Joint Committee on Health and Children
Thursday, 17 October, 2013
Question 1 (Deputy Catherine Byrne)
To ask the Minister what will be the future of the site at Our Lady's
Hospital Crumlin?
Response:
The site of Our Lady’s Children’s Hospital Crumlin is owned by the Board
of Our Lady’s Children’s Hospital Crumlin. The hospital will continue to
provide acute paediatric care for local/national patient base for a number
of years to come. It will be a matter for the Board of Our Lady’s Children’s
Hospital Crumlin, in consultation with the HSE & DOH, at the appropriate
time, to consider the most appropriate future for the site when service
provision is moved to the new children's hospital currently being
developed on the St. James’s Hospital campus.
Question 2 (Deputy Catherine Byrne)
To ask the Minister what measures have been taken to reduce the cost of
medication/drugs and what phase are we at regarding the introduction of more
types of generic drugs?
Question 11 (Deputy Eamonn Maloney)
Would the Minister explain why Drugs which are manufactured in Cork, sell in
the Republic of Ireland at 6 times the price they are sold for in Northern Ireland.
Response
The prices of drugs vary between countries for a number of reasons, including
different prices set by manufacturers, different wholesale and pharmacy markups, different dispensing fees and different rates of VAT.
The State has introduced a series of reforms in recent years to reduce
pharmaceutical prices and expenditure. These have resulted in reductions in the
prices of thousands of medicines. Price reductions of the order of 30% per item
reimbursed have been achieved between 2009 and 2013; the average cost per
items reimbursed is now running at 2001/2002 levels.
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A major new deal on the cost of drugs in the State was concluded with the Irish
Pharmaceutical Healthcare Association (IPHA) in October last. It will deliver a
number of important benefits, including
o
o
o
o
significant reductions for patients in the cost of drugs,
a lowering of the drugs bill to the State,
timely access for patients to new cutting-edge drugs for certain
conditions, and
reducing the cost base of the health system into the future.
The IPHA agreement provides that prices are referenced to the currency
adjusted average price to wholesaler in the nine EU member states. The prices
of a range of medicines were reduced on 1 January 2013 in accordance with the
agreement.
The gross savings arising from this deal will be in excess of €400m over 3 years.
€210 million from the gross savings will be available to fund new drugs.
A new agreement has also been reached with the Association of Pharmaceutical
Manufacturers in Ireland (APMI), which represents the generic drugs industry.
From 1 November 2012, the HSE will only reimburse generic products which are
priced at 50% or less of the initial price of an originator medicine. This
represents a significant structural change in generic drug pricing and should lead
to an increase in the generic prescribing rate. It is estimated that the combined
gross savings from the IPHA and APMI deals will be in excess of €120 million in
2013.
The Health (Pricing and Supply of Medical Goods) Act 2013, which came into
operation on the 24th of June, introduces a system of generic substitution and
reference pricing. This legislation will promote price competition among suppliers
and ensure that lower prices are paid for these medicines resulting in further
savings for both taxpayers and patients.
Under the Act, the Irish Medicines Board (IMB) is responsible for the assessment
for interchangeability of medicines. Generic substitution will be introduced
incrementally with the IMB prioritising those medicines which will achieve the
greatest savings for patients and the State. The Board is in the process of
reviewing an initial 20 active substances, which equates to approximately 1,500
individual medicines. They include statins, proton pump inhibitors, angiotensinconverting-enzyme (ACE) inhibitors and angiotensin II receptor blockers.
The first List of Interchangeable Medicines, containing groups of atorvastatin
products, was published by the IMB on the 7th August. The second and third
lists containing groups of esomeprazole and rosuvastatin products were
published on 20th and 24th September respectively. Once the IMB has assessed
the initial 20 priority products, then a further list of priority products will be
identified and assessed by the IMB and the process will continue until all
medicinal products on the reimbursable list have been assessed.
Once a List of Interchangeable Medicines is published by the IMB a two stage
price reduction process gets underway. First, under the terms of the 2012 APMI
Agreement, the price of all relevant products fall by 20%, e.g. atorvastatin
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prices were reduced from 1st September while esomeprazole and rosuvastatin
prices were reduced on 1st October . Secondly, the legislation also provides that
the HSE may set a reference price for each group of interchangeable products
published on the List of Interchangeable Products with a view to introducing
further significant price cuts.
Reference pricing involves the setting of a common reimbursement price, or
reference price, for a group of interchangeable medicines. It means that one
reference price is set for each group of interchangeable medicines, and this is
the price that the HSE will reimburse to pharmacies for all medicines in the
group, regardless of the individual medicine’s prices. It is expected that the first
reference price for atorvastatin products will be implemented by November and,
subsequently, reference prices for esomeprazole and rosuvastatin products will
be implemented by the HSE in accordance with the timelines set out in the
legislation. Reference pricing will ensure that generic prices in Ireland will fall
towards European norms.
Question 3 (Senator Colm Burke)
Would the Minister and the HSE outline the following:
(a)
The total number of Consultant Posts currently vacant in HSE
Hospitals.
(b)
The total number of Consultant Posts currently vacant in
Voluntary Hospitals.
(c) The total number of Locum Consultants presently in place in the
HSE Hospitals.
(d)
The total number of Medical Consultants who are employed
under an Agency Contractor in the HSE Hospitals.
Response:
As of September 2013 there were 2,653 approved Consultant posts in HSE and
HSE-funded hospitals and agencies.
A large number of posts are joint appointments between HSE and HSE-funded
agencies – meaning the Consultant has a commitment to two or more separate
hospitals or agencies.
There were a total of 2,538 consultants employed in the public health system in
September 2013, as follows:



1,528 Consultants were employed by the HSE;
966 were employed in voluntary hospitals funded by the HSE; and
the remaining 64 were employed in primary, community and continuing care
agencies funded by the HSE.
The number of approved posts exceeded Consultants employed by 115 –
indicating that there were 115 approved posts vacant at that time, as follows:
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

HSE – 69 posts
Voluntary hospitals – 48 posts
At any one time there are approximately 100 locum Consultants engaged in HSE
and HSE-funded hospitals. In some cases they will occupy a joint appointment
between a HSE and a HSE-funded agency.
Question 4 (Senator Colm Burke)
In the Annual Report published by the HSE for the year ended the 31st
of December 2012 it sets out that over € 3.4billion euros was paid by the HSE
to Hospitals and Organisations which are not under the direct control of the HSE
and the Department of Health.
Would the Minister and the HSE confirm the following:
a) If Audited Accounts have been made available for each of these Hospitals and
Organisations to the HSE.
b) If each of these Voluntary Hospitals or Organisations can be individually
audited by the Accountant Generals Office or by Auditors appointed by the HSE
or the Department of Health.
c) If the pay scale in each of these Organisations for the different grades of
employees is in line with the pay scale which applies to equivalent grade for HSE
employees.
d) Are the full details of the salary of Senior Management and Chief Executive
Officers of the these Voluntary Hospitals and Organisations disclosed to the HSE
and the Department of Health and if the pay scales which apply are similar to
the pay scales which would be paid to an equivalent position in a HSE
Hospital. In addition to salary which is paid to these staff in Hospitals and
Voluntary Organisations, is the HSE or the Department of Health aware of any
other remuneration which is being paid in addition to salary.
Response:
A If Audited Accounts have been made available for each of these Hospitals and
Organisations to the HSE.
Reply:
The primary legal framework under which the HSE provides financial support
to non-statutory service providers is set out in the Health Act 2004. To
ensure the HSE and non-statutory sector are meeting their respective
obligations, the HSE has developed a formalised national governance
framework to manage the funding provided to the non-statutory sector. See
extract for HSE Statement of Internal Financial Control (SIFC) attached at
Appendix 1. Included in this framework is a requirement that annual financial
4
statements are submitted by all funded agencies on an annual basis. Where
funding is in excess of €150K audited accounts are required. It is a condition
of ongoing funding that these accounts are submitted each year by the
relevant organisations.
The table below based on 2012 Annual Financial Statements (AFS), shows
that 0.4% of the funded agencies receive over 56% of the total non-statutory
funding and nearly 80% of all agencies receive only 1% of the funding.
Funding Range
No. of Agencies
Amount of Funding
% of Total Funding
€m.
> €100 million*
> €50m < €100 million*
> €10m. < €50 million**
> €1m. < €10 million
> €100,000 < €1million
< €100,000
8
4
36
131
442
2,311
1639
316
898
423
145
42
47.3%
9.1%
25.9%
12.2%
4.2%
1.2%
* Made up of the larger Voluntary Hospitals and four larger Disability providers.
** Made up of the remaining larger Voluntary Hospitals, Disability and Older Persons service providers
B
If each of these Voluntary Hospitals or Organisations can be individually
audited by the Accountant Generals Office or by Auditors appointed by the
HSE or the Department of Health.
Reply:
The C&AG office can inspect the books and accounts of any organisation
which receives 50% or more of its annual income from the State. Voluntary
organisations are audited by private sector firms of auditors appointed by the
board of the organisation. As these organisations are legal entities it would
not be appropriate for the HSE to appoint auditors to audit their
affairs. However in circumstances where the HSE is concerned about
matters of financial governance in an organisation funded by it the HSE can
arrange for an examination of the books and accounts of the organisation.
The Service Level Arrangements / Grant Aid Agreements with funded
organisations provide the HSE with access to accounts, data and records of
all transactions arising out of or related to the purpose of the grant. (See
extract below).
Access Rights as defined in the Service Level Agreement
1.1
The Executive shall be entitled to inspect and review the performance and provision
of the Services by the Provider and may arrange for an independent party to inspect
and review the same throughout the Duration of the Arrangement.
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1.2
C
Any person duly authorised by the Executive (“Authorised Person”) may visit the
Provider’s premises on reasonable written notice to carry out an audit and/or
inspection of the provision of the Services. Such audits and inspection shall include,
inter alia, the inspection, monitoring and assessment of the Provider’s premises,
facilities, staff, records, equipment and procedures. The Provider shall give all such
assistance and provide all such facilities as the Authorised Person may reasonably
require for such audit or inspection.
If the pay scale in each of these Organisations for the different grades of
employees is in line with the pay scale which applies to equivalent grade for
HSE employee
D Are the full details of the salary of Senior Management and Chief Executive
Officers of the these Voluntary Hospitals and Organisations disclosed to the
HSE and the Department of Health and if the pay scales which apply are
similar to the pay scales which would be paid to an equivalent position in a
HSE Hospital
E
In addition to salary which is paid to these staff in Hospitals and Voluntary
Organisations, is the HSE or the Department of Health aware of any other
remuneration which is being paid in addition to salary.
Reply to C, D and E above:
The Service Level Agreement (SLA) documentation contains a clause which
requires each voluntary and community funded agency to adhere to salary
scales not exceeding public sector norms or where the agency is funded
under Section 38 of the Health Act 2004 they must conform to the
consolidated pay scales.
The SLA also sets out a requirement for the organisations to comply with all
requests for information by the HSE. In 2013, the SLA was amended to
include a requirement for the declaration of the salary and other allowances
paid to senior employees at Grade VIII equivalent or above
The HSE conducted an internal audit into remuneration rates for senior
personnel in Section 38 agencies during 2012/2013. The audit found that
there is a wide range in the level of pay to CEOs of these agencies. These pay
rates developed over many years on an agency by agency basis and do not
necessarily reflect the comparable size, scale and complexity of each
organisation today. This matter is currently being addressed jointly between
the HSE and Department of Health with a view to bringing the pay rates of
Section 38 agencies into line with the DOH salary scales and a pay policy will
issue shortly in this regard.
The SLA for section 39 agencies sets out a requirement that the agency does
not pay or subsidise salaries, expenses or other perquisites which exceed
those normally paid within the public sector. The extract attached of the
SIFC makes reference to the updates in 2012 “to ensure that Section 38
clause to ensure only salaries within public sector norms are paid has been
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made so as to include all funded agencies.” This extract also outlines the
detail of the operation of the Register of Non-Statutory Agencies Service
Arrangements and Grant Aid Agreements with 2,680 separate agencies to a
value of in excess of €3bn.
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Appendix 1:
HSE Statement of Internal Financial Control
The primary legal framework under which the HSE provides financial support to non-statutory service
providers is set out in the Health Act 2004. To ensure the HSE and non-statutory sector are meeting their
respective obligations, the HSE has developed a formalised national governance framework to manage the
funding provided to the non-statutory sector. A cornerstone of this governance framework is the application of
national standard governance documentation to all agencies funded to provide personal health and social
services. This national standard governance documentation was developed with the agreement of all major
service providers and has been in operation since 2009; following a consultation process with the relevant
stakeholders it was reviewed in 2011 with newly updated documentation in use from 1 January 2012. Changes
made include:
 greater emphasis is being placed on collaboration between agencies and the HSE in
relation to procurement; and
 a clause has been inserted requiring the recruitment of all NCHDs (not filling approved
training posts) to be carried out through the HSE National Recruitment Office/Public
Appointments Service.
 An extension of the Section 38 clause to ensure only salaries within public sector norms
are paid has been made so as to include all funded agencies; and
 A requirement to comply with the conditions of the 2010 Voluntary Early Retirement
and Voluntary Redundancy schemes was also added for all agencies.
 In addition the schedules to the Service Arrangement were also reworked, to include
additional and detailed information of services, to enable the governance
documentation to be a more comprehensive and useful framework for the totality of the
service and funding relationship with each Agency.
Additional changes were made to ensure the documentation reflected current legislation,
regulation and government department directives. A number of editorial changes were, also,
required to address such matters as changes in the HSE’s organisational structure and job
titles. The National Standard Suite of Documentation now also includes a Service
Arrangement for use with “commercial / for profit” agencies providing health and personal
social services, ensuring consistency of approach, in all of the non-statutory sector.
 A Register of Non-Statutory Agencies - Service Arrangements and Grant Aid Agreements, is
in operation. This provides local, regional and national management information on 2,680
separate Agencies which operate 4,381 separate funding arrangements to a value of
approximately €3.27 billion. This Register is managed by the National Business Support Unit
(NBSU) and has created a unique identifier for each agency allowing the maintenance of key
information on each separate funding arrangement which includes both current and historic
funding, compliance with national standard governance documentation, and key contact
details. This is available on the HSE intranet site as a reference guide for all HSE managers.
From the first quarter of 2012, monthly performance monitoring statistics and reports were
prepared. The figures for 2012 funding report a compliance rate of 93.69% of funding covered
by completed governance documentation. All of the 16 Voluntary Hospitals had signed
Service Arrangements in place for 2012. Organisations which did not complete the signing
process for 2012 have been formally communicated with and the appropriate actions have
been taken, resulting in some cases in the cessation of contracts. The HSE Management Team
has ensured a continued focus on compliance with the governance framework and has
included this as a key performance indicator for both corporate and regional reporting.
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Question 5 (Senator Colm Burke)
Currently over 2,000 Hospital Doctors are employed by the HSE or
VoluntaryHospitalson six month contracts only. The Minister has announced that
it is proposed to put in place a new system whereby these Doctors would be
offered Contracts of a 2 or 3 year duration. Would the Minister and the HSE
outline:
(a) If any members of the staff of the HSE or Management have met with the
Medical Training Bodies on this issue.
(b) If progress has been made about setting up a structure where the Contracts
offered to the Hospital Doctors would be in accordance with the training
programme established by the Medical Training Bodies.
(c) When is it expected that these new Contracts will be made available to
Hospital Doctors.
(d) Has any meeting taken place between the HSEHospitalsand
VoluntaryHospitalswith a view to putting place the necessary infrastructure in
order to allow 2 or 3 years Contracts to be offered where the Doctor may be
required under the training programme to work in different Hospitals.
Response:
Matters relating to the introduction of longer term contracts for NCHDs are
currently the subject of discussions with the Irish Medical Organisation as part of
the process to agree an approach to reduce NCHD working hours and achieve
EWTD compliance and as part of the Graduate Retention process agreed under
the Public Service Stability Agreement (Haddington Road Agreement or HRA).
The HRA states that:
“Retention of graduates of Irish Medical Schools - The parties have committed to
review the current Public Health & Community Medicine, NCHD and Consultant
career structure with the aim of further developing the career and training
pathways from Intern to Consultant / Specialist level. This will take account of
service needs, training and service posts, the health reform programme, the
urgent requirement to reduce NCHD working hours and developments in relation
to EU legislation. The overall objective is the retention of graduates of Irish
Medical Schools within the public health system and the attraction back to
Irelandof such graduates - where they have left previously. The Management
side and the IMO will begin the process by June 2013.” (HRA, Appendix 7, 1,
p38)
The above process commenced in June and continues.
Separately, the Minister for Health has established a group chaired by the
President of Dublin City University, Brian McCraith to address the NCHD Career
structure and make recommendations re same.
9
An outcome is awaited from these processes prior to meetings with the
postgraduate training bodies or issue of contracts.
As previously indicated, at a broad level, NCHDs are divided into training and
non-training or service posts. The duration of the employment contract they hold
is determined by the nature of their training arrangements, the location of their
employment, whether they rotate between different sites and who their
employer is.
NCHDs in training posts are either Interns – who hold a one year contract; Basic
Specialist Trainees (Senior House Officers and sometimes Registrars) – who
participate in structured two / three training schemes but may hold multiple 6
month or annual contracts depending on whether they move location or change
from one employer to another; or Higher Specialist Trainees (Specialist
Registrars and Senior Registrars) – who participate in training schemes varying
from four to six years.
Some Higher Specialist Trainees hold multi-year contracts but others hold
multiple annual contracts as they change location and/or employer over the
course of their training.
It is important to differentiate between the NCHD’s participation in a multiannual training scheme from employment. Entry to postgraduate training and
continued participation on same is determined by postgraduate training bodies
and is subject to the NCHD obtaining registration on the trainee specialist
division of the Medical Council’s register. While the NCHD may have therefore
secured a place on a multi-annual scheme, they can often vary where and for
how long they work in particular sites as part of that scheme.
In that regard while they have a multi-annual training arrangement, they may
choose to move between a wide range of different employers as they participate
in that training. This can include moving between HSE hospitals or agencies and
HSE-funded – but legally independent – hospitals or agencies.
In legal terms, while the HSE is a single employer, it is obliged by the Revenue
Commissioners to maintain multiple separate payrolls because of its size. This
has meant that HSE employees leaving one payroll for another – including
NCHDs – are effectively required to transfer employment to recommence in a
different HSE area. It is anticipated that the move to a Shared Service model in
the coming years will address this issue.
Question 6 (Deputy Caoimhghín Ó Caoláin)
The impact of Budget 2014 on the health, safety, quality of care and
provision of services for patients in our public health system and the
need to 'healthcare-proof' this and all future Budgets.
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The health care system has, over recent years, had to deal with a number of
major challenges, including reduced overall levels of funding and employment
levels, demographic pressures, and increased numbers of people with chronic
illnesses.
Despite this, major improvements in mortality and morbidity rates have been
achieved in certain core areas, including diseases of the circulatory system,
where the death rate per 100,000 has fallen by almost 36% since 2002, and
overall cancer rates, which have witnessed an 8% overall reduction in the same
period.
This has been achieved during a period when the average length of stay in acute
hospitals has also reduced and the number of patients receiving the treatment
they require without having to stay in hospital (that is day case patients) has
increased as a percentage of total discharges by over 50%.
The 2013 Service Plan required the HSE to continue to focus its delivery of
services on the dual challenge of protecting patient outcomes while, at the same
time, reducing costs. 2014 will be no different in this regard and any measures
impacting on the health system as a result of Budget 2014 will again be
assessed against these key criteria – with the outcomes of this consideration set
out in the HSE’s National Service Plan for 2014, which will be submitted to me
for consideration within a matter of weeks of the Budget.
The National Service Plan, in setting out the operating framework for the
delivery of HSE services throughout 2014, will look to deliver the maximum level
of safe quality services possible, with prioritisation, where necessary, of certain
services to meet the most urgent needs.
The Plan will also set out targets in respect of each programme area to ensure
that performance can be evaluated throughout the year in order to identify any
emerging areas of concern, and, should any such concerns arise, allow for the
implementation of necessary remedial measures without delay.
Question 7 (Deputy Caoimhghín Ó Caoláin)
The need to make immediate progress in reform of hospital medical staffing and
in our medical training and recruitment system to ensure compliance with the
European Working Time Directive for non-consultant hospital doctors, to recruit
and deploy doctors in sufficient numbers and appropriate grades, including new
grades as required (and providing a proper career path), in order to guarantee
safe practice, better working conditions and, above all, improved care for
patients.
Response:
Non consultant doctors play a fundamental role in the provision of services in
Irish hospitals. The current NCHD workforce comprises approximately 4,910
NCHDs, including 570 Interns, 1,812 Senior House Officers (SHOs), 1,620
Registrars and 908 Specialist / Senior Registrars.
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Of the 4,910, 80% hold structured training posts; while 20% of NCHDs hold
service posts.
In recent years the HSE has increased the proportion of NCHDs in formal
training schemes from less than 40% to approximately 80%, increased the
number of Specialist Registrar posts by 60% and this year, will further increase
intern posts from 570 to 639.
Full implementation of the European Working Time Directive (EWTD) poses very
significant challenges for the Health Service and has been the subject of a series
of reports over the past decade, including the Report of the National Joint Study
Group on Working Hours of NCHDs (2001), Forum on Medical Manpower (2001),
National Task Force on Medical Staffing (2003), Hospital Activity Analysis
(2005), and the National Implementation Group (December 2008).
The HSE in conjunction with other between health / public service management
(i.e. Department of Health, Department of Public Expenditure) have met the
Irish Medical Organisation (IMO) to identify and discuss further actions that can
be put in place to reduce working hours for Non-Consultant Hospital Doctors
(NCHDs) and achieve EWTD compliance. Discussions have taken place under the
auspices of the Labour Relations Commission (LRC).
The HSE and IMO (in partnership with the Department of Health and Department
of Public Expenditure) have agreed the following actions to achieve EWTD
compliance:






Establishment of a national group to oversee verification and implementation
of measures to reduce NCHD hours, eliminate shifts in excess of 24 hours
and achieve EWTD compliance.
Creation of an NCHD Committee and a consequent Lead NCHD role aligned
with the Clinical Directorate structure to provide for a formal link between
NCHDs and hospital management. The Lead NCHD will report to the Clinical
Director. Key areas of work for the NCHD Committee and Lead NCHD will
include NCHD welfare, training, EWTD, executive decisions affecting NCHDs
and individual/group grievances.
Roster changes and revised work practices to commence during November.
Elimination of shifts in excess of 24 hours to commence at the earliest
opportunity after verification visits.
Health service management to prioritise resource allocation to promote full
EWTD compliance in 2014.
Agree guidance on measures to promote EWTD compliance, implementation
of a maximum 24 hour shift and associated best practice at hospital level.
Requirement for each hospital to formally establish a Hospital-level EWTD
Implementation Group. The Hospital EWTD Implementation Group will be
subject to direction and guidance from the National Group.
In parallel to these actions, the HSE is also seeking to rapidly introduce an
electronic time and attendance system in each acute hospital. In the interim,
hospitals will act immediately – where technologically feasible - to ensure NCHDs
are covered by existing electronic time and attendance systems by 1st November
2013.
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Implementation and achievement of a maximum 24-hour shift will then be
verified jointly by the HSE and IMO to ensure changes are compliant with
contractual and other requirements and with the involvement of the LRC as
appropriate.
To ensure that there are sufficient numbers of NCHDs recruited, the HSE has
also initiated the following actions:

Transfer of NCHDs to General from Supervised Division - the HSE has worked
with the Medical Council since November 2012 to support the transfer of just
over 200 NCHDs from the Supervised to the General Division, prior to their
Supervised Division registration expiring in September 2013.

College of Physicians and Surgeons of Pakistan – the HSE has worked
together with the College of Physicians and Surgeons of Pakistan to place
trainees in a structured training programme in Ireland for two years.

Ongoing local and national recruitment - the normal NCHD recruitment
process continues to take place in parallel to the measures above following
advertising by the National Recruitment Service nationally and
internationally.

Retention of Irish medical graduates - the HSE is a partner in an NCHD
Graduate Retention initiative established in 2012. As part of this initiative
appropriate support services for trainee doctors are being identified
To ensure that intern welfare is promoted as well, the HSE has introduced Intern
Networks to ensure coordination of intern placement and transition into training
schemes on successful completion of the Intern Year. In addition, the HSE is
working with the Postgraduate Training Bodies to ensure training contracts are
aligned with NCHDs career aims, service and workforce needs.
Question 8 (Deputy Caoimhghín Ó Caoláin)
The need to maintain and upgrade public nursing home facilities to meet HIQA
standards, to invest sufficiently to do so and to ensure that the public nursing
home sector is enhanced, given the growing need for, and overall shortage of,
nursing home beds and the over-reliance on private nursing home provision,
leading to 'cherry-picking' by private providers with higher dependency
applicants for nursing home places left at the back of the queue.
Response:
Current Approach to Service Delivery
Government policy on Services for Older People recognises the implications of
the demographic changes facing Ireland and in particular the projected increase
in the over 65 population over the next 20 years. It is recognised, health and
personal social services for older people need to be developed, planned and
reconfigured in a coordinated way to support this projected demand, with
particular focus on the following core elements:
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 Supporting the older person to live at home for as long as possible by
providing appropriate community based services on an assessed needs
basis.
 Providing, when required, accessible acute hospital care including inpatient
services through a Consultant Geriatrician where appropriate and to support
the older person in the acute hospital setting to return home or to an
appropriate setting, preserving and supporting their independence in as far
as possible.
 Providing transitional care facilities where required through rehabilitation,
convalescence and respite to minimise the need and avoid unnecessary
acute hospital care as well as providing such requirements when acute care
is no longer required.
 When a person can no longer remain at home, providing person centred
residential care in accordance with the Nursing Home Support Scheme 2009
(NHSS) and the requirements of the National Residential Care Standards, as
inspected by HIQA since July 2009.
An integrated model of care for older people is being developed which will
provide for appropriate care in appropriate settings along a continuum from
home and community based services through acute intervention to long term
residential care with older persons needs and preferences being central to the
decision making that is required throughout the process.
In respect of long stay care services, the Department of Health is working
closely with the HSE to develop an overall plan regarding future public provision
of long stay residential care services. This plan will reflect both national and
regional requirements and will have regard to HIQA standards as well as
statutory requirements in respect of health & safety and fire regulations, all of
which pose challenges for community nursing units across the Country.
While the HSE have reviewed the viability of their existing facilities and
submitted its initial findings to the DOH, this is only the first part of the planning
process. The review of the NHSS (Nursing Homes Support Scheme) has also
commenced and the findings from this review will also influence the future plans
for development of residential care services including the balance to be struck
between public and private provision and the requirements to meet HIQA
standards by 2015.
CNU Developments
The CNU construction programme which began in 2006 has now been
completed. Over the past two years, a number of new public long stay beds
have come on stream in the following locations:



Ballincolling & Farranlea Road in Cork
Beauford CNU in Navan
Raheny CNU, St. Vincent's Fairview, Clonskeagh CNU, the Orthopaedic
Hospital in Clontarf, Dublin.
14


Tralee Community Unit in Kerry and earlier this year a new Unit in
Kenmare in Kerry.
Clan Lir Unit in St Mary’s Mullingar
These developments have provided additional bed capacity as well as a number
of replacement beds in order to meet HIQA standards. In addition minor capital
continues to be invested as part of our programme of refurbishing existing public
facilities to enable all the public infrastructure to meet HIQA regulations by
2015.
Home Care & Community Support Services
While it is essential to continue to invest in the development of our long-stay
bed capacity, particularly having regard to our ageing population, it is equally
important to further develop home care and community support services. In line
with national policy the HSE is seeking to reduce the percentage of older people
in long stay care by investing in community services to facilitate persons staying
at home for as long as possible. Our emphasis over the next number of years
will be in the development of an integrated model of care with the emphasis on
home care and other community support services such as day-care, respite and
convalescent care as well as intermediate and rehabilitation services, to avoid
hospital admission or where acute care is required to support early discharge,
while providing access to appropriate quality long term residential care when
appropriate.
Single Assessment Tool (SAT)
The HSE recognises the importance of the assessment of need process in
identifying dependency levels and in matching the needs of the individual with
the services provided in a nursing home. In this regard a key priority for the
DOH and the HSE has been the development of a SAT to better support
integrated service delivery and best practice in older person’s care.
Further, the development of SAT is aimed at providing better monitoring and
better reporting of assessment data to help ensure better value for money in
planning, improving quality of care through clinical decision support, and by the
tracking of key measures of quality. Work is well underway on developing the
SAT tool.
Through the implementation of SAT, an older person’s entry into the Nursing
Home Support Scheme (NHSS), Home Care Package (HCP) and Home Help (HH)
schemes will be based on a standardised assessment of their needs, improving
equity and the delivery of timely and consistent care for the older person in
hospital or living at home. Prioritisation for those most in need will also be
addressed from both a service urgency and resource allocation perspective.
Question 9 (Deputy Eamonn Maloney)
On the occasion of appointments to the Children's Hospital Group Board and to
the National Paediatric Hospital Development Board, it was stated that an
analysis was being carried out to determine the location and number of Urgent
15
Care Centres and in view of the earlier commitment to locate an Ambulatory and
Urgent Care Centre on the campus of Tallaght Hospital, would the Minister
outline the result of the analysis or when it will be published and when the roll
out of the Urgent Care Centres can be expected.
Response
The provision of a single national tertiary paediatric hospital follows on from the
recommendation of the 2006 McKinsey report, Children’s Health First. The
McKinsey report also recommended that there should be adequate geographic
spread of A&E facilities with 2-3 in the Greater Dublin Area, with treatment at
urgent care centres being another option. As part of the development of the
RKW Framework Brief for the new children’s hospital in 2007 the requirement for
satellite centres separate to the main hospital was considered. That report
recommended developing an Ambulatory and Urgent Care Centre (AUCC) on the
grounds of Tallaght Hospital, on the basis of access, population density and
projected activity. The Tallaght AUCC was planned to provide urgent care,
outpatient care including specialist outpatients, and daycase services.
Following the announcement on 6 November 2012 that the main hospital was to
be located on the St James’s campus, it was acknowledged that there would be a
requirement to review the previous plan for an AUCC. The review has been
ongoing and is almost complete. The National Clinical Programme for Paediatrics
has been closely involved in this work. In addition, consultation on the
appropriate model has taken place with the surgeons and anaesthetists from the
three hospitals, with paediatric ED consultants and with paediatric hospital
management.
The number and location of these satellite centres in the Dublin area is a key
decision, as the size, activity and infrastructure of these satellite centre(s) has
implications for the main hospital brief. I expect the review to be complete in the
very near future, following which a decision will be made about the configuration
and location of a satellite centre or centres.
The satellite centre(s) will be up and running before the new children’s hospital
opens. This will provide an opportunity to introduce and test the new model of
paediatric care and ICT in advance of the new hospital opening. This new model
is aligned with international trends and best practice by expanding the role of
ambulatory and urgent care and reducing the reliance on inpatient beds.
Question 10 (Deputy Eamonn Maloney)
The KPMG Independent Review of Maternity Services (2008) proposed
that the Coombe Hospital be transferred to Tallaght Hospital. To date the
Coombe conducts ante natal outpatient clinics on the Tallaght Hospital
campus. Would the Minister outline the further development of maternity
services in Tallaght and the time frame in which the transfer will be
completed.
Response:
16
A comprehensive review of maternity and gynaecology services in the
greater Dublin area was completed in 2008. The KPMG Independent
Review of Maternity and Gynaecology Services in the Greater Dublin Area
Report was informed by an international analysis of maternity and
gynaecology service configurations and best practice models of care.
The report noted that Dublin’s model of stand-alone maternity hospitals is
not the norm internationally. It recommended that the Dublin maternity
hospitals should be located alongside adult acute services and that one of
the three new Dublin maternity facilities should be built on the site of the
new children’s hospital (tri-location of paediatric, maternity and adult
services). In this context the proposal was that the National Maternity
Hospital was to be relocated to St Vincent's, the Coombe Women and
Infants University Hospital to Tallaght and the Rotunda to the Mater. In
May this year, I announced the relocation of the National Maternity
Hospital to the St Vincent’s campus.
However, recognising the need to plan for the provision of tri-located
maternity, paediatric and adult services, the Government decision to
locate the new children’s hospital on the St James’s campus means that a
review of other maternity-adult co-location plans is required.
This review will take place in the context of the development of a National
Maternity Stategy. I confirmed on 10 October that my Department will be
leading the development of this Strategy in collaboration with the HSE
and its National Clinical Programme in Obstetrics and Gynaecology. The
Strategy will provide the blueprint for the safe, effective delivery of
maternity services nationally. The development of the Strategy will build
on the work already undertaken as part of the KPMG Independent Review,
and on the work underway by the Clinical Programme.
Question 12 (Deputy Seamus Healy)
To ask the Minister for Health what steps he intends to take to ensure that
medical card holders are not charged for the taking of bloods by general
practitioners.
Response:
The current GMS capitation contract is based on a contract agreement first
introduced in 1989. Under the General Medical Services (GMS) contract, a
general practitioner (GP) is expected to provide his/her patients who hold a
medical card or GP visit card with all proper and necessary treatment of a kind
generally undertaken by a GP.
17
In circumstances where the taking of blood is necessary to either:
(a) Assist in the process of diagnosing a patient or
(b) Monitor a diagnosed condition,
the General Practitioner may not charge that patient if they hold a Medical Card
or GP visit card i.e. are eligible for services under the Health Act, 1970, as
amended. The HSE has written to all GMS GP’s on the matter.
The HSE Local Health Offices will fully investigate any reported incidents of
eligible patients being charged for phlebotomy services. Any instances of either
(a) a Medical Card or (b) a GP Visit card holder being charged for the taking of
blood will result in deductions being made from routine payments (including
reimbursements and subsidies) to the General Practitioners concerned.
Question 13 (Deputy Seamus Healy)
To ask the Minister to update the Committee on the appointment of chairpersons and
board members to the new hospital groups.
Response:
 Following Government approval, the Minister published two reports
on 14th May: the Higgins Report on ‘The Establishment of Hospital
Groups as a transition to Independent Hospital Trusts’ and
‘Securing the Future of Smaller Hospitals: a Framework for
Development’.
 Professor John Higgins has concluded over 60 information and
consultation meetings (in conjunction with the Department and the
HSE) with every acute hospital in the country.
 Separately, the Minister, in conjunction with the Department and
the HSE Director General visited all 6 hospital group areas..
 Leo Kearns, CEO
Strategic Advisory
Groups and the
services. The SAG
be established.
of the RCPI has been selected to chair the
Group to oversee the establishment of Hospital
subsequent reorganisation of acute hospital
and the HSE Implementation Team will shortly
 A Chairperson and Board members are being appointed for each
Hospital Group.
In July expressions of Interest were invited
through the Public Appointments Service for appointment as
Chairpersons and members of Hospital Groups Boards.
 Sanction has been given to the HSE to appoint each Group's
management team (with the exception of the Chief Academic
Officers). Group CEOs and the Management Teams are being
appointed through the PAS.
18
 The Minister has appointed Mr Thomas Lynch, chairman of Dublin
Academic Medical Centre (DAMC), as Chairperson of the Dublin
East Hospital
 Chairpersons and Boards are in place for the pilot Midwest Hospital
Group and the West Hospital Group. It is the Minister’s intention to
announce the appointment of Chairpersons to the three remaining
hospital groups, Dublin Midlands, Dublin North East and
South/South West shortly. The process of recruiting CEOs will then
be commenced, in consultation with the Chairpersons, through the
PAS. The Department of Health will also enter into discussion with
the Chairpersons with a view to appointing the other Board
members as soon as possible.
Question No. 14 (Deputy Dan Neville)
To ask the minister for Health to outline the position regarding the regulation of
psychotherapy and /Counselling under the Health and Social Care Professionals
Act 2005.
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, physiotherapists, podiatrists,
psychologists, radiographers, social care workers, social workers and
speech and language therapists.
1.2Five registration boards (Social Workers, Radiographers, Occupational
Therapists, Speech & Language Therapists and Dietitians) have been
established to date and a sixth (Physiotherapists) will be established
shortly. The registration boards and their registers for the remaining
designated professions should be established by 2015.
2. Immediate Priority/Commitment
Whilst my immediate priority is to proceed with the establishment of the
registration boards for the twelve professions currently designated under
the Act, I am committed to bringing counsellors and
psychotherapists within the ambit of the Act as soon as possible.
3. Issues to be Clarified
3.1While an amount of preparatory work has been done by a number of
counsellor and psychotherapist national groups in coming together as the
Psychological Therapies Forum to advise as a single voice for the
professions in so far as is possible, a number of issues are still being
clarified.
3.2These include:
19



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
4.1Quality and Qualifications Ireland (QQI – formerly HETAC) is currently
working on the establishment for the first time of standards of knowledge,
skills and competence to be acquired by students of counselling and
psychotherapy. While this will inform the education and training of future
students of Counselling and Psychotherapy this work is an essential prerequisite to regulation of the profession. The output of the work being
done by QQI should:


enable me to proceed with designation of the profession(s) under
the Health & Social Care Professionals Act
guide my Department in the very difficult task of assessing the
adequacy of the wide range of qualifications held by existing
practitioners against the QQI benchmark in establishing their
eligibility for registration.
4.2
QQI is well advanced in its work and has recently issued a
comprehensive consultation document which it intends to follow up
with a stakeholder workshop in mid-November, 2013.
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
legislation similar to other practitioners including consumer legislation,
competition, contract and criminal law.
Question 15 (Deputy Dan Neville)
To ask the minister for State at the Department of Health to outline the up to
date position regarding the implementation of the programme for development
of the mental health services resulting from the allocation of €70 million in 2011
for 2012 and in 2012 for 2013.
Response:
The Programme of investment in Mental Health in 2012 and 2013
In 2012, prioritised under the Programme for Government, the HSE reinvested
€35m and 414 WTES to enhance General Adult and Child and Adolescent
Community Mental Health Teams, to improve access to psychological therapies
in primary care (Counselling in Primary Care) and to implement suicide
prevention strategies in line with Reach Out – National Strategy for Action on
Suicide Prevention.
A breakdown of the 2012 Initiatives and the funding and WTEs associated with
each one is provided in Appendix 1 below.
20
Building on this investment, the HSE’s Service Plan 2013 committed to reinvest
a further €35m and up to 477 WTES to further enhance Community Mental
Health Team capacity in General Adult and Child and Adolescent Mental Health
Services and to support the development of services for older people with a
mental illness, those with an intellectual disability and mental illness and forensic
services.
Further investment will also be made in implementing the recommendations of
the suicide prevention strategy Reach Out and in the Counselling in Primary Care
Initiative. A breakdown of the 2013 Initiatives is available in Appendix 1.
Update on recruitment to 2012 and 2013 posts
In 2012, 414 posts were approved as part of the €35 million investment. While
budgetary pressures within the HSE delayed the full utilisation of this funding in
2012, recruitment was underway in late 2012 and, of the 414 posts allocated,
the recruitment process is complete for 378 or 91% of the posts as at
30th September 2013. There are a number of posts for which there are
difficulties in identifying suitable candidates due to factors including availability
of qualified candidates and geographic location and the remainder are at various
stages in the recruitment process.
In 2013, a further €35m and up to 477 WTES, was reinvested, building on the
2012 commitments and also to support the development of specialist mental
health services.
Of the posts allocated in 2013, as at 30th September 2013, the process is
complete for 19 or 4% of the posts, 236 49% of the posts are in the final
stages of the recruitment process with a further 149 or 31% of the posts at
various stages in the recruitment process, indicating that 85% of the 2013
allocation are in the recruitment process with the balance in the HR
approvals process.
Table 1 – Progress in recruitment to 2012 posts and 2013 posts
Recruitment
Process
Complete
2012
2013
Posts
Acceptedprocessing
clearances
Posts
Offered
Posts in
recruitment
process
14/3%
/ 209/44%
1/0.24%
18 /4%
27/ 6%
149/31%
378//91%
19/4%
As at
30/09/13
As at
30/09/13
Building on the work of the National Recruitment Service in streamlining the
recruitment process, the National Director for Mental Health is engaging directly
with the National Recruitment Service to maximise the benefit of a national
shared service, to comply with the requirements of the recruitment license and
to maximise local flexibility in the management of specialist panels to further
improve the effectiveness and speed of the recruitment process. This focus on
21
maximising the efficiency of the process must be balanced against the
requirement to ensure that a good quality recruitment process secures the most
suitably skilled staff for the posts and service for which they are being recruited.
Update on the remainder of the Initiatives:
NCS- Mental Health in Primary Care Initiative (CIPC):- The Counselling
in Primary Care Service was launched by Minister Kathleen Lynch and
Minister Alex White on 11th July, 2013 and is rolling out across the country.
As at 16th August, 2013 1,210 individuals with a medical card had opted in to
avail of the service following referral from their GP or Primary Care Team.

Genio Innovation Investment:- Specific innovation initiatives to deliver on
A Vision for Change are provided through the allocation of funding by HSE to
The Genio Trust. This support was €2m in 2012 and €1.8m in 2013.

Investment in Suicide Prevention:- In January 2013, NOSP was
requested by the Director General Designate of the HSE to review the work of
the NOSP so as to formulate a new strategic direction for the NOSP. The new
Framework will build on current work and its aim will be to support
population health approaches and activities that will assist in reducing the
loss of life through suicide in Ireland. Four posts have been allocated from
the 2013 allocation to ensure that the necessary resources are in place to
progress the Framework. The NOSP continues to sponsor and promote
innovative services for people in emotional distress. In 2013 NOSP is
supporting the extension of the SCAN (Suicide Crises Assessment Nurse)
service in 8 sites and also the national roll-out of Dialectical Behavioural
Therapy, as examples. NOSP continues to support the training of community
gate-keepers through a number of training initiatives. In 2013 NOSP together
with the ICGP produced an e-learning programme for GPs.

The HSE recognises the importance of service user, family member and carer
involvement in the ongoing development of mental health services and has
begun a consultation with these and other stakeholders in the coming weeks
with a view to seeking guidance and direction as to how the voice of the
service user, family members and carers will continue to be heard and
heeded in the development and delivery of mental health services into the
future.

Implementation of the Clinical Programmes in Mental Health:- A series
of national training programmes have been developed to ensure
comprehensive skills development in each service in the country and are
directed towards ensuring the delivery of evidence-based targeted
interventions. The training is key to modern high quality service delivery and
is being supported by a strong clinical leadership structure.
The 37 WTE posts identified in 2013 for the Self harm Programme are in the
process of recruitment. When these posts are in place, a training programme
based on the Clinical Programme will then be implemented.

Building Capacity of Community Mental Health Teams – Enhancing
Teamworking Project:- The investment in mental health in 2012 and 2013
22
meant that over 800 new mental health professionals are taking their places
on community mental health teams and working to introduce the new clinical
programmes. Together these initiatives constitute a very considerable
change management project and a plan to support change management
focussed on team functioning was devised to help optimise the positive
impact of Community Mental Health Teams in service provision. Enhancing
Teamworking is a programme being rolled out to all Community Mental
Health Teams with an initial focus on new, emerging and reconfigured teams.

National ICT System for Mental Health Project:- An allocation of
€405,275 to establish a National Project to prepare for a tender process and
to seek the necessary resources to provide a National Mental Health ICT
system and to support any implementation both nationally and locally when a
system is being tested was made from 2013 investment.
Significant work has been undertaken recently to consult with a range of
health professionals and clinicians, together with service users
representatives, across the mental health services to clarify the business
requirements for a clinical information and service delivery management
system encompassing an electronic service user mental health record. It is
hoped to conclude this consultation within the next 6-8 weeks.
A Project Structure for the National Mental Health ICT Project has been
drafted and work is in train to establish each of the elements as soon as
possible.
Appendix 1 - 2012 AND 2013 INVESTMENT BY INITIATIVE
TABLE 1 – 2012 INITIATIVES
The table below summarises the Initiatives for the 2012 investment:Objective
Projected FYC
General Adult
€16,000,000
Community Mental
Health Teams
Child and Adolescent
€7,000,000
Community Mental
Health Teams
Counselling in Primary
€5,000,000
Care Initiative
National Office for
€3,000,000
Suicide Prevention
Genio Trust Innovation
€2,000,000
Funding
Funding for NSUE
€110,000
Implementation of
€402,000
Clinical Programmes
Enhancing
€1,488,000
Teamworking Project
WTE
254
150
10
0
0
0
0
0
23
and other capacity
building initiatives to
maximize the benefit of
the investment
€35,000,000
414
TABLE 2- 2013 Initiatives
The table below summarises the Initiatives for the 2013 investment:Objective
Projected FYC €m
General Adult
10,771,020
Community Mental
Health Teams
Clinical Programme to
2,214,044
address self-harm in
Emergency
Departments
Additional sites for
€478,712
Suicide Crisis
Assessment Nurse
Service
Implementation of
1,000,000
Suicide Prevention
Framework - NOSP
Mental Health Services
€5,983,900
for Older People
Community Mental
Health
Objective
Projected FYC €m
Mental Health and
3,750,000
Intellectual Disability
Community Mental
Health Teams
Forensic Mental Health
€578,400
Services - Prison
Inreach
MHID Forensic
€1,821,600
Child and Adolescent
€5,531,750
Community Mental
Health Teams
Counselling in Primary
2,465,299
Care
Implementation of the
0
Suicide Prevention
Framework
National ICT Mental
405,275
Health Project
development
35,000,000
WTE
180
37
8
0
100
WTE
40
8
20
80
0
4
0
477
24
Question 16 (Deputy Dan Neville)
To ask the Minister for Health to outline
(a) The remuneration paid to private care companies for 2010, 2011 and 2012.
(b) The levels of reduction in Home Help hours for 2010, 2011 and 2012.
Response:
The HSE working within approved resource levels has sought to maintain and
when possible to expand the services available to support dependent people to
remain in their own homes; to prevent early admission to long term residential
care and to support people to return to their homes following an acute hospital
admission. This is in the context of decreasing resources generally and a growing
older population.
The HSE provides home help and home care packages to approximately 56,000
people at any one time within an overall budget of €315m. The target level of
service provided in 2012 has been maintained in the 2013 Service Plan with
10.3m home help hours to be provided and home care packages to be provided
to 10,870 persons at any time.
Arrangements for Service Delivery – Public, Voluntary & Private
This significant budget for home care is provided to support the service needs of
these clients through a variety of arrangements – through direct HSE service
provision (HSE home help staff), through services provided by voluntary
agencies, funded by HSE (not for profit) and through arrangements funded by
the HSE with private providers (for profit).
Voluntary agencies have traditionally delivered home help services mainly in the
greater Dublin areas and to a far lesser extent in areas outside of Dublin e.g.
Clare.
The HSE uses private providers principally for the delivery of enhanced home
care (funded from the HCP Scheme which was introduced in recent years) where
direct HSE services are not available at a particular time or location or in
response to the particular complexity of care needs of an individual, including
late evening visits, weekends etc.
The HSE has undertaken a procurement/tender process to ensure that all
external, private providers of enhanced home care meet a range of
comprehensive standards. The providers are monitored through service
agreements, are required to provide a prescribed range of information in relation
to the services provided, and are supervised through regular local operational
meetings and reviews of care plans.
Reduction in Home Help Hours
25
During the period 2009-2011, the HSE Service Plan target was developed on an
existing level of service (ELS) basis and there was no planned reduction in home
help hours. In 2012, in the context of the overall budgetary position, home help
services, similar to all other care areas, were required to reduce services in
order to live within the level of resource provided for the year. In this context, a
target of 10.7m hours were included in the Service Plan, which represented a
3.6% reduction on the previous years outturn. During the course of the year,
this figure was reduced to 10.3m hours having regard to technical adjustments
on how hours had been counted in DNE. This position was the subject of
discussion at the Joint Committee on Health & Children at the time. Members will
also recall that due to the requirement to achieve breakeven in the last quarter
of 2012, there was a once-off reduction in hours, however this position was
revised in Service Plan 2013, which sets the provision for the year at 10.3m
home help hours, which is the same as the 2012 Service Plan target.
Similarly in relation to Home Care Packages service provision has been
maintained at 2012 levels.
Provision of Private Home Help Hours
A total of €22.4m was paid to all private home care providers in 2010. A total of
€28.9m was paid to all private home care providers in 2011 and €47.958m was
paid in 2012.
It is important to restate that the private provision of home help hours is
principally related to the provision of enhanced home care, funded from the HCP
scheme, and is governed by a formal procurement process.
Recent Labour Court Binding Agreement
The HSE and unions have been engaged over the past number of years in a
comprehensive negotiation process, under the auspices of the Labour Relations
Commission to resolve a range of issues relating to the delivery of home help
services. This culminated in the consideration by the Labour Court of the
outstanding issues concerning home helps, with a binding recommendation
issued by the Labour Court on the 13th September, 2013.
One of the principal concerns on the staff side, was that some areas within the
HSE were not providing home help workers with their full contracted hours, and
that this was happening in circumstances where private providers were being
given additional hours. However the Labour Court acknowledged that this was
being addressed and referred to the HSE Management Memorandum dated 17th
February, 2013, which directed managers to ensure that directly employed staff
would have their contracted hours maximised before additional hours would be
allocated elsewhere.
A full range of measures have now been agreed in line with the Labour Court
recommendation to deal appropriately with the issue of annualised hours
contracts and also with the issue of private providers.
26
In relation to the use of private providers, the Labour Court in its findings noted
that, in line with the Public Service Agreement 2010-2014, the HSE confirmed its
ongoing commitment to the direct employment of home helps to maximum
effect for those with the appropriate skill set. However, it accepted that the HSE
had also confirmed, that private providers are part of the landscape for home
help provision and will continue to be used – not least because of the choice of
care which they allow to the user of the service.
The Labour Court went on to state that in all of the circumstances and in the
context of the newly agreed contractual arrangements for directly employed
home helps; the commitments given by the HSE with regard to private hours
and the experience to date – since the management memo was issued, the court
was satisfied that all the necessary steps are being taken to ensure that the
correct balance of service provision will be achieved, whilst at the same time
allowing for the provision of choice of care for users of the home help service.
In line with the recommendation of the Labour Court, the HSE is drawing up a
comprehensive implementation plan which will be agreed with the unions and
implementation will progress over the coming month.
Question 17 (Senator Jillian Van Turnhout)
Can the Minister outline the Department of Health’s strategy and
objectives in terms of family participation in the major strategic reforms
currently being undertaken by the HSE in the area of disability services?
Response:
The HSE and the DOH acknowledge the importance of involving service users,
parents & families and wider community in the planning organisation & delivery
of services with people with a disability. In this context, the development of a
partnership approach between all these stakeholders has been an important part
of the model of service over many years. A range of both formal and informal
processes are in place to give effect to this strategic objective.
At a national level, the National Consultative Forum (NCF) which was established
by the HSE is the mechanism for bringing these key stakeholders together.
The forum includes representatives of the various umbrella bodies representing
service providers e.g. Federation of Voluntary Bodies, The Disability Federation
of Ireland (DFI), the Not for Profit Business Association, a number of bodies
representing families or service users are involved e.g. Inclusion Ireland and
National Parents and Siblings Alliance. The National Disability Authority is also
represented as are the DOH & HSE.
Similar fora have been developed at regional and local level. In addition to the
above, the development of many of the key strategic policy documents have
included such representation e.g. the Report on Congregated Settings, New
Directions the HSE’s policy document on the development of day services and
27
the Policy on Progressing Disability Services for Children and Young People. As
these strategic policies are being implemented, the HSE is ensuring that local
implementation groups provide for the involvement of service users and/or
parents & families as active participants.
The current process, for implementation of 0-18 Children’s Service model, as
outlined below, is a good example of the processes being put in place to ensure
full participation by service users, parents & family representatives.
Children’s Services Model:
-
Membership of the National Coordinating Group includes Inclusion
Ireland CEO and 2 parent representatives
A subgroup on Communications was established to focus on improving
communications with all stakeholders, including parents..
The programme’s recent Local Implementation Group (LIG) Lead
Workshop included a presentation by the Special Needs Parents
Association representative on how to involve parents in the LIG from a
parent perspective which was extremely very well received. Guidelines
on Parent and Service User representation on Local Implementation
Groups was developed with input from Special Needs Parents
Association and Inclusion Ireland and shared with LIG Leads Subgroup
on development Outcome Focused Performance Management
Framework for Children and their Families” included a parent’s voice in
the working group. Ongoing work being done at local level across the
country to hold parent information/briefing sessions in order to inform
parents of the proposed changes and to seek parental involvement on
the local
Question 18 (Senator Jillian Van Turnhout)
Can the HSE clarify the procedures in place in the event that an emergency
medical card issued on the grounds of terminal illness (and therefore not subject
to means test requirement) needs to be renewed after six months, to ensure
that the renewal process will be on the same basis as the initial application – i.e.
on the provision of evidence from the GP or hospital consultant of the terminal
nature of the condition - and the applicant will not be asked to provide details of
means?
Response:
The HSE can issue a medical card where a Doctor or a Consultant certifies that
there is a terminal illness. Where a patient is terminally ill in palliative care, the
nature of the terminal illness is not a deciding factor in the issue of a medical
card in these circumstances and no means test applies. Given the nature and
urgency of the issue, the HSE has appropriate escalation routes to ensure that
the person gets the card as quickly as possible. The HSE monitors such cases
and can renew the clients’ eligibility if necessary. In such circumstances there is
no assessment of means.
28
Under the provisions of the Health Act 1970, the assessment for a medical card
is determined primarily by reference to the means, including the income and
expenditure, of the applicant and his or her partner and dependants.
While people with specific illnesses such as cancer are not automatically entitled
to medical cards, the HSE can apply discretion and grant a medical card where a
person's income exceeds the income guidelines.
In these cases, social and medical issues are considered when determining
whether or not undue financial hardship exists for the individual in accessing GP
or other medical services. Discretion will be applied automatically during the
processing of an application where additional information has been provided
which can be considered by staff or a medical officer, where appropriate.
The HSE set up a clinical panel to assist in the processing of applications, where
a person exceeds the income guidelines but there are difficult personal
circumstances, such as an illness. The Medical Officer reviews and interprets
medical information provided by the applicant on a confidential basis. He/she
can liaise with general practitioners, hospital consultant and other health
professionals as appropriate so as to determine the health needs of the applicant
and his/her family and dependants.
It is important to stress that the medical card system is founded on the "undue
hardship" test. The Health Act 1970 provides for medical cards on the basis of
means. That is what the law states and we must operate within the legal
parameters.
The HSE can also provide a medical card for patients in an emergency where
they are seriously ill and in urgent need of medical care that they cannot afford.
Emergency medical cards are issued within 24 hours of receipt of the required
patient details and letter of confirmation of condition from a doctor or consultant
and are generally requested by a manager in a Local Health Office or a Social
Worker.
Emergency cards are issued for six months on the basis that the patient is
eligible for a medical card on the basis of means or undue financial hardship,
and will follow up with a full application within a number of weeks of receiving
the medical card.
The HSE ensures that the system responds to the variety of circumstances and
complexities faced by individuals in these circumstances.
Question 19 (Senator Jillian Van Turnhout)
With the Children’s Hospital Group Board appointed on 2 August 2013 to oversee
the long overdue operational integration of the three existing paediatric hospitals
in Dublin into a new children’s hospital, can the Minister provided us with an
update on progress and the timeline for each phase?
29
Response
The Children’s Hospital Group Board will oversee the operational integration of
the three existing paediatric hospitals in advance of the move to the new
hospital and is also the client for the new hospital. I appointed Dr Jim Browne as
Chair of the Children’s Hospital Group Board last April. On 2 August I announced
nine further appointments to the Children’s Hospital Group Board. The Chairs of
the three paediatric hospitals are members of the Group Board. Other
competency-based appointments have been made, with further competencybased appointments to be made at a later stage. The first meeting of the new
Board took place on 2 October last.
On 13 September I announced that Ms. Eilísh Hardiman had been selected as
CEO of the Children’s Hospital Group. This follows an open recruitment process
led by the Public Appointments Service. The role of CEO of the Children’s
Hospital Group is critically important in driving forward the integration of the
three hospitals, and the project as a whole.
The Children’s Hospital Group Board will work closely with the National Paediatric
Hospital Development Board on the capital project. The National Paediatric
Hospital Development Board (NPHDB) is the body responsible for the design,
building, planning and equipping of the new hospital building. Also on 2 August,
I announced appointments to the NPHDB which will ensure that the necessary
capital development skills are available to drive this priority project to
completion, including the appointment of Mr Tom Costello as Chair. These
appointments replace the transitional Board of officials from DOH and HSE who
had been charged with progressing the project on an interim basis.
The key
post of Programme Director for National Paediatric Hospital Development Board
was advertised on 4 October and will be recruited via open competition. The
Programme Director will be the chief officer of the agency, will lead the project
and will be responsible directly to the Board for the delivery of this priority
project.
Work on developing a detailed project timeline is continuing and I expect to
receive an update on this within the coming weeks. This will reflect the urgency
and priority of the project and also its scale and complexity. The estimated
programme will be kept under continuous review and validation by those to be
charged with project delivery.
In the near term, the tender process for the procurement of a new design team
is well underway, and the aim is to have the new design team in place by the
end of 2013. Pre-application planning discussions have commenced and the aim
is to secure planning permission by December 2014 with construction to
commence in Spring 2015. A review of urgent care centre(s) configuration is
almost complete; the number and location of these satellite centres in the Dublin
area is a key decision, as the size, activity and infrastructure of these satellite
centre(s) has implications for the main hospital brief. In parallel, St. James's
Hospital is working closely with HSE Estates and the National Paediatric
Development Board in regard to the decant phase of the project.
30
The new children’s hospital is a priority for me and for this Government.
Everyone involved in the drive to deliver the new children’s hospital capital
project is working to do so by the earliest possible completion date. I am
confident that the appointments made to the two Boards will ensure the new
hospital is completed as swiftly as possible, with optimal design and value for
money.
Question 20 (Deputy Robert Dowds)
To ask the Minister how he proposes to come up with a system for employing
junior hospital doctors which (a) reduces their hours on the job to ensure they
are within EU norms; and (b) helps to lead to a situation where they are less
inclined to emigrate from the country?
Response:
Non consultant doctors play a fundamental role in the provision of services in
our hospitals. The current NCHD workforce comprises approximately 4,910
NCHDs, including 570 Interns, 1,812 Senior House Officers (SHOs), 1,620
Registrars and 908 Specialist / Senior Registrars. Of the 4,910, 80% hold
structured training posts; while 20% of NCHDs hold service posts. In recent
years the HSE has increased the proportion of NCHDs in formal training schemes
from less than 40% to approximately 80%, increased the number of Specialist
Registrar posts by 60% and this year, will further increase intern posts from 570
to 639.
Full implementation of the European Working Time Directive (EWTD) poses very
significant challenges for the Health Service and has been the subject of a series
of reports over the past decade, including the Report of the National Joint Study
Group on Working Hours of NCHDs (2001), Forum on Medical Manpower (2001),
National Task Force on Medical Staffing (2003), Hospital Activity Analysis
(2005), and the National Implementation Group (December 2008).
The HSE in conjunction with other between health / public service management
(i.e. Department of Health, Department of Public Expenditure) have met the
Irish Medical Organisation (IMO) to identify and discuss further actions that can
be put in place to reduce working hours for Non-Consultant Hospital Doctors
(NCHDs) and achieve EWTD compliance. Discussions have taken place under the
auspices of the Labour Relations Commission (LRC).
To reduce the number of hours NCHDs must undertake, the HSE and IMO (in
partnership with the Department of Health and Department of Public
Expenditure) have agreed the following actions to achieve EWTD compliance:


Establishment of a national group to oversee verification and implementation
of measures to reduce NCHD hours, eliminate shifts in excess of 24 hours
and achieve EWTD compliance.
Creation of an NCHD Committee and a consequent Lead NCHD role aligned
with the Clinical Directorate structure to provide for a formal link between
NCHDs and hospital management. The Lead NCHD will report to the Clinical
Director. Key areas of work for the NCHD Committee and Lead NCHD will
include NCHD welfare, training, EWTD, executive decisions affecting NCHDs
and individual/group grievances.
31




Roster changes and revised work practices to commence during November.
Elimination of shifts in excess of 24 hours to commence at the earliest
opportunity after verification visits.
Health service management to prioritise resource allocation to promote full
EWTD compliance in 2014.
Agree guidance on measures to promote EWTD compliance, implementation
of a maximum 24 hour shift and associated best practice at hospital level.
Requirement for each hospital to formally establish a Hospital-level EWTD
Implementation Group. The Hospital EWTD Implementation Group will be
subject to direction and guidance from the National Group.
In parallel to these actions, the HSE is also seeking to rapidly introduce an
electronic time and attendance system in each acute hospital. In the interim,
hospitals will act immediately – where technologically feasible - to ensure NCHDs
are covered by existing electronic time and attendance systems by 1st November
2013.
Implementation and achievement of a maximum 24-hour shift will then be
verified jointly by the HSE and IMO to ensure changes are compliant with
contractual and other requirements and with the involvement of the LRC as
appropriate.
To increase and encourage NCHDs to take up employment in Ireland, the HSE
has put in train the following actions:

Retention of Irish medical graduates - the HSE is a partner in an NCHD
Graduate Retention initiative established in 2012. As part of this initiative
appropriate support services for trainee doctors are being identified.

The HSE works with the Postgraduate Training bodies to expand the scope of
existing rotational arrangements – some of which already include hospitals in
Northern Ireland. The HSE also funds scholarship programmes to support
NCHDs working in hospitals internationally and gain training and experience
that will benefit the Irish public health system.
In July a group chaired by the President of DCU was established to carry out a
strategic review of the medical training and career structure of NCHDs, with a
view to improving retention of graduates in the public health system. An interim
Report is to be provided in November.
To ensure that intern welfare is promoted as well, the HSE has introduced Intern
Networks to ensure coordination of intern placement and transition into training
schemes on successful completion of the Intern Year. In addition, the HSE is
working with the Postgraduate Training Bodies to ensure training contracts are
aligned with NCHDs career aims, service and workforce needs.
Response to Question 21 (Deputy Robert Dowds)
To ask the Minister the extent and type of sanction which HIQA may impose on
errant individuals /institutions which fail to adhere to best hygiene practice?
Response
32
Established as an independent statutory body under the Health Act 2007, the
Health Information and Quality Authority’s (HIQA) mandate extends across the
quality and safety of the public, private and voluntary sectors. Since late 2012
HIQA has been carrying out a monitoring programme against the National
Standards for the Prevention and Control of Healthcare Associated Infections
(HCAIs), 41 of which have been completed. The Minister and the Department
welcome the publication of HIQA’s reports and note the concerns raised in these,
and indeed, previous reports about hand hygiene practices particularly among
medical staff. With regard to hand hygiene the findings of the Authority suggest
that hand hygiene best practice needs to become more operationally embedded
at all levels. HIQA requires those hospitals who have failed to meet the
requirements of the standards to publish a Quality Improvement Programme to
demonstrate the actions taken to address areas of non-compliance.
Achieving a culture of patient safety in which best practice in hand hygiene is
embedded requires actions at all levels. It is the responsibility of management
and clinical leadership to make this a priority and ensure that the correct
conditions to allow for the improvements in hand hygiene are in place.
Question 22 (Deputy Robert Dowds)
To ask the Minister for an update on the Government's proposed alcohol
strategy?
Response
The Government is very clear about its commitment to deal with alcohol
misuse in Irish society and the widespread harm it causes. The issues are
wide-ranging and require a collective approach across Government.
Proposals are currently being finalised on foot of the recommendations in
the National Substance Misuse Strategy report. My Department has
consulted and negotiated with Government colleagues extensively, since
the publication of the Report, in order to reach consensus on the most
effective way to tackle the problem of alcohol misuse in society.
The Cabinet Committee on Social Policy recently discussed these
proposals and I intend to submit specific proposals for consideration by
Government very shortly.
In the meantime, work on developing a framework for the necessary
Department of Health legislation is continuing. A health impact
assessment has been commissioned in conjunction with Northern Ireland
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.
33
Question 23 (Deputy Sandra McLellan)
To ask the Minister for Health to provide the Committee with an update on his plans
to reconfigure the Hospital Networks, as outlined in the Framework for Smaller
Hospitals, to provide the Committee with details on what actions following on from
that report have been taken thus far, any progress has been made towards its
objectives, whether any implementation plans have been produced for the key
significant changes contained in the document, and what actions are likely to be
taken in the forthcoming 6 months on foot of the recommendations of the report.
Response:
The Smaller Hospitals Framework is intrinsically linked to the development of
Hospital Groups. The Smaller Hospitals Framework will inform each group
management team as they address the requirements for their group to deliver a
full range of services. Being part of a hospital group ensures the future of
smaller hospitals, not least because the new group system cannot function
without them. This is in the context of the key necessity to move high volume
lower complexity cases to smaller hospitals whilst moving more complex cases
to larger hospitals commensurate with the necessity to deliver the safest, best
quality outcomes possible for patients. There is also significant potential for
enhancing their roles within the groups. Putting smaller and larger hospitals into
groups together will help to make sure that the services provided in all hospitals
are:
-
Safe
Efficient
high quality
appropriate
effective
accessible
sustainable
well-integrated
Work continues across smaller hospitals to put in place appropriate service
arrangements.
The HSE has provided the following update:

Ennis, Nenagh and St.John’s Hospital are now fully compliant with the
small hospitals framework having opened Medical Assessment Units
(MAUs) and Local Injuries Units (LIUs) in each centre. Each of these
hospitals now only operates a differentiated medical intake model and
appropriate ambulance bypass protocols are in place to ensure diversion
of complex and trauma cases.

The newly built Medical Assessment Unit at Mallow General Hospital
opened on the 3rd September 2013. The new MAU is an eight bedded
unit, open seven days a week from 8am to 8pm. This unit was part of a
34
€4.5m capital investment in Mallow General Hospital which consists of a
two storey extension with the Medical Assessment Unit on the ground
floor and a replacement Endoscopy Suite suitable for the following
procedures gastroscopy (upper digestive tract), sigmoidoscopy and
colonoscopy (lower intestine) and cystoscopy (urinary system). The
endoscopy unit is due to open in October 2013.

Bantry General Hospital (BGH) opened the Bantry Urgent Care Centre
on the 8th July 2013. The Bantry Urgent Care Centre is open seven days a
week and is made up of a Local Injury Unit and a Medical Assessment Unit
with patients attending the Unit that best suits their healthcare needs.

At Louth Hospital, the Small Hospital Framework has been fully
implemented since summer 2010. However, the hospital has continued to
progress the development of its services particularly in the area of elective
and day services.
Overall the numbers of elective surgery being
undertaken on this site continues to increase. In addition, in the last six
months a new Colorectal Screening service for NCCS has commenced. A
new Hysteroscopy service is due to commence before year end. Additional
Cystoscopes have been purchased for the Urology service at Louth.

At Our Lady’s Hospital Navan, trauma bypass has been in place in
Navan since early 2010. The Emergency Department continues to accept
non trauma ambulance presentation and self-presentations.
Elective
General and Orthopaedic Surgery is undertaken and full Endoscopy
service is also provided.
There have been three new Consultant
appointments to Navan, Consultants in Endocrinology, Rheumatology and
Gastroenterology, each with cross site commitments.
Work will
commence during the month of October to upgrade the building currently
housing ED this will be multi-function building that will be used as a Minor
Injuries Unit . The Air Handling unit in general theatres is also being
upgraded together with the infrastructures of the theatres.
Full
implementation of the framework is dependent on the development of
capacity for Emergency Department and Bed capacity elsewhere in the
region to safely manage the ED, Intensive Care and acute medical
workload.

A significant amount of preparatory and planning work has taken place
between St. Vincent’s and St. Colmcilles Hospital. There has been
significant clinical engagement to ensure the appropriate organisation of
services. An Intermediate care vehicles (ICV) service in South County
Dublin to target lower acuity ambulance transports has been put in place.

In Roscommon Hospital a number of further developments have taken
place which include:
o New Consultants in Endocrinology, surgery, anaesthestia have been
appointed.
o
Western Regional Rehabilitation Centre at Roscommon Hospital, in
association with the National Rehabilitation Hospital (NRH) are
interviewing for Consultant in Rehabilitation Medicine in Mid October
35
2013. The post will be based in Roscommon Hospital, with sessions
in the NRH.
o
A business case for capital development of 20 bed Specialist
Rehabilitation facility on the Roscommon Hospital site was
submitted for approval to the National Capital Steering Committee
in July 2013.
o
Colorectal Screening in association with the National Cancer
Screening Service is expected to commence at Roscommon Hospital
in Q4 2013.
o
Capital Development of Endoscopy Suite at Roscommon Hospital –
Planning Permission was granted for the Capital Development of a
purpose built Endoscopy Suite on the roof od the Urgent Care
Centre at Roscommon Hospital in June 2013. Tenders for a
contractor will issue by the end of October 2013. Contractor
expected to be on site in February 2014. Ancillary work has already
commenced at Roscommon Hospital with the upgrade of the boiler,
generators and BMS systems.
o
Roscommon Hospice – CEO of Mayo Roscommon Hospice has
confirmed that the Mayo Roscommon Hospice Foundation will fund
the capital construction of an 8 bed Hospice on the grounds of
Roscommon Hospital. The Mayo Roscommon Hospice Foundation is
also seeking Planning permission is to be sought next month for the
development of a fourteen bed specialist palliative care unit to be
built in Castlebar.
o
Chronic Pain Service – Dr Chris Maharaj, GUH Consultant
Anaesthetist / Pain Control. The proposal is to run 1 pain OPD clinic
and 1 interventional list under CT control in Roscommon per month
initially (Mondays), to accommodate 12 patients per OPD clinic and
6 interventional procedures per day. A start date of the 14th
October has been proposed.
o
Roscommon Hospital’s day case activity continues to increase, and
patient from the Galway University Hospital’s inpatient list are being
treated at the hospital under the care of the Roscommon hospital
Consultant teams.
o
The Plastic and Reconstructive Surgery Consultant continues to
deliver OPD, Day case and in-patient treatments at Roscommon
Hospital, 2 days per week.
Question 24 (Deputy Sandra McLellan)
To ask the Minister for Health to discuss the Programme for Government
commitment for Free GP care for all, what progress has been made in this
regard, to comment on recent reports that legislation is being prepared to
provide for free GP care for those under 5, whether those reports are correct,
and to provide a timeline for any extensions of GP care planned by the Minister.
36
Response
As set out in the Programme for Government and the Future Health strategy
framework, the Government is committed to introducing, on a phased basis, a
universal GP service without fees.
The introduction of a universal GP service constitutes a fundamental element in
the Government's health reform programme. The current Government is the first
in the history of the State to have committed itself to implementing a universal
GP service for the entire population. A well-functioning health system should
provide equal access to healthcare for its patients on the basis of health needs,
rather than ability to pay. The principles of universality and equity of access
mean that all residents in Ireland should be entitled to access a GP service that
is free at the point of use. Universal access to GP care will facilitate the early
identification of medical conditions reducing the burden of illness, greater
collaboration in the provision of primary care services, improved management of
chronic diseases and will improve the delivery of essential health promotion and
protection measures.
It has become clear that the legal and administrative framework required to
provide a robust basis for eligibility for a GP service based on having a particular
medical condition, as outlined initially in the Programme for Government, is
likely to be overly complex and bureaucratic. Relatively complex primary
legislation and detailed regulations would be required in order to provide a GP
service to persons on the basis of their having a particular illness. In my view,
this would entail putting in place a cumbersome legal and administrative
infrastructure to deal with what is only a temporary first phase on the way to
universal GP service to the entire population.
There has been no Government decision, at this stage on the details of the rollout of a universal GP service, such as a proposal for a specific age cohort.
The Government is firmly committed to introducing a universal GP service within
its term of office. The Cabinet Committee on Health has discussed the issues
relating to the roll-out of the universal GP service and has agreed that a number
of alternative options should be set out with regard to the phased
implementation of a universal GP service without fees. As part of this work,
consideration is being given to the approaches, timing and financial implications
of the phased implementation of this universal primary care health service. A
range of options are under consideration with a view to bringing developed
proposals to Government shortly.
37
Question 25 (Deputy Sandra McLellan)
To ask the Minister for Health to comment on the substantial increase in the
number of people having their medical cards refused, and replaced by a GP card,
to provide an outline of the number of people, broken down by constituency,
who have had medical cards refused, and, of those, who were subsequently
provided with a GP card in its place.
Response:
Medical Card eligibility is assessed in accordance with the national
guidelines. Where a person’s assessable means fall within the guidelines for a
Medical Card he or she is issued with a Medical Card. Where a person’s means
falls within the guidelines for a GP Visit Card he or she is issued with a GP Visit
card.
As of 1 September 2013, 12,600 individuals have had their medical card
replaced by a GP Visit card following a review of their assessable means. The
HSE does not collate medical card eligibility by constituency. The number of
persons currently eligible for a Medical Card or a GP Visit Card, as at 1
September 2013 broken down by Local Health Office, is included for information.
PRIMARY CARE
HEALTH SERVICE EXECUTIVE
POSITION REGARDING MEDICAL CARDS / GP VISIT CARDS as at 1st September 2013
LHO AREA
NUMBER OF ELIGIBLE
PERSONS ON MEDICAL
CARDS as at 1st September
2013
NUMBER OF ELIGIBLE
PERSONS ON GP VISIT
CARDS as at 1st September
2013
DUBLIN/MID LEINSTER
DUBLIN SOUTH
25,121
1,269
DUBLIN SOUTH EAST
24,330
1,443
DUBLIN SOUTH CITY
38,355
1,940
DUBLIN SOUTH WEST
68,199
3,509
DUBLIN WEST
62,150
4,056
KILDARE/WEST WICKLOW
76,794
5,177
WICKLOW
46,768
2,853
LAOIS/OFFALY
70,609
4,870
LONGFORD/WESTMEATH
57,292
3,946
469,618
29,063
NORTH WEST DUBLIN
70,587
3,756
DUBLIN NORTH CENTRAL
53,136
3,359
NORTH DUBLIN
81,503
5,131
TOTAL
DUBLIN NORTH EAST
38
LHO AREA
NUMBER OF ELIGIBLE
PERSONS ON MEDICAL
CARDS as at 1st September
2013
NUMBER OF ELIGIBLE
PERSONS ON GP VISIT
CARDS as at 1st September
2013
CAVAN/MONAGHAN
59,943
4,205
LOUTH
61,894
3,454
MEATH
68,441
4,810
TOTAL
395,504
24,715
GALWAY
104,354
7,821
MAYO
67,218
3,667
ROSCOMMON
30,695
1,929
DONEGAL
91,013
5,740
SLIGO/LEITRIM
43,384
3,226
CLARE
NORTH TIPPERARY/EAST
LIMERICK
49,923
2,838
30,973
2,380
LIMERICK
80,895
5,225
498,455
32,826
CORK-SOUTH LEE
63,063
5,225
CORK-NORTH LEE
81,753
6,880
WEST CORK
22,110
1,857
KERRY
61,303
4,775
NORTH CORK
36,741
3,242
CARLOW/KILKENNY
61,405
4,613
WATERFORD
58,531
3,675
SOUTH TIPPERARY
42,762
2,711
WEXFORD
71,817
4,779
499,485
37,757
1,863,062
124,361
WEST
TOTAL
SOUTH
TOTAL
GRAND TOTAL
Primary Care
Health Service Executive
39
Question 26 (Deputy Billy Kelleher)
To ask the Minister for Health his assessment of the impact of Budget 2014 on
the provision of health services in 2014?
Response
The level of funding available for the health budget and the extent of the savings
required in the health sector are being considered as part of the Estimates and
budgetary process for 2014 which is ongoing. Deliberations by the Government
on the expenditure allocations for next year are likely to continue up until
Budget time and it would not be appropriate for me to comment further at this
stage pending the outcome of those deliberations. The very difficult financial
position facing the Exchequer will obviously require very careful management
across all areas of expenditure.
Question 27 (Deputy Billy Kelleher)
To ask the Minister for Health the number of medical cards holders at the start
of 2013 that have lost their medical card; and if they will make a statement on
the matter?
Response:
On 1 January 2013 there were 1,853,877 individuals covered by a Medical Card.
On 1 October 2013 the number of individuals covered was 1,864,509.
In the period 1 January to 31 August 2013 more than 103,300 new Medical
Cards were issued. In the same period, 96,400 Medical Cards were removed.
The cards removed includes those persons who did not confirm that they still
reside in Ireland; persons who were deceased and persons deemed ineligible
pursuant to the national guidelines, which were amended in April 2013. In
addition to this, following an assessment of their means, 12,600 persons had
their eligibility changed from a medical card to a GP Visit card and 14,900 people
who previously had eligibility had this reinstated on assessment.
Question 28 (Deputy Billy Kelleher)
To ask the Minister for Health his response to the HIQA hospital hygiene reports
published on the 4 September 2013.
Response:
The HSE leadership team discussed the prevention and control of healthcareassociated infection and antimicrobial resistance on 10th Sept in light of the
recent HIQA inspections against the National Standards for the Prevention and
40
Control of HCAI (2009). On review of the reports and the national Healthcare
Associated Infections and Anti Microbial Resistance indicators, the HSE found
that while there are examples of good practice and compliance with the national
standards and there have been improvements in some of the national indictors
(e.g., hand hygiene, MRSA & C. difficile), there are areas that require immediate
attention. These include:
 Cleaning and decontamination of the patient environment and patient care
equipment in hospitals
 Embedding a culture of hand hygiene within healthcare facilities & improving
hand hygiene of medical staff
 Ensuring appropriate isolation of patients with transmission based
precautions
 Improving antibiotic stewardship in hospitals and the community to prevent
the emergence of Anti Microbial Resistance – the increase in resistance in
gram negative bacteria & of VRE was noted.
 Commitment from hospital management to improve prevention & control of
Healthcare Associated Infections and Anti Microbial Resistance
Evidence suggests that multimodal approaches are required for long-term
sustained change. The five elements of the World Health Organizations’ (WHO)
multimodal hand hygiene improvement strategy were discussed. This evidenced
based approach includes:
 System changes to enable hand hygiene to be performed readily
 Staff education
 Audit & feedback
 Establishing an institutional safety climate with visible support from senior
management and a culture of hand hygiene excellence in the institution.
The HSE has decided to refocus efforts on the prevention and control of
Healthcare Associated Infections and Anti Microbial Resistance, support existing
good practice and improve those areas that require so. Therefore, the HSE
Director General has requested that all hospitals immediately act on the
following;
1. Ensure that a member of the senior management team is responsible for
hygiene. This person must give a report to the facility management team on
the facilities performance against the 2006 cleaning manual with a
remediation plan & on the facilities multimodal hand hygiene plan by end of
2013. Each RDPI will produce a report on progress by end of March 2014.
2. Ensure that there is a hygiene programme in place by the end of 2013 which
clearly demonstrates the hospitals commitment to hygiene, specifically
focusing on patient care equipment, the patient environment & hand hygiene.
The programme should be based on the WHO multimodal framework. This
will be reviewed and approved by the National Director for Acute Services
3. Ensure that 100% staff have received hand hygiene education & training by
June 2014.
Hospitals will provide monthly reports on progress to the National Director for
Acute Services
Through the national clinical programme for Healthcare Associated Infections
and Anti Microbial Resistance prevention, the HSE are also actively working with
41
the main medical professional bodies to address the issue of doctor attitudes and
behaviour around hand hygiene.
Question 29 (Deputy Jerry Buttimer)
To ask the Minister for Health and the HSE to provide details of the number of
administrative staff employed by the HSE, the changes in numbers each year
since 2002, if a review has been conducted on the role and function of all
administration positions.
Response:
Prior to the establishment of the Health Service Executive in 2004, the public
health service comprised health boards and a large number of agencies funded
directly by the Department of Health or the Eastern Regional Health Authority.
The number of management / administrative staff employed in the public health
service (now the Health Service Executive and HSE-funded agencies) was
14,471 WTE (whole time equivalent) in December 2001. The number rose to
18,421 WTE in June 2007 before decreasing by 15.7% to 15,513 WTE in June
2013.
Of the total staff coded under the staff category of management/administration,
close to 79% are at grades lower than Grade V and include grades IV, Clerical
Officers, telephonists, supply officers etc, most of whom are operating in frontline services, directly engaging with the general public, e.g. Outpatient
departments, Emergency Departments, Primary Care Centres, or in direct
support of clinicians in their service delivery.
86.60% or 13,434 WTEs of the total 15,513 WTEs are in Acute Services, Primary
& Community Services, Children & Family Services, Ambulance Services and
Health & Wellbeing.
The remaining 13.40% or 2,079 WTEs are in functions without which front-line
services could not operate, e.g. Payroll, Corporate Finance, Corporate HR,
National Shared Services across the range of corporate services, including ICT,
Estates, Procurement, and national planning and management
The attached graph Appendix 1 (included) and table 1 Appendix 2 (included)
illustrate the reduction in management / administrative staff as the number of
employees in other disciplines increases.
When the various disciplines of employees in the public health service are
compared, it should be emphasised that any distinction between the ‘front line’
and management / administrative staff or between ‘front line’ and ‘back office’
hides the realities in the provision of health services to the public. No Consultant
can operate efficiently without diagnostics or a secretary to schedule care. No
hospital can operate without a manager to look after budgets, staff and
buildings. No Public Health Department can prepare for emergencies or plan for
a flu pandemic nor can any of our services exist without recruitment or payroll.
These staff are critical for the functioning of these services and the organisation.
42
Taking that into account, total employment levels across the health services
have reduced by 11,877 WTEs since they peaked in September 2007 to a
recorded level at the end of July 2013 of 100,894 WTEs.
This brings
employment levels back to those last seen in early 2005, despite significant new
service developments and a range of formerly independent agencies being
subsumed into the HSE. These agencies - with their WTE impact - are listed
below:









Post Graduate Medical/Dental Board - 8.80 WTEs
National Crisis Pregnancy Agency - 14 WTEs,
National Cancer Screening Service - 258 WTEs
IBTS – MUH - 5 WTEs
Office of Tobacco Control - 3 WTEs
HRB/RCSI - 25 WTEs
National Council for Nursing & Midwifery - 7 WTEs
Former ‘Subsidiary Companies’ (ECW, EVE Holdings, Tolco, APT) - 341
WTEs
Children’s Advisory Board - 4 WTEs.
Total - 665.8 WTEs
During the period since 2007, permanent approved Medical Consultant posts
have grown by over 30%. Targeted grades within the staff category of Health &
Social Care Professionals have all recorded significant increases during this time,
albeit in some cases from relatively low bases; Occupational Therapists
increased by 92.8%, Physiotherapists by 59.75%, Speech & Language
Therapists by 69.9%, Social Workers by 48.3% and Psychologists and
Counsellors by 46.9%.
In 2007 a review was commenced of management / administrative levels
however it was superseded by controls on staffing arising from the Government
moratorium on recruitment. Since 2007, a combination of the four staff
categories of Medical/Dental, Nursing, Health & Social Care Professionals and
Other Patients & Client Care moved from a combined 71.8% of the workforce to
74.8% as recorded at July 2013. This reflects a shift in the public health service
workforce as the proportion of staff focused on patient and client care increases.
In parallel, the two categories of Management / Administrative staff and Support
Staff have reduced from 28.2% to 25.2% of health sector employment. Over
40% of overall health service staff reductions since 2007 have been from these
two categories of staff.
43
Appendix 1
(Management/Admin grades include staff working at the frontline or supporting frontline clinical
staff and include medical secretaries, telephonists, receptionists, outpatient dept, emergency
department, primary care centres, supplies officers, ICT staff, Payroll and shared services ).
44
Table 1 – Appendix 2
Employment levels - 2004* to July 2013 - By main staff category
Change
2005 to
Sept 07
Change
Sept 07
present
Change
Dec 12
present
WTE
Change
Dec 12 present
31/12/2004
30/09/2007
31/12/2012
31/07/2013
Change
from 2005
to present
Medical/Dental
(Consultants)
(NCHDs)
Nursing
(nurse managers)
7,013
1,888
4,199
34,313
7,227
8,100
2,285
4,871
38,965
8,218
8,320
2,514
4,905
34,637
7,502
8,256
2,540
4,825
34,528
7,505
17.72%
34.51%
14.92%
0.63%
3.85%
15.50%
21.00%
16.02%
13.56%
13.72%
1.92%
11.17%
-0.95%
-11.39%
-8.68%
-0.77%
1.06%
-1.63%
-0.31%
0.04%
-64
27
-80
-109
3
Health & Social Care Professionals
(Occupational Therapists)
(Physiotherapists)
12,830
705
1,132
15,762
1,014
1,433
15,717
1,176
1,534
15,767
1,224
1,510
22.90%
73.65%
33.34%
22.86%
43.80%
26.57%
0.03%
20.76%
5.36%
0.32%
4.10%
-1.59%
50
48
-24
693
1,782
498
865
2,084
678
952
2,304
798
990
2,310
805
42.80%
29.62%
61.78%
24.82%
16.93%
36.24%
14.40%
10.86%
18.74%
3.91%
0.28%
0.90%
37
6
7
16,157
863
13,771
1,062
7,104
2,198
14,640
10,600
18,421
1,232
13,351
1,070
6,383
2,061
18,171
13,694
15,726
1,059
9,978
885
4,667
1,628
17,129
12,515
15,592
1,071
9,853
874
4,592
1,626
16,898
12,390
-3.49%
24.09%
-28.45%
-17.75%
-35.36%
-26.02%
15.43%
16.89%
14.02%
42.77%
-3.04%
0.76%
-10.14%
-6.26%
24.12%
29.19%
-15.36%
-13.08%
-26.20%
-18.37%
-28.06%
-21.07%
-7.00%
-9.52%
-0.85%
1.07%
-1.25%
-1.23%
-1.59%
-0.09%
-1.35%
-1.00%
-134
11
-125
-11
-74
-1
-231
-125
98,723
112,771
101,506
100,894
2.20%
14.23%
-10.53%
-0.60%
-611
Staff Category
(Psychologists & Counsellors)
(Social Workers)
(Speech & Language Therapists)
Management/Admin
(include staff working at the frontline or supporting
frontline clinical staff and include medical
secretaries, telephonists, receptionists, out patient
dept, emergency department, primary care centres,
supplies officers, ICT staff, payroll and shared
services etc)
(senior managers)
General Support Staff
(Catering)
(Household Services)
(Portering)
Other Patient & Client Care
(HCA, Nurse Aide, etc)
Total - Health Services
Source: HSPC
* Establishment of the HSE on 1st January 2005
45
Question 30: (Deputy Jerry Buttimer)
To ask the Minister for Health and the HSE what efforts have been made to implement
the HIQA recommendation to implement a unique patient identifier reference, if
further improvements in ICT infrastructure is required to implement such a proposal
and if there has been an analysis of the cost of such a system and the future savings
which could be achieved.
Response
Preparation of the general scheme of a Health Identifiers Bill which will to give effect
the HIQA recommendations to implement a unique patient identifier was approved by
the Government in July and work is currently at an advanced stage. A commitment
has been given to early publication. The Bill will provide for a system of identifiers for
patients, professionals and organisation. Provisions in relation to health service
identifiers were originally envisaged as part of the Health Information Bill. The system
of identifiers are necessary to strengthen patient safety, privacy, wider regulation and
to facilitate audit.
The patient identifier to be known as the Individual Health Identifier will leverage as
much as possible the existing Public Service Card infrastructure.
An expert working group, made up of representatives of the Department of Health,
Department of Social Protection, Department of Public Expenditure and Reform, HSE
and HIQA has been established to advise on identifier policy.
It is currently planned that, insofar as possible, existing ICT infrastructure and
resources will be used to host the core databases underpinning the patient identifier.
Costs and benefits estimation is on-going and will be refined during the drafting
process. It is anticipated that the costs will be made up of a number of elements
including central systems infrastructure and linkage to the Department of Social
Protection, ongoing running costs (including staffing) for the central register,
necessary technical changes in health service provider organisation (e.g. hospitals and
GP practices) and change management costs. Consultation with the Data Protection
Commissioner is ongoing to ensure that rollout and implementation is in line with the
highest data protection standards.
Question 31 (Deputy Jerry Buttimer)
To ask the Minister for Health and the HSE, regarding medical cards for people with
disability, particularly those with Down’s Syndrome, to outline the eligibility criteria
that applies and previous and current practices in awarding such medical cards.
Response:
Medical Cards are granted to persons who cannot arrange general practitioner medical
and surgical services without undue financial hardship. Medical cards are not granted
on the basis of a person’s medical condition alone, without regard to their financial
means.
Eligibility for a medical card is assessed in line with national guidelines. The first test
in the assessment process is to determine if, pursuant to guidelines, the applicant is
within the financial thresholds, applicable to their personal or family circumstances.
46
If the applicant is above the financial thresholds and there is evidence of
circumstances (medical or social) applicable to the applicant and his/her dependents,
which might result in undue financial hardship in arranging GP, medical and surgical
services, the granting of eligibility, to Medical Card or a GP Visit Card, on a
discretionary basis, remains a routine aspect of the eligibility assessment process.
A person with Down’s syndrome is entitled to a Long Term Illness book irrespective of
income. Long Term Illness applications are processed by HSE Local Health offices.
Question 32 (Deputy Catherine Byrne)
To ask the Minister for an update on the 50-bed long stay unit on the site of the old
CBS School Inchicore (Hollybrook) and when is this likely to open?
Response:
The HSE has in light of its overriding strategic commitment to the earliest possible
delivery of the National Paediatric Hospital on HSE lands forming the campus of St.
James’s Hospital, has agreed that the community nursing unit at Inchicore will be
brought into service under the operational management of St. James’s Hospital at the
earliest possible date.
This will facilitate the relocation of “Hospital 7” which currently accommodates a
number of long term patients who, if suitable nursing community facilities were
available, would likely be already resident in those facilities. This in turn will allow the
demolition of the existing patient care facilities which is prerequisite to the provision
of a brown field site for the National Paediatric Hospital.
Another significant advantage of this arrangement is that it will unlock the potential
for St James’s Hospital to deepen its engagement with the local community by
providing a range of relevant services within that community. This is in keeping with
the commitments made locally in relation to the operation and function of the unit.
This decision also has the distinct and immediate advantages of bringing an unused
capital facility into immediate use without additional revenue cost accruing to the
Health Service since its operational management will be facilitated by the transfer of
existing resources from St. James’s Hospital. In addition the overarching clinical
governance arrangements of St. James’s Hospital would apply to the facility.
Arrangements are being put in place for the immediate transfer of the facility under
appropriate licence arrangements to St. James’s Hospital. Full title and ownership of
the facility will remain with the HSE and all necessary service level arrangement
amendments will be made as appropriate to reflect this change.
47
Question 33 (Deputy Ciara Conway)
To ask the Minister for an update on progress in addressing the issues raised in the
recent HIQA report into hygiene practices in WRH, and in particular in relation to
hand-hygiene
Response:
Following publication of the HIQA report, WRH developed a Quality Improvement Plan
to address the findings of the report. The hospital’s Executive Management Board is
responsible for ensuring the implementation of the Quality Improvement Plan. The
Quality Improvement Plan which will be published and includes actions in the following
aspects of hospital hygiene management:

The implementation of a multimodal hygiene programme that clearly demonstrates
the hospital’s commitment to cleanliness / hygiene and hand hygiene. The hand
hygiene programme will be based on the WHO multimodal framework.

Embedding a culture of hand hygiene compliance across all services in the hospital.
Ensuring that 100% of staff will receive hand hygiene education and that practices
are supported by on-going audit.

Ensuring that there is a clean and maintained hospital environment and patient
equipment to maximise service user safety.
The implementation of the Quality Improvement Plan at WRH is well underway. A
senior nurse manager has been appointed as the designated lead to oversee the
implementation of the Plan and will report regularly to the Executive Management
Board within WRH.
WRH will maintain an up-to-date system to record the hand hygiene training within
the hospital. The HSE South Regional Management Team is currently implementing an
agreed process for receiving reports related to the percentage of staff who have
received mandatory induction training in order to receive assurance that hand hygiene
training is being carried out.
It is well recognised that measurement of hand hygiene is important in order to
improve compliance. Hand Hygiene audits are carried out internally by hospitals to
measure compliance and the national target compliance rate must be achieved by all
hospitals and where compliance rates are not achieved an action plan is developed in
order to achieve compliance.
The use of HCAI policies, procedures, protocols and guidelines are regularly monitored
and reviewed in WRH to determine effectiveness, and where required actions are then
taken to improve the effectiveness of these policies, procedures, protocols and
guidelines based on evidence based information.
The WRH is in the process of implementing HIQA Standards for Safer Better
Healthcare which also provides a framework for services including the prevention and
control of HCAIs to organise, manage and deliver safe and sustainable healthcare.
48
Management and staff at Waterford Regional Hospital are committed to the prevention
and control of HCAIs through effective leadership and governance arrangements and
through the implementation of relevant national standards and legislation.
Question 34 (Deputy Ciara Conway)
To ask the Minister if he will provide an update on progress being made on the
'Higgins report ' in relation to the re-organisation of hospitals services in the South
East. In particular I would like an update on how the relationship between UCC and
WRH is progressing?
Response:
The Government’s decision to re-organise the acute hospitals service through the
establishment of new hospital groups was informed by two 2013 reports - The
Establishment of Hospital Groups as a Transition to Independent Hospital Trusts and
The Framework for Development – Securing the Future of Smaller Hospitals.
The next step will be the creation of Hospital Group Boards with Group Chief Executive
Officers. Initially Hospital Group Boards will be established on a non-statutory
administrative basis. These Boards will not have specific status in legislation and preexisting Hospital Boards will continue to retain their existing legal responsibilities until
the Hospital Group Board is given the necessary standing in legislation to accept the
formal transfer of legal responsibilities. Therefore while the Voluntary and Joint Board
Hospitals will necessarily continue to maintain their legal governance structures, it is
expected that they will fully co-operate with the Hospital Group Boards and the HSE
and / or its successor in supporting effective decision making by Hospital Groups.
The HSE expects to advertise for the Group CEO posts and associated Hospital Board
positions in the very near future.
Specifically in relation to Waterford Regional Hospital and UCC, positive developments
to establish and build relationships have commenced. Key staff from Waterford
Regional Hospital attended a meeting and evening event, hosted by UCC recently.
Contacts have continued since then to ensure the development of this relationship and
identification of key issues of interest. The South are currently establishing a Liaison
Group to facilitate further contacts and work between the university and hospitals
across the region. This group with UCC will be formally established very soon. To
further this work the Deputy Corporate Secretary from UCC has been given specific
responsibility to work on further developing the ties between the University and the
hospitals in the Group.
Question 35 (Deputy Ciara Conway)
If the Minister can confirm if a study, or any research has been carried out by the
Department of Health about the prescribing of patterns of tranquilisers and antidepressants by geographical area. If this has not happened could the Minister indicate
if there are plans to conduct research into this? If such a study does exist, could we
have details of the main patterns, findings and recommendations and perhaps the
49
Minister could update the Committee what work is being done on implementing the
recommendations.
Response:
Benzodiazepines are drugs with a clear addictive potential. They have specific clinical
indications but should be used for a limited time period to avoid problems of
habituation Anti depressants are a very different group of drugs prescribed for the
management of moderate to severe depression. This is a very common often chronic
disease in our community and anti depressants are of clinically proven benefit. They
should be viewed quite differently to benzodiazepines and other tranquilisers
The Benzodiazepine Committee was set up by the Department of Health in June 2000
to examine the prescribing and use of benzodiazepines and to make recommendations
on good prescribing and dispensing practice. The Committee’s report was published in
August 2002. It made a number of recommendations for implementation by the
Department, the Health Service Executive (HSE), the Irish Medicines Board, the Irish
College of General Practitioners and the Pharmaceutical Society of Ireland. The
majority of the recommendations have been implemented in full or in part, the main
one being the preparation and issuing of Good Practice Guidelines to all GPs.
In addition GPs can now audit their prescribing of benzodiazepines through systems
put in place by the HSE; the systems allow GPs to compare their prescribing practices
with that of their peers. The use of Antidepressants has not received the same level of
attention but GPs can also monitor their own prescribing by reviewing the data
provided to them on the PCRS Suite of Online Services for GPs.
The Department of Health has recently launched a consultation on stronger legislation
to address the problem of illicit trading and supply of certain prescription medicines,
to include Benzodiazepines and ‘z’ drugs. Research has been carried out by the
Department of Health previously in relation to the use of Benzodiazepines
(Tranquilisers). The Health Research Board has also published research in this field
which can be found on there website www.drugsandalcohol.ie
Question 36 (Deputy Sandra McLellan)
To ask the Minister for Health, whether he is aware of the lengthy waiting lists, of 6-8
months in many instances, for ASD assessment for Autistic Children in the North Lee
HSE Area, whether such waiting times are replicated in other parts of the state, her
view on whether such waiting times are acceptable, and to make a statement on how
the Minister intends to ensure that such assessments are carried out in a short time
frame.
Response:
Background
Children seeking Autistic Spectrum Disorder (ASD) assessment may present either
through the Assessment of Need process under the Disability Act, 2005 or through
Community Services. In the latter, there is a variety of methodologies employed in
respect of children with suspected ASD and services to these children are offered in
different ways in different areas. For example, in some areas there may be Specialist
50
ASD Teams in place, in others there may be integrated children’s disability network
teams, (as envisaged under the 0-18s programme), while in some areas, services
may be uni-disciplinary. In respect of children with disabilities, a key priority for 2013
is the continued roll out of the 0-18s Programme which envisages the establishment
of integrated, geographically based Early Intervention and School-Age Teams. This
work is organised at national, regional and local level and includes representatives
from the health and education sectors, service providers (statutory and non-statutory)
and parents working together to see how current services can be reorganised. A
detailed action plan is being implemented with the following objectives:
 One clear pathway to services for all children with disabilities according to need
 Resources used to the greatest benefit for all children and families
 Health and education working together to support children to achieve their
potential
HSE South
The HSE South West Intellectual Disability Service works in partnership with the
voluntary Service providers to provide day, respite, residential and therapy support
services to meet the needs of all clients with Intellectual Disability and/or Autism in
the area. The main service provider in the North Lee Area is COPE Foundation.
Children living within the North Lee area, who present with behaviours suggestive of
an ASD are generally referred to the North Lee ASD team based within COPE
Foundation. The team provides both a diagnostic and intervention service.
Interventions for children involve a wide range of individual, group and therapeutic
work as well as practical support. Some children attend special ASD pre-school/school
units but the majority of children on the North Lee ASD Service caseload attend
mainstream class settings. Staff work in homes, schools and other locations as
appropriate to meet each child’s needs.
Both COPE foundation and the HSE have been proactive in reducing waiting times for
children requiring assessment under the Assessment of Need process. COPE for
example have reviewed and reduced assessment times for each individual child to
approximately twelve to fourteen hours. This has been achieved by the provision of
one common multi disciplinary report and also the elimination of routinely providing
individual therapy reports in addition to the core diagnostic assessment. Individual
therapy reports are provided as required.
In line with the national roll out of the 0-18’s programme significant progress has
been made in West Cork in the reconfiguration of services involving a shift from
disability specific teams to network teams catering for assessment and intervention
for all children.
North Lee services are in the process of being reconfigured as envisaged under the 018’s programme and with the provision of 3 additional posts to COPE, i.e. Speech &
Language Therapist, Psychologist and Occupational Therapist, waiting lists are already
being positively impacted upon.
The HSE acknowledges that there is significant variation, between the different Local
Health Office Areas, in the number of applications for a statutory assessment of need
and in the number of these completed within the statutory timeframes. The HSE has
placed particular emphasis on tackling the issues involved with a view to ensuring that
51
all applicants for assessment under the Act receive their Assessment Report within the
statutory time-frames.
It should be noted that the HSE has issued guidance to the effect that, where there is
a delay in the assessment of need process, this should not affect the delivery of
necessary and appropriate interventions that have been identified for a particular
child. It should be noted that children waiting for their Assessment Report may
already be receiving interventions from the service.
52