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 Header Item Written Answers Nos. 26-40
 Header Item Health Insurance Prices
 Header Item Maternity Services
 Header Item Health Services Funding
 Header Item Health Insurance Regulation
 Header Item Substance Misuse
 Header Item Hospital Services
 Header Item HSE National Service Plan
 Header Item Rare Diseases Strategy Publication
 Header Item Services for People with Disabilities
 Header Item Medical Card Data
 Header Item Accident and Emergency Services Provision
 Header Item HSE Reports
 Header Item Hospital Consultants Recruitment
 Header Item Mobility Allowance Review

Thursday, 13 February 2014

Dáil Éireann Debate
Vol. 830 No. 3

First Page Previous Page Page of 77 Next Page Last Page

Written Answers Nos. 26-40

Health Insurance Prices

 26. Deputy Dara Calleary Information on Dara Calleary Zoom on Dara Calleary asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the measures he will be taking in 2014 to reverse the decline in the numbers with private health insurance; and if he will make a statement on the matter. [6929/14]

 28. Deputy Timmy Dooley Information on Timmy Dooley Zoom on Timmy Dooley asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly his response to a Health Insurance Authority projection that the number of 18 to 29 year olds with health insurance will have fallen by almost 40,000 in March 2015 compared with July 2013; and if he will make a statement on the matter.  [6940/14]

 253. Deputy Eoghan Murphy Information on Eoghan Murphy Zoom on Eoghan Murphy asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if he will provide an update on his engagement with health insurance providers regarding the increasing cost of private insurance, the need to encourage younger people to secure private insurance, and continued preparations towards the provision of a universal health care system.  [7316/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly I propose to take Questions Nos. 26, 28 and 253 together.

  There are currently just over 2 million people, or 44.6% of the population with private health insurance. While this has fallen from a peak of 50.9% in 2008, Ireland continues to retain a high level of population holding voluntary private health insurance.  There are a number of measures being progressed by my Department to help maintain a competitive and sustainable private health insurance market.

  My immediate focus is to keep health insurance affordable for as many people as possible. I have been strongly seeking much greater cost control in the private health insurance industry and established the Consultative Forum on Health Insurance, comprising representatives from the private health insurance companies, my Department, and the Health Insurance Authority, to generate ideas to address health insurance costs. Last year, I appointed an independent Chairperson Mr. Pat McLoughlin, to work with my Department and the insurers under the auspices of the Forum on a review process to give effect to real cost reductions in the private health insurance market. Mr. McLoughlin's first report was published on 26 December 2013, and the second phase of the review has commenced and will report within three months. In particular it will study further the drivers behind rising costs in the PHI industry and seek to address them.

  I am supportive of the concept of Lifetime Community Rating (LCR) as a potential means of helping to address decreasing membership of the private health insurance market, in particular to provide an incentive for people to take out private health insurance at a younger age. This is important as the health insurance market requires a sizeable cohort of younger members, who are generally healthier, to offset the high cost of older and less healthy members, which is critical to the sustainability of our system of community-rated health insurance. My Department is working on proposals in this regard and will work, in conjunction with the Health Insurance Authority and industry stakeholders, to develop these further over the coming months.

  With regard to the provision of a universal healthcare system, intensive work is currently underway on the preparation of a White Paper on Universal Health Insurance which will provide more detail on the UHI model for Ireland, including the overall design of the model, the standard package of services, funding mechanisms and the key stages of the journey to UHI. Drafting is at an advanced stage and I intend to bring the White Paper to Government very shortly with a view to publication as soon as possible.

Maternity Services

 27. Deputy Mick Wallace Information on Mick Wallace Zoom on Mick Wallace asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly his views on the statistics on public maternity units, recently released under freedom of information, which show a wide variation in caesarean section rates, ranging from 19.1% in Sligo General Hospital to 38% in St. Luke's General Hospital, Kilkenny; and if he will make a statement on the matter.  [6953/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly I am aware of, and have noted, the variations in the rates of C-Section throughout the country. The Deputy may wish to note that a new National Maternity Strategy will be developed by my Department this year. This Strategy will determine the future model of services to ensure that women have access to safe, high quality maternity care in a setting most appropriate to their needs. As part of the development of the Strategy, it is proposed to review and evaluate current maternity services. The issue of variations in c-section rates will be considered in that context.

  Question No. 28 answered with Question No. 26.

Health Services Funding

 29. Deputy Michelle Mulherin Information on Michelle Mulherin Zoom on Michelle Mulherin asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if he will provide assurances that the necessary investment will be made in the refurbishment of St. Augustine's, McBride and D'Alton community nursing units in County Mayo in order that they will meet Health Information and Quality Authority standards after 2015, thus allowing these facilities to stay open; and if he will make a statement on the matter.  [6702/14]

Minister of State at the Department of Health (Deputy Kathleen Lynch): Information on Kathleen Lynch Zoom on Kathleen Lynch As this is a service matter it has been referred to the Health Service Executive for direct reply.

Health Insurance Regulation

 30. Deputy Michael McGrath Information on Michael McGrath Zoom on Michael McGrath asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly when he will address the regulatory position of the VHI; the reason this was not done in 2013 as previously pledged; and if he will make a statement on the matter. [6942/14]

 54. Deputy Michael McGrath Information on Michael McGrath Zoom on Michael McGrath asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly his plans for the VHI; and if he will make a statement on the matter. [6943/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly I propose to take Questions Nos. 30 and 54 together.

The Government agreed in December 2011 to address the European Court of Justice ruling of September 2011 and to work with the VHI in its application process for authorisation by the Central Bank of Ireland (CBI), subject to further Government consideration of any application for authorisation. Despite good progress, it was not possible to authorise the VHI before the deadline of 31 December 2013, and the EU Commission was notified accordingly. The Government has committed itself to continuing the work towards authorising the VHI as soon as possible and agreed that a request be made to the EU Commission to extend the deadline, with a commitment to seek to have VHI authorised by end 2014. The VHI Board has committed to this approach.

VHI's readiness for authorisation will be determined by the CBI after its assessment of VHI's application. Officials from my Department, the VHI and CBI continue to engage regularly to progress the application and my officials are also in regular contact with the EU Commission in relation to the authorisation and related issues.

Substance Misuse

 31. Deputy Finian McGrath Information on Finian McGrath Zoom on Finian McGrath asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly his position regarding dealing with binge drinking by young people; and if he will make a statement on the matter.  [6900/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly Ireland has a significant alcohol problem which needs decisive and innovative action to address it. Last October, the Government approved an extensive package of measures to deal with alcohol misuse to be incorporated in a Public Health (Alcohol) Bill. These measures are based on the recommendations contained in the Steering Group Report on a National Substance Misuse Strategy. The aim is to reduce alcohol consumption to the OECD average by 2020 (i.e. 9.1 litres of pure alcohol per capita per annum). In 2011 the average per-capita pure alcohol consumption for everyone over the age of 15 was 11.63 litres in Ireland.

A broad range of complementary measures is required to successfully reduce consumption of, and harms associated with, alcohol misuse. The package of measures to be implemented will include provision for minimum unit pricing, regulation of the marketing and advertising of alcohol, regulation of sports sponsorship, structural separation of alcohol from other products in mixed trading outlets and labelling of alcohol products. Minimum unit pricing is a mechanism of imposing a statutory floor in price levels per gram of alcohol that must be legally observed by retailers in both the on and off trade sector. Its primary function would be thus to discourage at risk levels of alcohol consumption and is targeted in particular at harmful and hazardous drinking. The Government also agreed that new low risk limits for alcohol consumption be introduced based on Irish standard drink of 10 grams of alcohol i.e 11 standard drinks or 112 grams of pure alcohol per week for women and 17 standard drinks or 168 grams of pure alcohol per week for men.

Work is continuing in my Department on the development of a framework for the implementation of these measures. A health impact assessment, in conjunction with Northern Ireland, was commissioned in 2013, as part of the process of developing a legislative basis for minimum unit pricing. The health impact assessment will study the impact of different minimum prices on a range of areas such as health, crime and likely economic impact. The study should be finalised by mid-2014.

The other measures (e.g. for the HSE, professional bodies etc) set out in the Steering Group Report on a National Substance Misuse Strategy, were endorsed by Government and are to be progressed by the relevant departments and organisations. The HSE has responsibility for implementing a number of recommendations, including a number specifically aimed at young people, and this is reflected in the HSE Service Plan for 2014.

Hospital Services

 32. Deputy Finian McGrath Information on Finian McGrath Zoom on Finian McGrath asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if he will confirm that the new cystic fibrosis unit at St. Vincent's University Hospital is able to treat all cystic fibrosis patients; and if he will make a statement on the matter.  [6898/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly St. Vincent's University Hospital is the designated National Adult Referral Centre for patients with cystic fibrosis. The hospital currently treats 330 adults, which accounts for over 50% of the CF adult population. The designated inpatient and day care CF unit in the Nutley Wing development at St. Vincent's University Hospital became operational during summer 2012 and represents a major improvement in the care of patients with CF in Ireland. The unit provides 20 single ensuite rooms which are dedicated for inpatients with CF. This reflects best practice in terms of infection control. It also provides a dedicated CF day unit which includes 10 single ensuite day treatment rooms. The hospital's management works closely with the cystic fibrosis clinicians to ensure that the needs of cystic fibrosis patients requiring inpatient treatment are met within the overall bed complement at the hospital.

With regard to the provision of services for all patients with cystic fibrosis, which are also provided in a number of other hospitals both adult and paediatric, I have asked the HSE to respond directly to the Deputy in regard to the detail of this service matter.

HSE National Service Plan

 33. Deputy Bernard J. Durkan Information on Bernard Durkan Zoom on Bernard Durkan asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the extent to which he remains satisfied regarding the ability of the Health Service Executive to deliver the full range of health services as set out in the national service plan for 2014; if particular contingency plans exist in the event of inadequacies emerging later in the year; the extent to which such situations are likely to be provided for in view of the demand-driven nature of health services; and if he will make a statement on the matter.  [6872/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly There has been considerable focus, understandably, on the demanding and challenging financial and resource constraints within which the HSE has been required to prepare and adopt its 2014 Service Plan. Similar constraints have also applied in each of the last number of years due to the emergency financial situation the Irish State has had to address. During this period the HSE and its workforce have very successfully focused on how best to minimise the impact of these unavoidable constraints on front line services often by utilising innovative and more efficient and effective ways of using scarce resources.

The delivery of the health and social care services provided for in this year's Service Plan will again focus on the dual challenge of protecting patient outcomes while, at the same time, reducing costs. This requires, inter alia, increasing emphasis on models of care that treat patients at the lowest level of complexity and provide safe quality services at the least possible cost. I have every confidence that, despite the unavoidable resource reductions already referred to, the HSE will again, throughout 2014, manage, to a very significant extent, to maintain core services while also supporting growing demand for services arising from population growth, increased levels of chronic disease, increased demand for drugs, higher numbers of medical card holders (up by 590,000 since 2008) and new costly medical technologies and treatments.

The HSE has management systems in place to monitor service delivery throughout the course of the year. Should any unexpected contingencies arise the HSE is well positioned to identify such contingencies and to promptly take any necessary remedial actions without undue delay.

Rare Diseases Strategy Publication

 34. Deputy Thomas P. Broughan Information on Thomas P. Broughan Zoom on Thomas P. Broughan asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly further to Parliamentary Questions Nos. 698 and 699 of 19 November 2013, the status of the drafting of a rare diseases plan as required under European Council Recommendation 2009/C/151/02 of 8 June 2009 on an action in the field of rare diseases.  [6696/14]

 47. Deputy Thomas P. Broughan Information on Thomas P. Broughan Zoom on Thomas P. Broughan asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if research will be carried out into the prevalence of Ehlers-Danlos syndrome here to guide the provision and allocation of necessary supports and services to children and adults affected by this condition.  [6697/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly I propose to take Questions Nos. 34 and 47 together.

  My Department is finalising a national plan on rare diseases which is set in the context of the council recommendation of 8th June 2009. While no specific rare disease is mentioned, the council decision declared that it is estimated that there are between 5,000 and 8,000 rare diseases; and hence it states that the specificities of rare diseases are:

- A limited number of patients and;

- A scarcity of relevant knowledge and expertise.

  The council's decision recognised these specificities when it recommended that member states adopt a plan to guide actions in the general field of rare diseases. It is with this in mind that my Department is finalising a generic plan to apply to the 8,000 rare diseases - including Ehlers Danlos Syndrome - estimated to exist. An essential element of this plan is addressing broad epidemiological surveillance of rare disease in Ireland as an absence of such surveillance hinders - among other things - appropriate health and social service commissioning, and work-force planning.

Services for People with Disabilities

 35. Deputy Robert Troy Information on Robert Troy Zoom on Robert Troy asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly when he will move to tackle the enormous regional disparities in the provision of early intervention teams for children; and if he will make a statement on the matter. [6938/14]

 56. Deputy Colm Keaveney Information on Colm Keaveney Zoom on Colm Keaveney asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the way he will address the absence of early intervention teams for children in many areas of the country; and if he will make a statement on the matter. [6927/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly I propose to take Questions Nos. 35 and 56 together.

The Government is committed to the provision and development of services for children with a disability, including early intervention services, within available resources. While these services are in the process of being reconfigured under the HSE's National Programme on Progressing Disability Services for Children and Young People (0-18 years), it is important to note that all HSE areas have significant early intervention services in place for children with disabilities aged zero to eighteen years. These are provided directly by the HSE or by voluntary service providers funded by the HSE.

The aim of the Programme on Progressing Disability Services for Children and Young People 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. An additional €4m has been specifically allocated in 2014 to drive implementation of the Programme. This equates to approximately 80 therapy posts.

There are almost 60 geographic-based multi-disciplinary teams established as part of the reconfigured service model under the Programme. It is hoped that a further 30 teams will be reconfigured  this year, bringing the overall total to approximately 90 teams by the end of 2014. These figures reflect all children's disability teams that provide early intervention services to children aged between zero and eighteen years. The transition to this new model is being implemented on a phased basis and, importantly, includes consultation and engagement with stakeholders, such as service users and their families.

Medical Card Data

 36. Deputy Brendan Smith Information on Brendan Smith Zoom on Brendan Smith asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the number of discretionary medical cards currently in use; and if he will make a statement on the matter. [6948/14]

Minister of State at the Department of Health (Deputy Alex White): Information on Alex White Zoom on Alex White The HSE has informed me that, as of 1 January 2014, there are currently 1,849,380 medical cards in circulation and, of this figure, 50,294 were granted on a discretionary basis.

Accident and Emergency Services Provision

 37. Deputy Caoimhghín Ó Caoláin Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the action that will be taken to address the crisis situation at Tallaght hospital as highlighted by the INMO; and if he will make a statement on the matter.  [6920/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. 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 trolley count. These percentages are equivalent to 237 and 4,015 fewer patients on trolleys respectively.

  There is intensive engagement between the SDU, hospitals, community services and regional management to address peak pressure in Emergency Departments where it arises, through a range of different measures. Tallaght Hospital has recently experienced a surge in activity, with a 5% increase in ED attendances and a 13% increase in admissions. The hospital has taken appropriate action to manage the situation and the CEO has provided assurance that the hospital is providing adequate patient care.

  I am aware that the question of staffing had been raised and I am advised in this regard that Tallaght had 938 nurses in January 2014, more than at the same time the previous year, is actively recruiting and is using agency staffing where that is needed to address vacancies.  As with all hospitals experiencing pressure in the early weeks of 2014, Tallaght Hospital is making ongoing process improvements in its Emergency Department, in collaboration with the HSE SDU. These measures have led to significant improvements in the patient experience times in Emergency Departments.

HSE Reports

 38. Deputy Lucinda Creighton Information on Lucinda Creighton Zoom on Lucinda Creighton asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if he will provide the total number of Health Service Executive internal written reports that have been conducted into perinatal deaths since the HSE came into being; the total number of written reports that have been conducted into perinatal deaths where parents of those children have not been informed that such a report exists; the reasons in such cases those parents have not been informed that such a report exists; and if he will make a statement on the matter. [6892/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly The Health Service Executive conducts investigations into serious incidents including perinatal deaths and the Executive's Risk and Incident Investigation Process provides a framework for conducting such investigations. Investigations of serious incidents including baby deaths have been conducted under the Process with support provided by the Executive's National Incident Management Team as appropriate. The Department does not receive information on HSE investigations as a matter of course.

The Chief Medical Officer of my Department is currently preparing a report for me on the issues at Portlaoise. I have assured the families concerned that the process will be transparent, that they will be involved and will have the opportunity to see the report in advance of the release. The findings of the CMO's report will inform any subsequent work to be undertaken by HIQA or others including any wider review.

Hospital Consultants Recruitment

 39. Deputy Billy Kelleher Information on Billy Kelleher Zoom on Billy Kelleher asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly if he and the Health Service Executive will be making any changes to the terms and conditions in place for the recruitment of new hospital consultants; and if he will make a statement on the matter. [6923/14]

 50. Deputy Caoimhghín Ó Caoláin Information on Caoimhghín Ó Caoláin Zoom on Caoimhghín Ó Caoláin asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the number of consultant posts, by discipline and hospital site, unfilled at time of responding; the posts that have been advertised and the period of time that each post has been unfilled; the reason he believes some posts remain unfilled for inordinate periods; and if he will make a statement on the matter. [6919/14]

 266. Deputy Bernard J. Durkan Information on Bernard Durkan Zoom on Bernard Durkan asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly the extent to which the number of hospital consultants available here compares to that in other jurisdictions; the degree to which it is anticipated to improve this situation; and if he will make a statement on the matter. [7378/14]

Minister for Health (Deputy James Reilly): Information on Dr. James Reilly Zoom on Dr. James Reilly I propose to take Questions Nos. 39, 50 and 266 together.

Notwithstanding the need to reduce the numbers employed across the public service in order to meet fiscal and budgetary targets, the HSE has the capacity to recruit consultants. Arrangements are in place in the HSE to allow the recruitment of front-line staff where there is an established service need. 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. The ability of the public service to attract and retain high quality consultants shapes the extent to which the HSE can maintain and develop the range of health services required.

If the health services are to continue to provide consultant-level opportunities for doctors to replace consultants who retire and eventually to expand overall capacity, this can only happen on the basis of a lower-cost model, hence the decision to reduce the pay of new consultants by 30%. This decision is being modified to enable consultants currently working in permanent posts within the public service to move to different posts, while retaining their existing salaries. Application of the revised guidance will support consultant mobility. Allowing serving clinical consultants retain their existing salaries will remove a blockage on movement within the system at present. This mobility will, in due course, also facilitate the roll-out of the Hospital Group model with staff appointed to the Group rather than being confined to specific locations.

It is Government policy to move to a consultant delivered service and there has been a significant increase in the number of consultants (Whole Time Equivalents) over the past 5 years. The number increased from 2,260 in December 2008 to 2,555 in December 2013. However, the rate of increase has slowed over the past three years. There are some specialties in which there is an international shortage and which have been traditionally difficult to fill, regardless of the salary scale. There are also some hospitals to which it has historically been difficult to attract applicants, in particular smaller hospitals that have onerous rosters due to the limited number of consultants. The establishment of Hospital Groups will also help to address this issue, as this will allow doctors to be appointed as group resources - instead of to just one hospital.

I established the MacCraith Group last July to carry out a strategic review of medical training and career structures. The Group submitted an interim Report focused on training to me in December and is now progressing examination of the career structure to apply on completion of specialist training with a view to reporting to me by the end of March. Broader issues relating to recruitment and retention of NCHDs and consultants will be given further consideration on receipt of this report.

I have referred the Deputy's questions seeking data to the HSE for direct reply.

Mobility Allowance Review

 40. Deputy Timmy Dooley Information on Timmy Dooley Zoom on Timmy Dooley asked the Minister for Health Information on Dr. James Reilly Zoom on Dr. James Reilly when a replacement for the mobility allowance will be brought forward; and if he will make a statement on the matter. [6941/14]

Minister of State at the Department of Health (Deputy Kathleen Lynch): Information on Kathleen Lynch Zoom on Kathleen Lynch In November 2013, the Government decided that the detailed preparatory work required for a new travel subsidy scheme and associated statutory provisions should be progressed by the Minister for Health, in consultation with other relevant Ministers. The Department of Health is working to progress this matter in line with the Government's decision. The Department will draw on the work, last year, of the Review Group on Transport Supports for People with Disabilities and the Inter-Departmental Group tasked by Government to consider details of a statutory replacement for the discontinued Mobility Allowance and Motorised Transport Grant Schemes.


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