reflected in the care provided to Savita Halappanavar; and if he will make a statement on the matter.  [6701/14]

Minister for Health (Deputy James Reilly):   HIQA's 'Investigation into the safety, quality and standards of services provided by the Health Service Executive to patients, including pregnant women, at risk of clinical deterioration, including those provided in University Hospital Galway, and as reflected in the care and treatment provided to Savita Halappanavar' was published on 7th October 2013. On publication I made it clear that patient safety must become the number one priority for health system management and must be fully built into the governance, management and accountability systems throughout the HSE.

   My Department is ensuring that the actions required to implement the recommendations of the HIQA Report into the death of Mrs. Halappanavar are being undertaken across our health services with a view to improving patient safety and providing a more patient-centred model of care. I have also directed HIQA to ensure that their monitoring of the National Standards for Safer Better Healthcare include monitoring of the extent to which the health service has implemented the findings of both the HIQA and HSE investigations.

  A Progress Report by the HSE's National Director of Acute Hospitals who has been assigned responsibility for this body of work was forwarded to my Department on 23rd January last. The report provides evidence that clear progress has been made:

- Irish Maternity Early Warning Scores (I-MEWS) introduced in all maternity units;

- Guidance on miscarriage and management of crucially ill obstetric patients in place.

Progress in implementing all of the local and national recommendations is well under way and will continue throughout the year. The Deputy will understand that implementation of some recommendations will necessarily require a longer time period beyond the current year.

  Following on from the Authority's Report I have listed five key priorities in relation to patient safety:

- Patient Safety has been made a priority within the HSE's Annual Service Plan through specific measures focused on quality and patient safety including Healthcare Associated Infections, Medication Safety and implementation of Early Warning Score systems. My officials will meet the HSE each month to review progress on the Service Plan and patient safety will be a standing item on that agenda.

- My Department is leading the development of a Code of Governance which will clearly set out employers' responsibilities in relation to achieving optimal safety culture, governance and performance. It is expected that a Code of Governance will be developed during 2014.

- I have directed HIQA to ensure that my patient safety priorities are included in the monitoring programme against the National Standards for Safer Better Care, to ensure that there are clear governance and accountability mechanisms put in place and that there are clear arrangements to respond to the very specific findings in the above mentioned report.

- My Department, in conjunction with the HSE, will develop a new National Maternity Strategy this year. This will provide the strategic direction for the optimal development of our maternity services to ensure that women have access to safe, high quality maternity care in a setting most appropriate to their needs. Developing the Strategy will provide us with the opportunity to take stock of current services and identify how we can improve the quality and safety of care provided to pregnant women and their babies. The Strategy will ensure that going forward our services are fir for purpose and in accordance with best available national and international evidence,

- I have instructed the National Clinical Effectiveness Committee (NCEC) to commission and quality-assure four priority national guidelines on Sepsis, Clinical Handover, Maternal Early Warning Score and Paediatric Early Warning Score. This body of work is in progress.

Health Services Provision

 21. Deputy Caoimhghín Ó Caoláin   asked the Minister for Health   the progress to date in the implementation of the recommendations of the North-South feasibility study on co-operation in the provision of health services on the island of Ireland; and if he will make a statement on the matter.  [6916/14]

Minister for Health (Deputy James Reilly):   The North-South Feasibility Study, finalised in 2009, examined the potential for joint co-operation in health across an extensive range of health and social care services. It set out 10 priority recommendations and many of these are already being taken forward. Areas of ongoing collaboration include - child protection, cancer research, health promotion, suicide prevention, radiotherapy services, congenital cardiac surgery and a range of initiatives under the Interreg IVA funding initiative, which are being delivered by Co-operation and Working Together (CAWT). The Study was published on the websites of the Irish Department of Health and the Department of Health, Social Services and Public Safety in Northern Ireland in December 2011.

At a departmental level co-operation between the two jurisdictions is active and ongoing. "Transforming Your Care: a Review of Health and Social Care in Northern Ireland" also recommends co-operation on a number of key issues. The Deputy will be aware that I meet with Minister Poots, Minister for Health Social Services and Public Safety in Northern Ireland (DHSSPSNI) under the auspices of the NSMC to discuss and share experiences on a wide range of issues. My officials liaise with their counterparts in the DHSSPSNI on progressing areas of co-operation.

I am committed to working together with my Northern colleagues on issues of common concern and benefit.

Ambulance Service Provision

 22. Deputy Seamus Kirk   asked the Minister for Health   his views on whether the ambulance service has the necessary resources for 2014; and if he will make a statement on the matter. [6932/14]

 53. Deputy Billy Kelleher   asked the Minister for Health   his views on the concerns that have been expressed regarding the ambulance service; and if he will make a statement on the matter. [6925/14]

Minister for Health (Deputy James Reilly):   I propose to take Questions Nos. 22 and 53 together.

I am aware that concerns have been raised recently concerning ambulance service response times. In the circumstances, I have asked HIQA to bring forward its planned review of pre-hospital emergency care, which had been due to commence in Q2 2014.  The Authority will review the governance arrangements of pre-hospital emergency care services to ensure the timely assessment, diagnosis, initial management and transport of an acutely ill patient to an appropriate healthcare facility. Planning for the review has now commenced and HIQA is currently in the process of designing an Assessment Framework against the National Standards for Safer Better Healthcare.

I should also explain that the National Ambulance Service will undertake its own capacity review, to determine current and future service delivery needs. This process will examine a number of areas, including staff numbers and skill mix, as well as resource distribution.

Health Services Staff Recruitment

 23. Deputy Catherine Murphy   asked the Minister for Health   further to Parliamentary Question No. 5 of 20 March 2013, if he will indicate the reason the €20 million ring-fenced in the 2013 national service plan for the recruitment of 250 primary care posts has not been fully drawn down; if he will provide an update on the placement of new therapy posts to primary care teams across the four Health Service Executive regions, including those who have commenced working and those who are on a panel to be selected; if he will identify the regions most lacking in therapy providers and the proposals to tackle this gap in this financial year in view of the constraints on the 2014 service plan; and if he will make a statement on the matter.  [6874/14]

Minister of State at the Department of Health (Deputy Alex White):   In line with the commitment in the Programme for Government to a significant strengthening of primary care services, the National Service Plan 2013 provided for additional funding of €20 million to support the recruitment of prioritised front-line primary care team posts and enhance the capacity of the primary care sector (€18.525m for the recruitment of 264.5 posts to support Primary Care Teams and €1.475m to support the development and enhancement of Community Intervention Teams). The additional primary care posts included Public Health Nurses (PHNs), Registered General Nurses (RGNs), Physiotherapists, Occupational Therapists (OTs) and Speech and Language Therapists (SLTs).

  The breakdown of the 264.5 posts by HSE Region is as follows:

Midwifery Services

 24. Deputy Clare Daly   asked the Minister for Health   if he will remove the public services recruitment embargo in respect of midwives as a matter of urgency in view of the closure of Mount Carmel Hospital, which is placing further pressures on maternity hospitals to accommodate 1,200 additional births every year, and in view of the confirmation of severe midwifery staffing shortages, which are jeopardising pregnant women’s care and which have been known to his Department since 2006 and to the Health Service Executive since 2008 when its own KPMG study reported a shortage of 221 midwives in the greater Dublin region.  [6706/14]

Minister for Health (Deputy James Reilly):   I wish to confirm to the Deputy that there is no embargo on the recruitment of midwives in the public health service. While the numbers employed across the public service must be reduced in order to meet fiscal and budgetary targets it is recognised that certain services such as maternity are demand led and require specialist staffing. Arrangements are in place in the HSE to allow the recruitment of such staff where it has been established that there is an urgent service requirement.

The number of Staff Midwives, including the Senior Staff Grade, in the public health service at the end of 2013 was 1,341 (WTEs) - including 20 on the Graduate Placement Scheme. The number at the end of 2007 was 933 (WTEs). The December 2013 figure is noteworthy, as it shows the manner in which the HSE has the capacity to focus recruitment in specific areas where increases are required. The number employed at the end of 2012 was 1,310 and at the end of 2010 the figure was 1,178. As I have previously stated, the HSE examined the possibility of the State taking over Mount Carmel. However, given the relatively low number of births at the Hospital and the falling birth rate it was decided that it would not be necessary to do so. Arrangements have been made for pregnant patients who were attending Mount Carmel to be transferred to the public maternity hospitals.

I am satisfied that it is open to the HSE to recruit the levels of frontline staff necessary to ensure that we have safe service provision. More generally, in order to mitigate the impact on frontline services of the reduction in employment numbers, the priority is to reform how health services are delivered in order to ensure a more productive and cost effective health system.

Hospital Waiting Lists

 25. Deputy Thomas Pringle   asked the Minister for Health   the way in which he plans to ensure that hospitals enforce the new deadlines for reducing waiting lists; his views on whether hospitals have adequate resources to do so; and if he will make a statement on the matter. [6955/14]

Minister for Health (Deputy James Reilly):   The Operational Plan 2014 of the HSE Acute Hospitals Division states the specific access targets which have been determined by the SDU, sets out funding and activity requirements in relation to achieving overall reductions in respect of waiting times and provides assurance that these will be monitored on a monthly basis. In addition, targeted funding of €30m is provided to address areas of acute services which are likely to experience increased service demand, such as ED/inpatient services/day case procedures and outpatient services through the identification and utilisation of additional capacity and capability across the system. This approach of monitoring activity levels, supported by consistent robust data collection and targeted intervention where necessary, has proven to be effective in 2013.

As regards outpatient services, the HSE Service Plan aims to reduce the ratio of new to return OPD attendances from 1 (new): 2.6 (return) attendances in 2013 to 1:2 attendances in 2014. This is best international practice and its achievement will be assisted by the work of the clinical programmes and the concentrated engagement of the SDU. This, taken with the intense focus on OPD waits brought about by my initiatives in this area, will allow the HSE to reduce the actual number of OPD attendances overall whilst aiming to achieve the Government waiting list target. All of these measures will enable the HSE to provide a flexible service to patients and will require co-operation from patients in maximising resources for all.

In relation to in-patient and daycase activity, the planned activity levels presented in the HSE Service Plan for 2014 are 2% below projected outturn for 2013. This is the maximum that could be planned for, given the resources that are available to the HSE which have to be balanced across all the services they provide. Every effort will be used to deploy the €30 million fund provided to address hospital service pressures as effectively as possible to achieve and surpass service plan activity targets.

I have written to the HSE, asking them to manage waiting lists such that target waiting times are achieved by mid-year 2014 and maintained thereafter, rather than allowing waiting lists to escalate in the course of the year as has happened previously. Finally, it is important to bear in mind that the requirement to provide treatment is not guided solely by waiting list targets, but rather by the requirement to effect necessary urgent or elective treatment in case of clinical need. The ability to manage scheduled care waiting lists will also be effected by varying levels of unscheduled care activity and the resultant admissions which may result in prioritisation of emergency procedures over elective activity.